Cerebrovascular Diseases最新文献

Introduction: The approach to diagnostic classification of ischaemic strokes and post-stroke cardiac monitoring to detect occult atrial fibrillation (AF) differs among healthcare facilities within the United States (USA), as shown in the secondary stroke prevention through pathway management (DiVERT Stroke) study. The degree of international neuro-cardio pathway heterogeneity, specifically between the USA and the UK, has not been studied previously.

Methods: We conducted a retrospective review of consecutive patients with cryptogenic, large-vessel disease (LVD) and small-vessel disease (SVD) ischaemic strokes at large, certified stroke centres in the USA and UK. Qualitative assessments included stroke aetiology determination and post-stroke cardiac monitoring frequency by methodology.

Results: Between 2017 and 2020, we identified 881 stroke patients within the UK (189) and USA (692), respectively, with significant differences in aetiological classification for cryptogenic (50.8% vs. 33.1%, p < 0.001) and LVD (16.9% vs. 37.0%, p < 0.001), but not for SVD strokes (32.3% vs. 29.9%, p = 0.532). Insertable cardiac monitors were significantly less utilised for UK vs. US patients (5.9% vs. 10.6%, p = 0.049); however, external monitor utilisation (68.8% vs. 66.9%, p = 0.628) was similar. Correspondingly, AF was diagnosed significantly less in the UK (1.5% vs. 7.5%, p = 0.012).

Conclusion: Among hospitalised ischaemic stroke patients at comprehensive stroke centres in the USA and UK, significant differences exist in aetiological classification, cardiac monitoring, and subsequent AF diagnosis. Larger Anglo-American studies may confirm this finding, identify disparities in care, and standardise neuro-cardio pathways internationally to improve outcomes.

Introduction: Treatment of in-hospital acute ischemic stroke (AIS) is challenging. We aimed to characterize in-hospital AIS and identify predictors of receiving thrombolysis and thrombectomy.

Methods: We conducted an analysis of a retrospective cohort study using administrative data and chart review as part of the INPATIENTS study (Comparing In-Hospital and Community-Onset Strokes in Alberta). All in-hospital AIS patients admitted in the province between January 1, 2018, and December 31, 2022, were included. Clinical characteristics and quality of care measures were compared between treated and non-treated patients. We used multivariable logistic regression to identify predictors of acute treatment and assessed model performance using ROC curves and calibration plots.

Results: Only 7.3% (158 of 2,159) in-hospital AIS patients received thrombolysis or thrombectomy between 2018 and 2022. Treated patients had higher NIHSS scores (median 12 vs. 8), fewer recent invasive procedures (42% vs. 53%), and were less likely to have altered consciousness (12.0% vs. 52.1%). Common reasons for not receiving thrombolysis included delayed recognition and recent procedures. Treated patients more often received standard stroke evaluation. The final logistic regression model included age, sex, NIHSS, altered consciousness, admitting service, and comorbidities as predictors of treatment. It showed good discrimination (AUC = 0.8371), though calibration issues may affect its generalizability.

Conclusion: In-hospital AIS patients treated with thrombolysis and thrombectomy had more severe strokes, were less likely to have altered consciousness, and more often received standard stroke evaluations than non-treated patients. These differences emphasize the need to better understand barriers and develop new approaches to in-hospital stroke management.

Introduction: A global gap exists in access to standard care for ischemic stroke, including thrombolysis. Most thrombolysis-capable centers in India are located in major cities, making it difficult for many patients to reach them within the golden hour. Telemedicine can help facilitate thrombolysis in remote areas. This study aimed to evaluate the outcomes of patients who received thrombolysis under the Swasthya Ingit Telestroke Program in West Bengal, India, and to describe the challenges faced during the program.

Methods: This multicentric observational study analyzes secondary data collected from the Swasthya Ingit Telestroke Program. It compares the outcomes of patients who received thrombolysis in 32 hospitals that used teleconsultation (telemedicine group) with those treated in 9 hospitals where patients were thrombolyzed under the direct supervision of a neurologist (direct supervision group). Outcome comparisons included functional independence (modified Rankin scale [mRS] score of 0-2 at 90 days), all-cause mortality within 90 days, and symptomatic intracerebral hemorrhage (sICH).

Results: Since the start of the telestroke program in December 2021, 1,329 patients have received thrombolysis (1,034 in the "telemedicine group" and 295 in the "direct supervision group") through June 2024. After excluding patients without 90-day follow-up data, 1,145 patients were included in the analysis. The two groups showed no significant difference in good functional outcomes (mRS 0-2 at 90 days), mortality, and sICH (p values of 0.833, 0.73, and 0.61, respectively).

Conclusion: Telemedicine in stroke care has enabled thrombolysis in remote and resource-limited areas. Our study further emphasizes the effectiveness of telemedicine in increasing access to stroke reperfusion therapy in a lower-middle-income country. However, limited awareness prevents many ischemic stroke patients from receiving timely treatments like thrombolysis due to delayed arrival at equipped centers. Stroke awareness campaigns are crucial for the optimal utilization of a telestroke network.

Introduction: This study aims to examine the correlation between fasting remnant cholesterol (RC) levels and white matter hyperintensities (WMHs) in patients diagnosed with acute ischemic stroke (AIS).

Methods: Patients diagnosed with AIS were enrolled from the Department of Neurology at the affiliated Suzhou Hospital of Nanjing Medical University. The burden of WMHs was evaluated using the Fazekas scale on magnetic resonance imaging. RC was calculated as total cholesterol (TC) - high-density lipoprotein cholesterol (HDL-C) - low-density lipoprotein cholesterol (LDL-C). WMHs severity was categorized using Fazekas scores: low WMHs (0-3 points) and high WMHs (≥4 points). The relationship between RC levels and the burden of WMHs was examined through multivariate logistic regression and restricted cubic spline (RCS) logistic regression analyses. Finally, subgroup analyses were performed.

Results: A total of 650 patients with AIS were included in this study. The RC levels in the low-WMHs group were significantly higher than those in the high-WMHs group (t = 3.45, p < 0.05). When RC was treated as a continuous variable for logistic regression analysis, in fully adjusted models, there was a negative correlation between RC and WMHs scores (OR: 0.314, 95% CI: 0.143-0.685, p < 0.05). When RC was categorized, in fully adjusted models, there was a significant inverse association was observed in the highest RC quartile compared with the lowest (OR: 0.598, 95% CI: 0.372-0.961, p < 0.05). Using RCS analysis, when RC was ≥0.57 mmol/L, there was a negative correlation between RC and WMHs scores (OR: 0.179, 95% CI: 0.04-0.554, p < 0.05), and as RC values increased, the WMHs scores decreased. In subgroup analysis, there was a negative correlation between RC and WMHs, especially in males.

Conclusion: This study suggests that maintaining RC levels of ≥0.57 mmol/L during the acute phase of AIS may be associated with a reduction in WMHs burden, particularly among males. However, further prospective trials are required to validate its safety and efficacy.

Background: Intracranial aneurysm (IA), known as pathological dilation of cerebral arteries, commonly occurring at bifurcating arteries, carries a high risk of severe morbidity and mortality if left untreated. Although the treatment and early diagnosis have significantly improved, the complex pathophysiological process of IA formation presents significant challenges in the development of targeted therapies. Efficient disease-modifying therapies for IA are not yet available. This study aimed to utilize the Mendelian randomization (MR) approach to identify potential pharmaceutical targets for preventing and treating IA.

Methods: We systematically identified genetic variants associated with 1,577 druggable genes utilizing gene expression, DNA methylation, and protein expression quantitative trait loci. Genome-wide association study (GWAS) summary statistics were derived from a meta-analysis concentrating on IA, encompassing 10,754 cases and 306,882 controls. Subsequently, we conducted MR analysis integrating the identified druggable genes to estimate the causal effects on IAs. The robustness of the MR results was additionally validated through sensitivity analyses employing diverse techniques, such as the HEIDI test and Bayesian colocalization.

Results: Our study reveals that increased expression of SLC22A5 and SLC22A4 in the blood is associated with higher risk of IA and subarachnoid hemorrhage (SAH), while higher expression of NT5C2 is linked to a reduced risk of IA and SAH. Methylation of SLC22A5 is positively correlated with IA prevalence, while NT5C2 methylation shows an inverse correlation. We also found that higher methylation of CHRNA3 is associated with increased IA prevalence. Additionally, increased blood protein expression of HTRA1 is associated with elevated risks of both IA and SAH; the Bayesian colocalization analysis further supports the involvement of HTRA1 in both IA and SAH.

Conclusion: This large-scale MR analysis pinpointed four druggable target genes associated with IA and SAH, also highlighting HTRA1 as a potential prior druggable protein for medical intervention of IA.

Introduction: Stroke is a major cause of death in China. The epigenetic factors, especially the methylation of ABCA1/G1 genes implicated in cholesterol regulation, are being examined to comprehend their association with stroke.

Methods: In this nested case-control study, we examined data from the Northwest China Cohort (CNC-NX) initial phase. During follow-up, 63 incident stroke cases were identified, of which 10 were excluded due to predefined criteria (e.g., cancer, severe infections, or missing baseline/follow-up blood samples). After 1:1 matching by age, sex, ethnicity, and residence, 53 case-control pairs were initially enrolled. However, due to DNA degradation in long-term stored samples, only 35 matched pairs were ultimately included for analysis. All participants were adults aged ≥18 years. We used conditional logistic regression models to determine the odds ratio (OR) and 95% confidence interval (95% CI) for stroke occurrence.

Results: CpG_10.11.12.13 methylation levels in ABCA1 were associated with stroke risk (OR 0.93, 95% CI: 0.87-0.99), and dynamic changes in CpG_19.20 methylation levels in ABCG1 were associated with stroke risk (OR 1.62, 95% CI: 1.11-2.37). In dynamic methylation, high methylation levels of CpG_19.20 in ABCG1 were associated with a 5.10 times higher risk of stroke compared to low methylation levels (OR 5.10, 95% CI: 1.60-16.30).

Conclusions: In a rural population in northwest China, the hypomethylation status of ABCA1 and ABCG1 genes was strongly associated with the incidence of stroke. Significant correlations between CpG_19.20 methylation levels change in ABCG1 and stroke risk.

Introduction: Elevated blood pressure (BP) is a key modifiable risk factor for cardiovascular (CV) complications in patients with atrial fibrillation (AF). While current guidelines recommend modest BP targets, the optimal target in AF patients remains uncertain. The Cardiovascular Risk Reduction in Atrial Fibrillation Trial (CRAFT) is a multicenter, prospective, randomized, open-label, blinded endpoint trial that evaluates whether intensive home systolic BP control (<120 mm Hg) is superior to standard BP control (<135 mm Hg) in reducing major CV events. The primary outcome is a hierarchical composite of time to CV death, stroke, myocardial infarction, and heart failure hospitalization. A total sample of 1,675 participants provides 80% power to detect a win ratio of 1.50 between groups after a mean of 3 years of follow-up.

Methods: This statistical analysis plan (SAP) was developed by the trial statistician and principal investigators, in collaboration with the Steering Committee and international experts. The SAP specifies the planned analyses of baseline characteristics, patients' intervention, primary and secondary outcomes, subgroup effects, and safety outcomes. Analyses will be conducted on an intention-to-treat analysis using the win ratio method for the primary endpoint and Cox proportional hazards and Poisson regression for secondary analyses. Sensitivity analyses and strategies for handling missing data are also described.

Conclusion: A predefined SAP was established for the CRAFT trial to ensure a transparent and verifiable analysis. The SAP was finalized prospectively, independent of treatment assignment, with the goal of preserving internal validity and minimizing analytical bias.

Introduction: As digital health and artificial intelligence (AI) become integral to medicine, there is a growing need for physicians to develop computational thinking skills. In vascular neurology, a specialty reliant on algorithmic decision-making and complex data interpretation, programming logic (PL) offers a powerful cognitive framework. This review argues that PL can enhance diagnostic precision, clinical efficiency, and data-driven reasoning.. By aligning core programming structures-such as conditional statements, loops, and data abstraction-with clinical workflows, neurologists can improve protocol adherence, patient monitoring, and anatomical localization.

Methods: This narrative review aims to examine how programming logic concepts can enhance clinical reasoning, workflow organization, and data handling in vascular neurology. A non-systematic selection of relevant literature and expert insights was used to support the theoretical discussion.

Review: Programming logic parallels medical reasoning through multiple mechanisms. Concepts such as conditional statements mirror diagnostic algorithms, guiding step-by-step decision-making in acute stroke management. Loop structures reflect the iterative nature of patient monitoring, where repeated neurological assessments are performed based on evolving clinical conditions. Data structuring principles help neurologists organize complex information, improving the analysis of patient registries and clinical trial datasets. Furthermore, debugging methods encourage physicians to systematically re-evaluate diagnoses when patients deviate from expected recovery pathways, refining clinical hypotheses based on new evidence. The modularity principle aligns with stroke care strategies, allowing neurologists to divide complex treatment plans into manageable components spanning acute intervention, secondary prevention, rehabilitation, and long-term outpatient follow-up.. Pattern recognition skills developed through coding are directly applicable to identifying clinical syndromes, neuroimaging findings, and complications. Furthermore, familiarity with programming languages like Python or R enhances a neurologist's ability to manage and analyze clinical data, critically appraise AI-driven evidence, and contribute to the design of error-reducing digital workflows.

Conclusion: While not a substitute for clinical intuition, programming literacy is a complementary skill set that strengthens methodical thinking, innovation, and adaptability. Fostering these skills can improve patient care across the continuum of stroke management, optimize system-level outcomes, and empower neurologists to critically evaluate and co-create the next generation of digital health tools.

Background: The health disparities faced by transgender and gender-diverse (TGD) individuals in accessing healthcare, particularly in the context of non-communicable diseases (NCDs) and cerebrovascular diseases, are a significant public health concern.

Summary: This article highlights the importance of the early identification of NCDs and cerebrovascular diseases in TGD populations, emphasizing the need for culturally competent care and comprehensive healthcare strategies. Gender-affirming hormone therapy plays a crucial role in the health of transgender individuals. Yet, it is associated with increased cardiovascular risk, particularly among transgender females undergoing estrogen therapy. Studies show a higher prevalence of hypertension, hypercholesterolemia, prediabetes, and smoking in the TGD population, reinforcing the need for regular cardiovascular monitoring and targeted preventive strategies. Early identification of NCDs and cerebrovascular disease signs and symptoms is essential in mitigating long-term health complications and improving patient outcomes. Proactive screening and timely interventions can enhance quality of life, reduce healthcare disparities, and contribute to more cost-effective care strategies. Strengthening the integration of diagnostic tools and promoting inclusive healthcare policies will foster greater trust and engagement between transgender individuals and healthcare providers.

Key messages: Overall, this article underscores the need for inclusive healthcare policies and practices that address the unique healthcare needs of TGD individuals, improve health outcomes, and reduce disparities within this vulnerable population.