Search Results for: Stroke

Stroke, Ahead of Print. BACKGROUND:Carotid web is a rare and likely underrecognized cause of ischemic stroke, particularly in young patients. Given the high risk of recurrence, diagnostic delays may have serious consequences. This study aimed to assess the incidence and impact of delayed carotid web diagnosis after a first ischemic event.METHODS:We conducted a retrospective analysis using data from the French ongoing multicenter prospective CAROWEB (Carotid Web registry). We included patients with a first-ever ischemic stroke or transient ischemic attack in the anterior circulation, attributed to an ipsilateral carotid web with no other identifiable cause, between September 2013 and April 2023. Patients with missing data on the date of the first ischemic event or carotid web diagnosis, or with prior stroke history, were excluded. Participants were categorized into early diagnosis (≤30 days) and delayed diagnosis ( >30 days) groups. Factors associated with diagnostic delay were investigated through univariable and multivariable analyses. Stroke recurrence was evaluated using Kaplan-Meier survival analysis.RESULTS:Of 280 patients in the registry, 225 met the inclusion criteria. A delayed diagnosis occurred in 57 patients (25.3%). Independent predictors of diagnostic delay included lower initial National Institutes of Health Stroke Scale score (odds ratio, 0.92;P=0.002), stroke occurring before 2019 (odds ratio, 0.19;P

Stroke, Ahead of Print. BACKGROUND:The outcomes of endovascular therapy (EVT) across sexes for large infarcts remain unclear. This study aimed to evaluate the impact of sex on the outcomes of EVT or medical management for patients with large infarcts.METHODS:In this secondary analysis of the ANGEL-ASPECT (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core) randomized controlled trial conducted at 46 stroke centers across China between October 2, 2020, and May 18, 2022, we compared baseline characteristics and clinical outcomes between males and females, and each cohort further divided into EVT and medical management groups. The primary outcome was the 90-day modified Rankin Scale score distribution. Safety outcomes included symptomatic intracranial hemorrhage within 48 hours and mortality within 90 days.RESULTS:There were 176 of 455 patients enrolled in the ANGEL-ASPECT trial who were female. There were 54.0% (95/176) of females and 48.4% (135/279) of males who underwent EVT. The treatment effect of EVT did not vary in both sexes with large infarcts (allP >0.05 for interaction). Compared with medical management, EVT improved 90-day functional outcomes for both males (3 [2–5] versus 4 [3–5]; common odds ratio, 1.94 [95% CI, 1.27–2.97];P=0.002) and females (4 [3–6] versus 5 [4–6]; common odds ratio, 2.50 [95% CI, 1.41–4.45];P=0.002). The symptomatic intracranial hemorrhage rate was not different in both treatment groups across both sexes (males, 5.2% versus 2.8%; odds ratio, 2.05 [95% CI, 0.56–7.50];P=0.278; females, 7.4% versus 2.5%; odds ratio, 2.89 [95% CI, 0.55–15.14];P=0.210).CONCLUSIONS:In patients with large ischemic core, the treatment effect of EVT did not differ between females and males, with better outcomes with EVT versus medical management, without an increased risk of symptomatic intracranial hemorrhage. These findings emphasize the need for equal attention and care for both sexes with large infarcts in clinical practice.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT04551664.

Stroke, Ahead of Print. BACKGROUND:In symptomatic carotid stenosis, treatment decisions are currently primarily based on stenosis degree. We developed a clinical prediction model (Individualized Magnetic Resonance Imaging–Based Stroke Prediction Score Using Plaque Vulnerability for Patients With Symptomatic Carotid Artery Disease [IMPROVE]) incorporating the strong predictor, intraplaque hemorrhage on magnetic resonance imaging, stenosis degree, and risk factors to identify patients with high stroke risk.METHODS:IMPROVE was developed on data from 5 cohorts of 760 patients with symptomatic carotid disease on optimal medical treatment. Inclusion criteria included a recent transient ischemic attack/stroke (

Stroke, Ahead of Print. BACKGROUND:Evidence about the impact of multiple metal exposure on brain neuroimaging metrics remains limited. We aim to investigate the effects of single and mixed metal exposure on white matter hyperintensities (WMHs).METHODS:This cross-sectional study included 1183 subjects without stroke history from the META-KLS (Multi-modality Medical Imaging Study Based on Kailuan Study), which is an existing prospective cohort in Tangshan, China. Plasma metal levels, including Mg, Ca, V, Mn, Co, Ni, Cu, Zn, As, Se, Rb, Cs, Tl, Pb, and Cd, were measured using an inductively coupled plasma mass spectrometer. Ordinal and binary logistic regression models were used to examine the effects of metal exposure on the WMH burden, deep white matter hyperintensity, and periventricular white matter hyperintensity. All metal concentrations were naturally log-transformed to reduce skewness and were analyzed as both continuous and tertile forms. Weighted quantile sum regression, quantile-based g-computation model, and Bayesian Kernel Machine Regression were used in the metal mixture analysis.RESULTS:Compared with the first tertile, the adjusted odds ratios and 95% CIs for the WMH burden in the third tertile were 1.57 (1.05–2.34) for As, 2.01 (1.28–3.18) for Cu, 1.68 (1.14–2.50) for V, 1.61 (1.07–2.44) for Cs, and 1.56 (1.04–2.34) for Tl (allPfor trend

Introduction
The aetiology of sudden sensorineural hearing loss (SSNHL) is not certain in a significant number of cases. In 8%–31% of posterior fossa infarctions, acute hearing or vestibular loss precedes neurological symptoms. Also, several retrospective cohort analyses have indicated a higher chance of experiencing a stroke after SSNHL compared with the general population. This higher incidence of stroke suggests vascular involvement in the pathophysiology of SSNHL. The aim of this study is to evaluate the association of cardiovascular disease and idiopathic SSNHL (iSSNHL) by investigating the presence of cardiovascular risk factors and cerebral small vessel disease (CSVD), in patients with iSSNHL and compare this to controls.

Method and analysis
In this multicentre cross-sectional study, the ROSALIE study, 205 patients aged 50 years or higher diagnosed with iSSNHL, and 205 controls who are either suspected of trigeminus neuralgia, hemifacial spasm, vestibular paroxysmia or have a cerebellopontine angle neoplasm will be included. The primary outcome is the difference in CSVD, measured by the degree of white matter hyperintensities according to the Fazekas scale and the presence of brain infarctions on MRI, between patients with iSSNHL and controls. The secondary outcome is the difference in prevalence of the cardiovascular risk factors: hypertension, hypercholesterolaemia, smoking status, body mass index and cardiovascular comorbidities; diabetes, stroke and myocardial infarction, between both cohorts.

Ethics and dissemination
Ethics approval has been obtained by the institutional review boards of all participating hospitals. The Medical Research Involving Human Subjects Act does not apply to this study, as has been declared by the regional review board at Leiden University Hospital, registration number 22-3060.
Patients will receive the standard diagnostic protocol for iSSNHL in the Netherlands, which consists of pure tone audiometric assessment before and after treatment with corticosteroids and an MRI of the cerebellopontine angle displaying the entire cerebrum. The data will not be available publicly but might be shared on a reasonable request.

Introduction
Approximately 70% of patients with stroke experience varying degrees of cognitive impairment, which imposes a substantial direct and indirect socioeconomic burden. Previous studies have shown that scalp acupuncture (SA) or repetitive transcranial magnetic stimulation (rTMS) in combination with other therapies is effective for poststroke cognitive impairment (PSCI). Limited by interstudy heterogeneity and the limited number of included studies, there is insufficient evidence of the efficacy of rTMS in combination with SA in treating PSCI. Therefore, this protocol aims to investigate the effectiveness of rTMS in conjunction with SA for patients with PSCI through a comprehensive meta-analysis.

Methods and analysis
This study will undertake a comprehensive search across nine distinct databases (Web of Science, Embase, Cochrane Library, PubMed, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, China Biology Medicine and SCOPUS). The primary outcome will encompass the Montreal Cognitive Assessment and the Mini-Mental State Examination. The secondary outcomes are the modified Barthel Index, the Rivermead Behavioral Memory Test and the Digit Span Test. The bias risk assessment tool from the Cochrane Handbook for Systematic Reviews of Interventions will be used to evaluate bias risk, and the GRADE will be applied to gauge the quality of evidence. Furthermore, we plan to perform an analysis of subgroups to investigate the heterogeneity, employ the leave-one-out approach for sensitivity evaluation and use funnel plots and Egger’s test to determine publication bias, respectively.

Ethics and dissemination
Ethical approval is not required in systematic review and meta-analysis. The review will be published in a peer-reviewed journal.

PROSPERO registration number
CRD42024571762.

Introduction
Acute pneumonia (AP) remains a leading cause of death in the older population. Excess risk of death after AP is partly due to cardiovascular (CV) events. We aim to evaluate whether aspirin at a preventive dose (100 mg daily) introduced at the acute phase of AP reduces 90-day mortality.

Methods and analysis
The ASPirin for Acute Pneumonia in the elderlY study is a phase III multicentre randomised double-blind, placebo-controlled, superiority clinical trial, which will investigate the efficacy and safety of aspirin in older patients with AP hospitalised in a French university and non-university hospitals. Patients will be randomised in a 1:1 ratio between two groups receiving daily either 100 mg of aspirin or a placebo, within 84 hours following radiologically proven AP diagnosis for 90 days. This study aimed at assessing the efficacy of aspirin on all-cause mortality after AP at 90 days (D90) (primary objective), D30 and D120 after randomisation, CV mortality, major adverse CV events (MACE) (ie, myocardial infarction, stroke, heart failure, new atrial fibrillation and pulmonary embolism, CV death and sudden death) incidence, length of intensive care unit and hospital stay, unscheduled rehospitalisation, dependence, overall and MACE-free survival, as well as safety outcomes (bleeding incidence). The sample size, calculated considering a 90-day mortality of 25% and a reduction of 10% in the aspirin group, a two-sided alpha risk at 5% and power of 80%, is 500 patients to prove the superiority of aspirin over placebo. To account for screening failures and consent withdrawals, 600 patients (300 per arm) will be included.

Ethics and dissemination
This study has full approval from an independent Ethics Committee. Participants will sign a written informed consent ahead of participation. Findings will be published in peer-reviewed journals and conference presentations.

Trial registration number
EU CTIS: 2024-510811-32-00.

Stroke, Ahead of Print. BACKGROUND:Persistent upper extremity (UE) impairment is common after stroke. Durable treatment benefits for chronic ischemic stroke are needed. The purpose of this report is to determine the long-term effects of vagus nerve stimulation paired with rehabilitation on impairment, activity, and participation in people with UE impairment after ischemic stroke.METHODS:This is a post hoc analysis of data from the VNS-REHAB (A Pivotal Randomized Study Assessing Vagus Nerve Stimulation [VNS] During Rehabilitation for Improved Upper Limb Motor Function After Stroke) randomized clinical trial. Here, we report unblinded, partial crossover, and pooled 1-year outcomes. Initially, 108 participants across 19 sites with chronic ischemic stroke and moderate-to-severe UE impairment were enrolled in VNS-REHAB. Participants received 18 sessions of in-clinic intensive task-specific rehabilitation and 3 months of self-initiated home-based exercise with either real (active) or sham (control) vagus nerve stimulation. Thereafter, Control participants crossed over to receive in-clinic therapy paired with active stimulation. All participants performed home-based exercises paired with self-initiated active stimulation for 1 year. The Fugl-Meyer Assessment UE, Wolf Motor Function Test, and participation outcomes were assessed through 12 months.RESULTS:Seventy-four participants (69%; 51 male; age, mean±SD, 59.6±8.9) completed 1-year follow-up and provided pooled data through 1 year. At 1 year, compared with baseline, there were improvements in impairment (Fugl-Meyer Assessment UE, 5.23 [95% CI, 4.08–6.39];P

Introduction
Gait recovery remains one of the most determining factors in social participation for poststroke individuals, in whom ankle dorsiflexor function is closely related to gait speed. Focal muscle vibration has shown promising neurophysiological and clinical effects in neuromotor recovery. However, it remains to be determined whether tibialis anterior focal muscle vibration applied to the paretic limb could improve walking speed when implemented in early rehabilitation after stroke occurrence.

Methods and analysis
This study describes a multicentric randomised controlled trial in which 70 participants will be randomly assigned in a 1:1 ratio to the tibialis anterior focal muscle vibration group or the sham group, in addition to their conventional rehabilitation. Participants will receive 100 Hz vibration/sham for 30 min, five times per week, for 8 weeks. The primary outcome will be gait speed, as assessed through a 10 m walking test and will be compared between groups at the end of the intervention. Secondary outcomes will include gait abilities, neuromuscular clinical evaluations and neurophysiological measures. Outcomes will be assessed at baseline and across five visits during and after the intervention, until 16 weeks of follow-up.

Ethics and dissemination
Ethics approval was obtained from the French Ethics Committee ‘Protection des Personnes Nord Ouest III’ in 30 May 2023 (IDRCB: 2023-A00489-36). The results will be published in a peer-reviewed journal and presented at scientific conferences.

Trial registration number
NCT05945212.

Objectives
To develop and validate a risk prediction model for adverse outcomes in patients with angina with non-obstructive coronary arteries (ANOCA) confirmed by invasive coronary angiography.

Design
Retrospective cohort study.

Setting
A tertiary cardiovascular care centre in China.

Participants
From 17 816 consecutive patients undergoing coronary angiography for suspected coronary artery disease, 5934 met ANOCA criteria after rigorous exclusion: (1) significant stenosis (≥50% luminal narrowing), (2) established coronary artery disease history, (3) incomplete baseline/follow-up data, (4) non-cardiovascular life-limiting conditions.

Primary and secondary outcome measures
The primary outcome was a composite of all-cause death, non-fatal myocardial infarction (MI), stroke and repeat percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The secondary outcome was major adverse cardiovascular events, defined as cardiac-related death, non-fatal MI, non-fatal stroke, repeat PCI and CABG.

Results
The derivation cohort (n=4452) and validation cohort (n=1482) demonstrated comparable baseline characteristics. The nomogram incorporated eight prognosticators: age, haemoglobin, serum urea, serum sodium, alanine aminotransferase/aspartate aminotransferase ratio, N-terminal pro-B-type natriuretic peptide (NT-proBNP), left atrial diameter and left ventricular ejection fraction. The prediction model showed robust discrimination for primary endpoint, achieving area under the curve (AUC) values of 0.82 (1 year), 0.90 (2 years) and 0.89 (3 years) in the derivation cohort, with corresponding validation cohort AUCs of 0.75, 0.77 and 0.78. Calibration plots revealed close alignment between predicted and actual event-free survival probabilities in both cohorts. Risk stratification identified two distinct prognostic groups with significant survival differences (log-rank p

Stroke, Ahead of Print. BACKGROUND:The mechanism of the lipid paradox remains uncertain, and malnutrition may be 1 explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.METHODS:Patients with ischemic stroke in a single-center prospective cohort (Shanghai, China) from January 2018 to December 2022 were studied. Individuals were classified into 3 groups based on their Controlling Nutritional Status score. Poor outcome and all-cause mortality during up to 3 months of follow-up were compared among patients with varied nutritional status and RC levels utilizing multivariate logistic regression analyses, RC splines, and subgroup analyses.RESULTS:A total of 6892 patients with ischemic stroke were enrolled in the cohort, of which 5257 patients were included in the present study (without malnutrition: 2418 [46.0%]; mild malnutrition: 2516 [47.9%]; moderate-severe malnutrition: 323 [6.1%]). The median age was 69±12 years, and 3398 (64.6%) were male. Patients with moderate-severe malnutrition had the highest risks of poor outcome (198 [61.3%];P

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

This systematic review and meta-analysis aims to determine the annual incidence rates and cumulative incidences of stroke up to 10 years after a transient ischemic attack or minor stroke.

Stroke, Ahead of Print. BACKGROUND:Stroke survivors are highly sedentary and engage in minimal physical activity. This study aimed to investigate the independent and joint effects of daily sitting time and leisure-time physical activity on survival among stroke survivors.METHODS:The nationally representative cohort included 1446 stroke survivors (weighted population, 6 968 723) from the National Health and Nutrition Examination Survey from 2007 to 2018. Mortality data were obtained through December 31, 2019. Leisure-time physical activity was categorized as inactive (0 min/wk), insufficiently active (1 to

Stroke, Ahead of Print. BACKGROUND:There is a paucity of evidence on whether gestational diabetes (GDM) is a risk factor for cerebral vascular disease for Black women and lack of data on incident stroke as end point.METHODS:We conducted a large prospective cohort study of Black women across the United States and assessed the association between self-reported history of GDM and incident stroke. The study began when participants became parous or enrolled in 1995. We followed up 41 143 parous Black women who were free of cerebral vascular disease or cancer and followed up until incident stroke, death, or the end of 2021. Our exposure was self-reported history of GDM, and outcome was incident stroke. Multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% CIs, adjusting for major known risk factors for stroke.RESULTS:A total of 1495 incident stroke cases were identified among 41 143 Black women from 1995 until 2021 (881 505 person-years of follow-up). Black women with a history of GDM had a consistent 1.4-fold increased risk of stroke compared with those with a healthy pregnancy (age-adjusted HR, 1.44 [95% CI, 1.14–1.82]; multivariable HR, 1.41 [95% CI, 1.11–1.79]). Compared with healthy parous women with neither GDM nor type 2 diabetes, women with a history of both had a 2.6-fold increased stroke risk (multivariable HR, 2.59 [95% CI, 1.88–3.57]); women with only type 2 diabetes have 2-fold increased stroke risk (multivariable HR, 2.04 [95% CI, 1.79–2.32]); women with a history of GDM but no progression to type 2 diabetes do not have an increased risk of stroke (multivariable HR, 1.22 [95% CI, 0.86–1.73]).CONCLUSIONS:In this large prospective study of Black women, a vulnerable population at high risk for stroke, a history of GDM increased stroke incidence by 41%. There was no elevated risk of stroke for Black women with a history of GDM and no progression to type 2 diabetes, while the stroke risk increased by 2.6-fold for Black women with GDM and progression to type 2 diabetes. Our results highlight the importance of consideration of history of GDM for stroke early prevention, especially Black women with progression to T2DM after GDM.