Cerebrovascular Diseases最新文献

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.

Introduction: The impact of antihypertensive drugs on functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT) remains controversial and may vary with collateral status (CS). We aimed to investigate the joint effect of CS and antihypertensive drugs on functional outcome in patients with AIS.

Methods: We retrospectively analyzed anterior circulation large-vessel occlusion AIS patients who underwent EVT in our hospital between January 2018 and December 2022. The patients were dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) ≤0.4, and poor CS, reflected by HIR >0.4. Functional outcome was assessed using modified Rankin Scale (90d mRS). The primary outcome was defined as the 90d mRS > 2. The association between antihypertensive drugs within 48 h after EVT and functional outcome was evaluated. Furthermore, the interaction between HIR and antihypertensive drugs was measured.

Results: A total of 372 patients were included. The proportion of patients receiving antihypertensive drugs was comparable between the good CS and poor CS group (51% vs. 56%, p = 0.285). Antihypertensive drugs were significantly associated with higher odds ratio (OR) of unfavorable outcome {OR 3.83 (95% confidence interval [CI], 2.12-6.90); p < 0.001} in poor CS group. No correlation was found in good CS group (p = 0.159). The interaction between antihypertensive drugs and baseline CS was statistically significant (P_interaction = 0.040, adjusted P_interaction = 0.029).

Conclusion: The association between antihypertensive drugs and functional outcome varied based on the CS. These findings suggest that antihypertensive drugs should be used with caution in AIS patients with poor CS after EVT.

Introduction: The influence of multiple long-term conditions on the outcomes from acute ischaemic stroke (AIS) is not well defined. This study aimed to determine the association of multiple long-term conditions in participants of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

Methods: ENCHANTED was an international, multicentre, 2 × 2 quasi-factorial, open, randomized controlled, blinded endpoint assessed trial that assessed the effectiveness and safety of intensive blood pressure lowering and low-dose thrombolysis against standard of care in adults with AIS. Multiple long-term condition was defined as two or more coexisting chronic conditions according to medical history. The primary outcome was function recovery (distribution of scores on the modified Rankin scale) and mortality at 90 days post-randomization. Associations were estimated in multivariate logistic regression models, and an assessment of heterogeneity was undertaken in subgroups including age, sex, baseline systolic blood pressure, and clinical features.

Results: In 4,566 AIS participants (mean age 66.7 years, 37.8% female), those with multiple long-term conditions were older, more often female, and had more severe neurological impairment. Multiple long-term conditions increased the odds of poor functional outcome (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI]: 1.03-1.30; p = 0.020) and mortality (aOR 1.35, 95% CI: 1.04-1.76; p = 0.024). The association between multiple long-term conditions and mortality/functional outcome was consistent across all subgroups.

Conclusion: Individuals with multiple long-term conditions have higher odds of poor functional outcome and death after thrombolytic treatment for AIS.

Introduction: Moderate blood pressure (BP) reduction reduces hematoma growth, but this has not been shown to translate into improved functional recovery after intracerebral hemorrhage (ICH). This study aimed to define patient profiles according to hematoma growth and functional recovery patterns, and explore the prognostic factors of the patterns.

Methods: Analysis of the Blood Pressure in Acute Stroke Collaboration (BASC) dataset involved randomized controlled trials of early BP lowering in acute ICH. Latent class analysis was used to identify patient profiles by hematoma volume change from baseline to 24 h on outcome trajectories. Clinical outcomes include functional outcomes measured according to modified Rankin Scale (mRS) and serious adverse events at follow-up (usually 90 days). Generalized linear mixed models were used with adjustment of source trial as a random effect for clustering to identify the prognostic factors.

Results: Among 6,221 participants from BASC, 2,450 patients (mean age 64.1 + 13.1 years, female 36.7%) were included. Baseline hematoma volumes (mL) were 6.8, 13.2, 27.1, and 59.2, respectively, for each class identified by patient profiles: no growth with favorable outcome (52.1%, median growth 0.2 [IQR -0.4 to 1.1] mL, median mRS 2 [IQR 1 to 2]), mild growth with disability (32.6%, 0.8 [-0.8 to 4.6] mL, mRS 4 [4 to 5]), moderate growth with death or disability (13.2%, 11.2 [4.9 to 27.0] mL, mRS 4 [3 to 6]), and large growth with death (2.1%, 35.2 [12.8 to 81.2] mL, mRS 6 [6 to 6]). Patients with moderate growth were younger and more likely to undergo neurosurgery than those in the mild or large growth groups. Baseline hematoma volume was the only significant factor associated with all the hematoma pattern groups.

Conclusions: Patients with moderate growth were younger and more likely to receive neurosurgery than those in the mild or large growth groups. Baseline hematoma volume is the most important factor for hematoma growth and clinical outcome.

Introduction: Serum gamma-glutamyl transferase (GGT) was associated with cardiovascular disease. However, limited research has explored the relationship between GGT and polyvascular atherosclerosis.

Methods: This study is based on the baseline cross-sectional survey of the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based cohort study. Serum GGT levels were categorized into quartiles. Atherosclerotic plaques and stenosis were evaluated using magnetic resonance imaging and computed tomography angiography. The extent of atherosclerotic plaques and stenosis was assessed based on the number of these 8 vascular sites (e.g., intracranial, extracranial, coronary, subclavian, aortic, renal, iliofemoral, and peripheral arteries) and was classified as affected vascular sites as zero, one, two-three, or four-eight extensive atherosclerotic sites. The correlation of GGT with the presence and extent of plaques and stenosis was assessed by binary logistic and ordinal logistic regression models.

Results: A total of 3,046 participants were included with a mean age of 61.2 ± 6.7 years. GGT levels were associated with the presence (Q4 vs. Q1, odds ratio [OR] 2.14; 95% confidence interval [CI] 1.35-3.39) and the extent (common odds ratio [cOR], 2.08; 95% CI, 1.68-2.57) of atherosclerotic plaques and the presence (OR, 1.57; 95% CI, 1.24-2.00) and extent (cOR, 1.64; 95% CI, 1.30-2.06) of atherosclerotic stenosis after adjusting for age, sex, smoking, and alcohol consumption. However, associations were not significant after further adjusting for body mass index, low-density lipoprotein cholesterol, hypertension, diabetes mellitus, dyslipidemia, and medication history.

Conclusion: GGT levels were associated with the presence and burden of atherosclerotic plaques and stenosis but not after adjusting some metabolism-related factors.

Background: Transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS) have been referred to as the "brain stethoscope" as they provide real-time monitoring of both hemodynamic parameters and the structural image of the vessel and neighboring tissues. Its use has made important contributions to the field, with the ability to monitor important variables such as cerebral blood velocity to study cerebrovascular function. Although the use of B-mode with color-coded imaging allows identification of the vessel of interest in a more user-friendly approach compared to non-imaging TCD, TCD has unique functions that are complementary to TCCS studies. The aim of this review was to introduce these unique functions of TCD and discuss scenarios where the use of TCD would be justified without the combined use of TCCS.

Summary: Due to its portability and noninvasive nature, TCD is a reliable option for monitoring cerebrovascular conditions; with the ability to perform long periods of monitoring via a dedicated head frame or band. This provides an opportunity to monitor cerebrovascular function which could be named TCD functional monitoring (TCD fm). Importantly, TCD can be used to evaluate the main mechanisms involved in cerebral blood flow regulation such as cerebral autoregulation (CA) and neurovascular coupling (NVC). CA refers to the ability of the brain to maintain CBF despite changes in systemic arterial blood pressure. NVC evaluates the CBF response to local cerebral metabolism and neural activation. Both mechanisms are important in physiological and pathological conditions. Understanding and monitoring cerebrovascular regulation could develop new insights to design personalized treatments which may lead to better prognosis and outcome for patients. Moreover, TCD fm may be implemented for microembolism detection during long periods of recording, enhancing the ability to detect embolic activity. All these unique applications of TCD strengthen the importance of the method. Furthermore, several functions of TCCS could be accomplished using TCD, which is less expensive when compared to modern TCCS devices, and therefore is a reasonable option for low-income countries.

Key messages: TCD has utilities that are not covered by TCCS and considering the economic impact of broadening its use in specific areas, such as those with resource limitations, it is a reasonable option for the standard method for evaluation of cerebrovascular function. Further research is needed to combine these two modalities to provide a solution to the current limitations of using TCD and TCCS in isolation.

Introduction: Acute ischemic stroke (AIS) due to large vessel occlusion (LVO) remains a leading cause of disability and mortality. While endovascular thrombectomy (EVT) achieves high macrovascular reperfusion rates, residual microvascular obstruction may possibly contribute to poor outcome. This systematic review and meta-analysis assesses the efficacy and safety of intra-arterial fibrinolysis (IAF) administered post successful EVT.

Methods: Following a PROSPERO-registered protocol (CRD420250642689), we systematically analyzed four randomized controlled trials (RCTs, n = 1,392) and presented one observational study (n = 81) separately comparing EVT alone versus EVT plus IAF in AIS-LVO patients achieving successful reperfusion (mTICI ≥2b50). Primary outcomes included 90-day functional independence (mRS 0-1, 0-2), while secondary outcomes evaluated mortality and hemorrhagic complications.

Results: IAF mildly improved the rate of excellent functional outcomes (mRS 0-1: RR 1.17, 95% CI: 1.03-1.32, p < 0.05) but did not enhance overall functional independence (mRS 0-2: RR 1.03, 95% CI: 0.94-1.13, p = 0.56). No significant differences were observed in 90-day mortality (RR 0.93, 95% CI: 0.75-1.16, p = 0.54) or symptomatic intracranial hemorrhage (RR 1.28, 95% CI: 0.79-2.06, p = 0.32). Any intracranial hemorrhage incidence was higher but no significant difference (RR 1.89, 95% CI: 0.73-4.90, p = 0.19).

Conclusion: Adjunctive IAF following successful EVT may enhance the likelihood of excellent functional recovery without increasing mortality or major hemorrhagic risks. However, it still has some limitations such as specific obstruction positions, IAF types, IAF dosage, etc. Further high-quality RCTs are warranted to refine patient selection and optimize IAF protocols.

Introduction: Although endovascular treatment (EVT) for large vessel occlusion (LVO) generally yields better outcomes in younger patients compared to older individuals, the efficacy of this intervention and the age-related variations in factors influencing outcomes remain insufficiently elucidated. This study aimed to compare the outcomes of EVT between younger and older patients and to investigate the factors associated with favorable outcomes, with a particular focus on the relationship between procedural time and clinical results.

Method: The K-NET Registry comprised 3,187 EVT cases. For this analysis, 2,381 patients were included based on the following criteria: (1) a pre-stroke modified Rankin Scale score of 0-2, and (2) occlusion of the internal carotid artery or middle cerebral artery (M1 or M2). Patients were stratified into three age groups: <60 years (251 patients), 60-79 years (1,186 patients), and ≥80 years (944 patients). This stratification allowed for the evaluation of baseline characteristics, treatment outcomes, and factors associated with favorable outcomes. Procedural time was defined as the interval from puncture to successful recanalization.

Results: The proportion of women was higher in the <60 years group compared to the other age groups, while the prevalence of hypertension and dyslipidemia was significantly lower. Regarding stroke subtypes, intracranial artery stenosis/occlusion and arterial dissection were significantly more frequent in the <60 years group compared to the 60-79 and ≥80 years groups. The initial National Institutes of Health Stroke Scale (NIHSS) scores were significantly lower in the <60 years group. The median procedural time was 54 min, 44 min, and 49 min for the <60, 60-79, and ≥80 years groups, respectively, with the <60 years group demonstrating the longest duration. However, recanalization rates did not differ significantly among the three groups. The proportion of patients achieving favorable outcomes was significantly different among the age groups: 68.5%, 54.3%, and 30.8%, respectively. Independent factors associated with favorable outcomes across all groups included lower initial NIHSS scores, ASPECTS ≥6, and successful recanalization. While procedural time was not a significant factor for the <60 years group, it was a significant predictor in the 60-79 and ≥80 years groups.

Conclusion: In EVT for LVO, NIHSS score, ASPECTS, and successful recanalization were independent predictors of favorable outcomes, irrespective of age. Although procedural time does not directly represent the full therapeutic time window, our findings indicate that prolonged puncture-to-recanalization time was significantly associated with worse outcomes in patients aged ≥60 years. These findings suggest that minimizing procedural time is especially critical in older populations, whereas younger patients may have greater tolerance for pr

Introduction: Intra-arterial thrombolysis (IAT) after mechanical thrombectomy (MT) may improve microvascular reperfusion and reduce disability in patients with ischemic stroke. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies to investigate the efficacy and safety of MT combined with IAT for the treatment of acute ischemic stroke.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases in all languages published from inception to May 30, 2025, using the search terms "stroke", "thrombectomy", "intra-arterial thrombolysis". The primary efficacy outcome was excellent functional outcome (modified Rankin scale 0-1) at 90 days and the key safety outcomes were death and symptomatic intracerebral hemorrhage. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models.

Results: Seven RCTs and 9 cohort studies with a total of 6,258 patients met the inclusion criteria. The results of the RCTs indicated that for patients with large vessel occlusion stroke who were treated with MT and achieved successful recanalization, the subsequent administration of IAT significantly increased the chances of excellent functional outcome (mRS 0-1, RR: 1.24, 95% CI: 1.12-1.37, p < 0.0001) without increasing the risk of sICH or death. While cohort studies lacked excellent functional outcome rates, other endpoints were consistent with RCTs. The results of subgroup analysis suggested that, in patients who did not receive IVT before MT, the combination of MT and IAT significantly improved the likelihood of achieving excellent functional outcomes (RR: 1.17, 95% CI: 1.04-1.32).

Conclusion: This systematic review and meta-analysis indicated that MT combined with IAT could lead to a higher opportunity of excellent functional outcome (mRS 0-1) than MT alone in acute stroke. Importantly, adding IAT was safe and did not increase the risk of symptomatic intracranial hemorrhage and death.

Introduction: Endovascular treatment has become one of the standard therapies for intracranial aneurysms (IAs), yet the prognosis remains a persistent clinical challenge. This study aimed to systematically evaluate the efficacy and safety of adjuvant statin therapy following endovascular treatment (EVT) of IAs.

Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Cohort studies comparing outcomes between patients with IAs who received statin therapy following EVT and those who did not were included. Efficacy outcomes included retreatment, recurrence, and complete occlusion, whereas safety outcomes included ischemic stroke, intracerebral hemorrhage (ICH), thrombosis, and all-cause mortality. A random-effects model was applied, and subgroup and sensitivity analyses were performed on the basis of treatment modality and adjustment for confounding factors.

Results: Six retrospective studies comprising 3,692 patients were analyzed. Sensitivity analysis revealed that statin therapy significantly reduced the risk of retreatment (adjusted odds ratio [aOR] 0.35, 95% CI: 0.15-0.81) and recurrence (aOR 0.29, 95% CI: 0.12-0.65), whereas no significant difference was found in complete occlusion rates (aOR 0.94, 95% CI: 0.52-1.71). Although the unadjusted risk of ischemic stroke was greater in the statin group, this association was not significant after adjustment (aOR 1.04, 95% CI: 0.30-3.60). No significant differences were observed in other safety outcomes, including ICH, thrombosis, or all-cause mortality.

Conclusion: Statins may help reduce the risk of recurrence and retreatment of IAs following EVT, suggesting their potential adjunctive role in the management of IAs and providing a rationale for conducting prospective investigations.