Cerebrovascular Diseases最新文献

Introduction: Detecting atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is crucial for effective secondary stroke prevention, particularly in those with left atrial enlargement (LAE), as they have a higher risk of subclinical AF. This study aimed to evaluate and compare the efficacy and safety of a patch-type cardiac monitoring device (PCM) in detecting AF in ESUS patients with LAE.

Methods: This prospective, multicenter, open-label, randomized, controlled, investigator-initiated trial will recruit a total of 370 ESUS patients with LAE and randomize them in a 1:1 ratio into two groups: the intervention group, which will receive continuous monitoring with the PCM for 1 week, and the control group, which will undergo a single 12-lead electrocardiogram. LAE will be defined as a left atrial diameter greater than 40 mm in males and greater than 38 mm in females or a left atrial volume index exceeding 35. The primary endpoint is the proportion of participants with detected AF. Secondary endpoints include AF burden, detection of other arrhythmias, and the incidence of tachycardia, bradycardia, premature atrial contractions, and atrial flutter. A post hoc analysis will explore factors influencing AF detection and aim to develop a predictive model based on clinical and imaging data.

Conclusion: This trial is expected to provide valuable insights into the safety and efficacy of PCM in detecting AF, potentially influencing clinical strategies for AF detection and management in ESUS patients with LAE.

Introduction: Frailty is increasingly common in individuals after chronic stroke and is associated with poor outcomes. The repercussions of this syndrome on chronic stroke individuals are even worse for physical function. However, it may be reversible, requiring investigations into associated and motor modifiable factors. Thus, this study aimed to investigate whether modifiable variables (level of physical activity and walking speed) are associated with frailty in individuals after chronic stroke, as well as to verify whether these variables contribute to the presence of frailty in these individuals.

Methods: This is a cross-sectional study where individuals with chronic stroke, aged over 18 years, with unilateral involvement, and able to walk with or without assistive devices were included. The dependent variable was frailty, measured with the Clinical Frailty Scale (CFS). The modifiable factors (independent variables) were the level of physical activity, expressed through the adjusted activity score measured by the Human Activity Profile, and the habitual walking speed, measured with the 10-meter walk test, in m/s. A multiple linear regression analysis was performed to verify the association between the modifiable variables and frailty.

Results: Sixty-one individuals, with a mean age of 62.6 ± 15.7 years, 50.8% men, with a mean time of evolution of 46.4 ± 43.0 months were included. The level of physical activity alone explained 59.2% of the frailty variance (R2 = 59.2%; F = 88.1; p < 0.0). Physical activity and walking speed explained 59.9% of the frailty variance (R2 = 67.1%; F = 62.1; p < 0.0).

Conclusion: The level of physical activity and habitual walking speed were significantly associated with the presence of frailty in individuals after chronic stroke. Strategies aiming to increase the level of physical activity and walking speed may be a path to avoid frailty development in these individuals.

Introduction: Traditional lipid ratios were considered as robust predictors of cardiovascular disease risk. However, the relationships between traditional lipid ratios and atherosclerosis in the setting of ischemic stroke remain unclear. We aimed to explore the associations between traditional lipid ratios and carotid atherosclerosis in patients with ischemic stroke.

Methods: A total of 1,612 patients with ischemic stroke from 22 hospitals were included in this analysis. Traditional lipid ratios included Castelli's risk index-I (CRI-I), Castelli's risk index-II (CRI-II), and atherogenic coefficient (AC). Logistic regression models were used to assess the relationships between traditional lipid ratios and carotid atherosclerosis.

Results: The multivariable-adjusted odds ratios (ORs) (95% confidence intervals [CIs]) in quartile 4 versus quartile 1 of CRI-I, CRI-II, and AC were 1.65 (1.14-2.38), 1.48 (1.03-2.14), and 1.65 (1.14-2.38) for carotid atherosclerosis. Furthermore, the ORs (95% CIs) for the highest quartile of CRI-I, CRI-II, and AC were 1.51 (1.09-2.09), 1.38 (0.99-1.90), and 1.51 (1.09-2.09) for abnormal mean cIMT and were 1.60 (1.17-2.18), 1.59 (1.17-2.16), and 1.60 (1.17-2.18) for abnormal maximum cIMT, respectively. Restricted cubic spline models indicated that there were dose-response relationships between CRI-I, CRI-II, and AC and carotid atherosclerosis and abnormal cIMT (all P for linearity <0.001). Additionally, CRI-I, CRI-II, and AC offered incremental predictive capacity for carotid atherosclerosis beyond established risk factors, shown by increase in net reclassification improvement and integrated discrimination improvement (all p < 0.05).

Conclusion: Elevated traditional lipid ratios were positively associated with carotid atherosclerosis in patients with ischemic stroke, supporting that these lipid ratios could be promising atherosclerotic predictors.

Introduction: Individuals with impaired renal function are known to have an increased risk of stroke. However, studies from general populations that include individuals with various comorbidities remain scarce. This study aimed to investigate the association between renal function and stroke incidence according to the entire spectrum of estimated glomerular filtration rate (eGFR) levels in the general Korean population using a nationwide longitudinal analysis.

Methods: We included 2,708,874 participants who underwent health examinations between 2010 and 2011 from the Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) database. An eGFR was calculated to assess renal function and then categorized into clinically relevant ranges as well as deciles. Stroke incidence was defined as a new record of the International Classification of Diseases-10 codes I60-I63, requiring at least two claims with a main or secondary diagnosis within a year and confirmation via brain computed tomography or magnetic resonance imaging within 1 month of diagnosis.

Results: The mean age was 48.63 ± 14.02 years, with 112,913 (4.36%) stroke cases identified over 9.63 years. In the multivariable Cox regression analysis using eGFR ranges and deciles, impaired renal function was significantly associated with an increased stroke incidence. The highest stroke risk occurred in the lowest eGFR range (<30 mL/min/1.73 m2) (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.83-2.15) and lowest eGFR decile (<67.57 mL/min/1.73 m2) (HR, 1.51; 95% CI, 1.47-1.54), whereas the lowest risk was observed in the highest eGFR range (>120 mL/min/1.73 m2) (HR, 0.32; 95% CI, 0.30-0.34) and eGFR decile (≥113.41 mL/min/1.73 m2) (HR, 0.42; 95% CI, 0.40-0.44). A significant inverse linear trend was confirmed between stroke incidence and both eGFR ranges and deciles. These findings were consistent regardless of age, obesity, and stroke subtypes.

Conclusion: Stroke risk increased linearly with declining eGFR in the general population. Assessment of renal function may be a useful clinical tool for identifying individuals who would benefit most from stroke prevention interventions.

Introduction: This study aimed to evaluate the potential association of intracranial pressure (ICP) monitoring on postoperative outcomes among patients with spontaneous intracerebral hemorrhage (ICH).

Methods: This study conducted a systematic review and meta-analysis of relevant literature retrieved across the Cochrane Library, PubMed, Embase, and Web of Science from their inception to July 1, 2025. The primary efficacy outcome was unfavorable functional outcome (modified Rankin Scale 4-5 or Glasgow Outcome Scale 1-3). The primary safety outcome was mortality. Secondary outcomes included hospital stay, hematoma clearance rate, operative time, recurrent hemorrhage, and infection rates. Subgroup analyses were performed based on surgical intervention, hematoma type, and follow-up duration.

Results: A total of 551 patients who underwent surgical treatment for spontaneous ICH were included in the analysis, based on five observational studies. Compared with the non-ICP group, patients who received ICP monitoring were associated with lower rates of unfavorable functional outcome (OR = 0.27, 95% CI: 0.15 to 0.46) and shorter hospital stays (MD = -3.90 days, 95% CI: -5.09 to -2.71). No significant differences were observed in mortality (OR = 1.24, 95% CI: 0.71 to 2.17), hematoma clearance rate, operative time, or complication rates. Subgroup analyses further indicated that, among patients with hypertensive ICH undergoing minimally invasive surgery, the use of adjunctive ICP monitoring was associated with a lower incidence of unfavorable functional outcome without a corresponding increase in mortality.

Conclusion: The use of ICP monitoring was associated with improved functional outcomes in surgically treated patients with spontaneous ICH, without an observed increase in mortality or complications. These findings suggest a potential role of ICP monitoring in postoperative management, which warrants further validation in prospective studies.

Introduction: A significant proportion of patients with ischemic stroke exhibit high on-treatment platelet reactivity (HOPR) on aspirin therapy, which contributes to "aspirin resistance" and an increased risk of recurrent ischemic vascular events. Individualized antiplatelet strategies based upon platelet function testing may improve stroke outcomes.

Method: The PATH STROKE study is a multicenter, prospective, randomized, controlled, open-label, blinded outcome-assessed (PROBE) trial evaluating platelet function-guided precision antiplatelet therapy compared with standard aspirin monotherapy in patients with non-cardioembolic ischemic stroke. A total of 1,018 patients with a ischemic within the past 1-3 months and receiving aspirin 100 mg daily are eligible to be randomized 1:1 to guided therapy or standard care (control). In the guided group, patients identified with HOPR (maximum aggregation rate ≥35%) undergo stepwise adjustment of antiplatelet therapy switch to clopidogrel or ticagrelor. The standard care group continues to receive aspirin. The primary outcome is HOPR at 30 ± 5 days post-randomization. Secondary outcomes include all major ischemic events, any stroke (ischemic or hemorrhagic), health-related quality of life, and bleeding classified according to the Bleeding Academic Research Consortium (BARC) criteria.

Conclusion: PATH STROKE is the first clinical trial to evaluate a platelet function-guided, precision medicine, strategy for secondary prevention in ischemic stroke.

Introduction: The role of CTA in acute intracerebral hemorrhage (ICH) remains debated, yet its benefits are clear. In this viewpoint, we provide a case for the routine use of CTA in the initial assessment of patients with acute ICH.

Method: To argue for the clinical value of immediate CTA in acute ICH, six key domains were considered: (i) diagnostic performance (does it improve diagnosis?), (ii) prognostic performance (does it improve prognosis?), (iii) predictive performance (does it predict the treatment effect of an intervention?), (iv) safety (does it pose any risks?), (v) costs (is it too expensive?), and (vi) implementation (is it practical to implement?).

Results: CTA (i) enhances the etiological diagnosis of ICH, allowing prompt and appropriate early secondary prevention and specific acute treatment, (ii) improves prognostication, (iii) enables better prediction of ICH expansion with possible implications for acute treatment effect, and (iv) has a favorable safety profile, with minimal concern for contrast nephropathy, radiation exposure, or procedural delay, (v) a CTA-for-all-ICH approach seems economically justified, and (vi) its implementation is straightforward - simply continue the ischemic stroke imaging protocol.

Conclusion: We advocate for routine CTA in all suspected stroke cases - ischemic or hemorrhagic - supporting a unified "CTA-for-all" approach. Minimizing imaging in ICH ("diagnostic nihilism") reflects the same mindset that once limited early treatment ("therapeutic nihilism"), contributing to persistently poor outcomes in this population.

Introduction: The Optimal Post-rtPA-IV Monitoring in Ischemic Stroke Trial (OPTIMISTmain) was an international, pragmatic, stepped-wedge, cluster-randomized, non-inferiority trial designed to compare a low-intensity protocol to standard high-intensity monitoring in patients with mild-to-moderate acute ischemic stroke treated with thrombolysis. The results showed the safety, feasibility, and non-inferiority efficacy of the low-intensity monitoring protocol, supporting hospitals to consider adopting this approach in stroke care depending on local resources and circumstances. An embedded process evaluation was undertaken to explore factors influencing implementation and impact of the intervention in Latin America.

Methods: A convergent mixed-methods design was used to combine quantitative data and qualitative interviews with implementers and patients (or family members) at participating hospitals in Chile and Mexico. Purposive sampling ensured that a diverse range of experiences and discourses were captured, and normalization process theory (NPT) guided the identification of factors facilitating or hindering the incorporation of low-intensity monitoring. The analysis focused on key implementation outcomes.

Results: Low-intensity monitoring was widely accepted by clinicians who found it efficient, straightforward to implement, and potentially cost saving for hospital services. Patients and families expressed acceptance, emphasizing the protocol's potential to support continuous improvements in healthcare. Implementation challenges included staff turnover across shifts and hospital units, reliance on external contractors, and resistance to changing established care routines. Factors enabling successful implementation included strong team communication, dedicated stroke units, and ongoing feedback. Overall, the intervention demonstrated high acceptability, adoption and appropriateness, fidelity (median of 17 assessments in both countries), and sustainability. Feasibility outcomes were more variable, reflecting organizational challenges at the healthcare system level, such as initial resistance of nursing teams and high workloads in emergency services.

Conclusions: Implementation of a novel low-intensity monitoring protocol was well accepted by healthcare staff and offers potential benefits to patients with mild-to-moderate acute ischemic stroke admitted to hospitals in Latin America. Embedding a process evaluation into the main trial provided valuable insights into the challenges of implementing a complex intervention. A comprehensive understanding of the factors influencing organization change is critical to improving health outcomes.

In the article "The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis" [Cerebrovasc Dis. 2025; https://doi.org/10.1159/000547442] by Chen et al., the sICH rate in the Discussion section was incorrectly indicated as 40% but should be 25%. Additionally, the first author's institutional affiliation is incomplete and should be "Department of Neurology, The Eighth Affiliated Hospital of Southern Medical University (The First People's Hospital of Shunde), Foshan, China".