Cerebrovascular Diseases最新文献

Introduction: Although guidelines recommend smoking cessation after stroke, smoking cessation may not be adequately prioritized in stroke units. This study evaluated the practices of French stroke neurologists with respect to smoking cessation and sought to identify barriers to their involvement.

Methods: All French stroke units were invited by e-mail to fill an online questionnaire, with reminders sent every 15 days. Questions quantified the implementation in stroke units of practices derived from the Ask, Advise, Assess, Assist, Arrange model of tobacco treatment clinical guidelines on Likert scales, and were summed in an ad hoc total interventionism summary indicator (range 0-45). Associations were analyzed using multivariable mixed models adjusting for workplace clustering.

Results: Between September 2022 and July 2023, responses were received from 453 neurologists (42% of an estimated 190) across 103 stroke units (82% of 126 units). In total 60% of them declared having had no training about smoking cessation care. Most frequent obstacles identified to ideal care were patient reluctance to stop smoking (66%) and limited access to tobacco specialists (55%). Seniority (attending/teaching physician status), high self-rated familiarity with smoking cessation management, and availability of a tobaccologist, were all independently associated with more interventions (adjusted on workplace effect) (Bonferroni-corrected p ≤ 0.02 for all).

Conclusion and perspectives: The survey suggests that most French neurologists provide incomplete smoking cessation care to stroke unit patients. Stroke physician self-assessment/retraining and on-site availability of tobacco specialists seem to be promising interventions.

Introduction: We sought to investigate the dynamic changes in cerebral blood flow (CBF) and heart rate (HR) and their interconnectivity in response to active standing, a physiological model to simulate rapid blood pressure fluctuation, in patients with intracranial atherosclerotic stenosis (ICAS).

Methods: The study was a cross-sectional analysis within a prospective cohort. Transcranial Doppler monitoring was performed in 302 middle cerebral arteries from 182 subjects. All subjects started in the supine position, followed by rapid standing. The CBF velocity and HR trend curves were recorded and compared between the groups.

Results: After the subject stood up, the CBF velocity curve showed a rapid decrease followed by a rebound, while the HR curve showed a rapid increase and dropped back to the baseline. The time to peak CBF velocity rebound was prolonged in the stenotic arteries (19.53 ± 3.8 s) compared with the normal arteries (17.09 ± 3.09 s) (p < 0.001). In patients with ICAS, the maximum HR rangeability was lower (18.1 ± 8.1 vs. 21.3 ± 7.1 bpm, p = 0.013) and the HR variability (HRV) had a trend lower (1.20 ± 0.134 vs. 1.24 ± 0.118, p = 0.07) than the normal controls. The mediating effect analysis showed that the HRV acted as a partial mediating factor of the stenosis on the prolongation of the time to peak CBF velocity rebound, and the proportion of the mediating effect was 12.76%.

Conclusions: The CBF in the intracranial stenotic artery has a blunt response to rapid blood pressure fluctuation, which could be partially mediated by the decrease in HRV, suggesting a new potential heart-brain talk. HR monitoring could be considered in the management of ICAS-related cerebral hypoperfusion.

Introduction: Covert brain infarctions (CBIs) are imaging-detected ischaemic lesions without overt neurological symptoms. Their role in determining short-term outcomes and recurrence risk in acute ischaemic stroke (AIS) remains underexplored. Here, we aimed to evaluate the prevalence, predictors, and impact of CBI on outcomes and recurrence in patients with first-ever AIS in a South Indian cohort.

Methods: This was a single-centre ambispective observational study of patients with first-ever AIS who completed 1-year follow-up. Demographics, vascular risk profiles, imaging findings, including covert infarct location and phenotype, and outcome metrics (functional outcome and recurrence) were studied.

Results: We had 350 subjects in our study cohort. CBI was observed in 132 (37.7%) patients. Most common CBI locations were subcortical supratentorial (50.5%) and cortical supratentorial (27.2%). Frequent phenotypes included combined grey and white matter lesions (40%) and cavitatory lacunes (34.5%). CBI was significantly associated with older age (OR 2.38, p = 0.001), vertebrobasilar territory infarcts (OR 2.26, p = 0.004), watershed infarcts (OR 2.21, p = 0.012), and multiple embolic infarcts (OR 2.91, p = 0.001), but not with vascular risk factors or etiological subtypes. Though patients with CBI showed a trend towards increased recurrence risk in the early phase, functional outcomes at 1 year was favourable.

Conclusions: CBIs are prevalent in over one-third of first-ever AIS cases and are linked to specific infarct patterns and advanced age, rather than classic stroke risk factors. Though not associated with long-term disability, their presence may portend early recurrence. Recognition and characterization of CBI should inform post-stroke monitoring strategies and future preventative trials.

Introduction: Timely early reperfusion therapies improve stroke outcomes, but geographic barriers often limit patient access to these essential treatments. Innovative care models emerged as potential solutions to overcome these accessibility constraints. We introduce a new paradigm in stroke care: the marine mobile stroke units (MSUs).

Methods: This is a prospective study to evaluate the feasibility, image quality, and inter-rater reliability of images produced by portable brain computerized tomography (CT) scanner on a catamaran while exposed to winds, waves, and tides. We performed non-contrast brain portable CT scanning in healthy volunteers hourly, while the catamaran was docked on the river over 7 consecutive days. Six raters (3 neurologists and 3 radiologists) evaluated brain imaging. Twenty-three anatomical regions were assessed and categorized as ganglionic, supra-ganglionic, and posterior fossa. A quality imaging score ranges from 0 (lowest quality) to 5 (highest quality), with scores of 4 or 5 considered adequate image quality. We used Gwet's AC1 to assess inter-rater agreement. Radiation dose, safety data, and axis rotation data from catamaran were also collected.

Results: Of the 168 recruited participants, all completed the study. There were 3,864 anatomical locations included in the analysis. Adequate image quality was demonstrated in 94.9%, 93.0%, and 45.7% of anatomical items at the ganglionic, supra-ganglionic, and posterior fossa regions. Inter-rater agreement was substantial at the ganglionic level (Gwet's AC1 0.62, 95% CI: 0.54-0.70) and the supra-ganglionic level (Gwet's AC1 0.80, 95% CI: 0.74-0.85). The agreement at the posterior fossa level was fair (Gwet's AC1 0.21, 95% CI: 0.13-0.29). No adverse events occurred throughout the duration of the study.

Conclusions: Our study shows the feasibility and safety of a portable brain CT on a catamaran under real-world marine conditions. Our findings pave the way for testing the role of marine MSU for acute stroke management.

Introduction: Acute ischemic stroke (AIS) affects approximately 11.9 million people annually, with large vessel occlusion (LVO) accounting for 10-20% of cases. While endovascular thrombectomy (EVT) is established for AIS with LVO, recent trials have expanded treatment to patients with Alberta Stroke Program Early CT Score (ASPECTS) 3-5. However, the efficacy and safety of EVT in patients with ASPECTS ≤2, representing extremely large infarcts with poor prognoses, remain uncertain due to limited evidence. This study evaluates EVT outcomes in this high-risk population.

Methods: PubMed, Embase, and Web of Science were searched (January 1, 2010-September 20, 2024) for studies comparing EVT plus best medical treatment (BMT) versus BMT alone in AIS patients with ASPECTS ≤2. Outcomes included favorable functional outcome (FFO, mRS 0-2), moderate functional outcome (MFO, mRS 0-3), modified Rankin Scale (mRS) shift, symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and 90-day mortality. Unadjusted odds ratios (ORs) and risk differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I2 statistic.

Results: Seven studies involving 718 patients (305 EVT, 413 BMT) were included. EVT significantly improved FFO (11.8% vs. 1.6%; OR 5.39, 95% CI: 2.06-14.13, p = 0.0002), MFO (24.2% vs. 11.5%; OR 2.50, 95% CI: 1.53-4.09, p = 0.0003), and mRS shift (OR 1.64, 95% CI: 1.30-2.06, p < 0.001). However, EVT increased sICH (16.5% vs. 2.4%; OR 5.30, 95% CI: 1.03-27.39, p < 0.001) and any ICH (40.7% vs. 14.9%; OR 3.91, 95% CI: 2.24-6.83, p < 0.001). No significant difference in 90-day mortality was observed (45.5% vs. 50.8%; OR 0.72, 95% CI: 0.34-1.53, p = 0.40), though EVT showed a trend toward reduced mortality.

Conclusion: EVT significantly improves functional outcomes in AIS patients with ASPECTS ≤2; however, the absolute benefits remain modest, given the poor prognosis associated with large infarcts. While EVT increases hemorrhagic complications, it does not increase mortality and may provide meaningful benefits for carefully selected patients. Further large-scale trials are needed to refine EVT guidelines.

Introduction: Intracerebral hemorrhage (ICH) seriously threatens human health with a high mortality and disability rate. Promoting the microglia-mediated endogenous removal of hematoma can effectively reduce brain tissue damage. Adenosine 3 receptor (ADORA3) has been shown to participate in microglial phagocytosis; however, its role in ICH remains unclear. This study was performed to explore the potential role of ADORA3 and related mechanism in endogenous hematoma resolution after ICH.

Methods: Autologous blood injection was used to construct ICH model. Mice were administered with the microglial depletion agent (PLX3397) and the specific antagonist of ADORA3, MRS1523. The neurobehavioral function was evaluated through a serious of tests. The residual hematoma volume and hemoglobin content were measured. Erythrophagocytosis was assessed using flow cytometry. Immunofluorescence, Western blot, Nissl and TUNEL staining were also performed.

Results: The expression of ADORA3 increased dynamically, and ADORA3 was mainly located in the microglia after ICH. The ADORA3 inhibitor MRS1523 could improve neurological recovery, reduce the residual hematoma volume and hemoglobin content, and promote erythrophagocytosis of microglia. In addition, the inhibition of ADORA3 reduced the expression of phagocytotic receptors AXL and MerTK, decreased the number of damaged and apoptotic neurons around hematoma on day 3 after ICH, and alleviated the neuroinflammation. In addition, PLX3397, a microglial depletion agent, impaired the protective effect of MRS1523.

Conclusion: The inhibition of ADORA3 by MRS1523 promoted phagocytosis of microglia on erythrocytes, accelerating hematoma clearance after ICH, reducing the damage of neurons and neuroinflammation around the hematoma, and ultimately promoting neurological recovery.

Introduction: There is a need for measures of early stages of cerebral small vessel diseases (cSVDs). Recently, using 7T MRI, abnormalities of small vessel function were reported in patients with clinically manifest cSVD. The question is if such abnormalities are also present in early, covert stages of cSVD. We, therefore, studied the relation between cerebral small vessel function measures on 7T MRI and the burden of covert cSVD in the general aging population.

Methods: Two hundred participants (mean age [years] ± SD: 71 ± 5, 43% women) without a history of stroke or dementia from the Rotterdam Study were included. Small vessel measures at 7T MRI, including perforating artery blood flow velocity and pulsatility and cerebrovascular reactivity (CVR) to carbon dioxide, were related to markers of cSVD burden at 1.5T MRI, including white matter hyperintensity (WMH) volume and microbleed, enlarged perivascular spaces, and lacune presence, using linear and logistic regression analyses. We also included cognitive performance as a clinical indicator of covert cSVD.

Results: Across the population, neither perforating artery flow measures nor CVR were significantly associated with cSVD lesion burden or cognition, with small point estimates and no consistent direction of effects. Yet, within individuals, CVR was lower inside WMHs compared to normal-appearing white matter (CVR_NAWM = 0.54 ± 0.48%; CVR_WMH = 0.24 ± 0.94%; p = 0.006).

Conclusion: Although these data confirm that vascular function is affected within WMH, we did not observe relations between small vessel function measures at 7T MRI and the burden of covert cSVD in this population-based sample. Apparently, these measures have limited sensitivity to early stages of cSVD.

Background: Moyamoya disease (MMD), a chronic and occlusive cerebrovascular disorder, is characterized by progressive bilateral terminal stenosis or occlusion of the internal carotid arteries, accompanied by the formation of abnormal collateral vascular networks at the base of the brain. It is more prevalent in East Asia, with regional variation in China.

Summary: The clinical features of MMD differ significantly between children and adults. Most children with MMD experience cerebral ischemia, while most adult patients develop intracranial hemorrhage. Our understanding of MMD has advanced considerably. Recent advances indicate that MMD arises from a complex interplay of genetic predisposition, immune dysregulation, and abnormal angiogenesis. RNF213 has been identified as the major genetic determinant contributing to MMD susceptibility. However, issues still existed in diagnosis and treatment, including atypical early symptoms, a lack of specific diagnostic tools, and unclear indications for surgical treatment.

Key messages: MMD is a heterogeneous disease with distinct age-related clinical patterns and a strong genetic component. Advances in imaging and genetics are expanding our understanding. Future studies integrating genomics, immune biology, and angiogenesis research may enable biomarker discovery, precision risk stratification, and the development of disease-modifying treatments to improve long-term outcomes.

Introduction: Females have a higher incidence of aneurysmal subarachnoid hemorrhage and a higher prevalence and rupture risk of unruptured intracranial aneurysms than men. Underrepresentation of females in clinical trials would, therefore, limit their generalizability. The study aimed to evaluate sex disparities in aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysm trial enrollment and identify factors influencing female representation.

Methods: The authors searched Ovid Medline, Embase, Cochrane Central, Clinicaltrials.gov, and International Clinical Trials Registry for clinical trials on aneurysmal subarachnoid hemorrhage or unruptured intracranial aneurysms, published before June 2023, with ≥100 adult patients, requiring informed consent for participation. The primary outcome was the proportion of female patients enrolled. Random effects meta-analysis was performed, and multivariate beta-regression was used to assess the impact of trial characteristics and predefined subgroups on female participation.

Results: A total of 134 trials were included, with a total of 38,042 patients. Meta-analysis of the proportions of female participants resulted in a pooled proportion of 0.64 (95% CI: 0.63-0.66). Female participation was higher in trials on endovascular treatment (beta-estimate 1.32; 95% CI: 1.01-1.71) and in multicenter studies (beta-estimate 1.16; 95% CI: 1.01-1.33) but lower in Asian (beta-estimate 0.80; 95% CI: 0.67-0.95) and South American trials (beta-estimate 0.67; 95% CI: 0.47-0.97). Recruitment and consent procedures, sex of primary investigator, or burden of trial participation had no significant impact on female representation. Time trend analysis showed no statistically significant change in female participation over time.

Conclusion: Females are not underrepresented in clinical trials for aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms. Female participation is higher in trials on endovascular treatment and in multicenter studies and has regional differences, but other factors did not influence female representation. Our findings imply a good generalizability regarding sex distribution of the study results, strengthening the evidence guiding current clinical practice.