Risultati per: Il dolore neuropatico: review

Stroke, Volume 56, Issue Suppl_1, Page ATP110-ATP110, February 1, 2025. Introduction:Cardiovascular comorbidities are highly prevalent in patients who suffer from cerebrovascular disease. Peak oxygen uptake (VO2peak) is a well-established, independent predictor of cardiovascular health and premature mortality. Dyslipidemia also contributes significantly to cardiovascular disease risk. Although previous studies have demonstrated improvements in these parameters with any exercise, the evidence remains inconclusive regarding which exercise intensity offers the greatest benefit. This systematic review and meta-analysis aims to compare the effects of high-intensity training (HIT) with other exercise intensities, including moderate intensity (MIT) and usual activity (UA).Methods:We systematically searched the PubMed, Cochrane, Embase, and Scopus databases for studies comparing HIT with MIT or UA in stroke patients. We evaluated changes from baseline in VO2peak, serum LDL, and HDL levels. Additionally, a separate analysis comparing HIT with MIT and UA was conducted for VO2peak.Results:A total of eight studies, involving 338 patients, were included in our analysis, with 163 (48%) of these patients undergoing HIT. The pooled analysis revealed that VO2peak was significantly higher in the control group compared to the HIT group, with a mean difference (MD) of 2.01 ml/kg/min (95% CI: 0.85-3.18, p < 0.01). Further analysis of four studies comparing HIT with MIT and three studies comparing HIT with UA showed that VO2peak was significantly higher following MIT (MD 2.03; 95% CI: 0.70-3.35; p < 0.01) and UA (MD 3.73; 95% CI: 0.87-6.59; p = 0.01). A separate analysis of three studies involving 148 patients showed no significant difference in serum LDL levels (MD 0.51; 95% CI: -0.46-1.49; p = 0.30) or serum HDL levels (MD -0.02; 95% CI: -0.16-0.13; p = 0.83).Conclusion:High-intensity training, based on a moderate sized pooled sample, does not offer superior advantages in changes from baseline in cardiopulmonary parameters compared to different exercise intensities. Future well-structured randomized controlled trials are needed to evaluate different exercise intensities and durations for more definitive conclusions. Nevertheless, the early data seems to indicate that there are no differences between exercise modalities.

Stroke, Volume 56, Issue Suppl_1, Page ATP119-ATP119, February 1, 2025. Introduction:Informed consent is a cornerstone of modern clinical research, though ensuring consent has long been recognized as problematic. This is especially true for acute stroke trials, where the time-sensitive nature of treatment challenges traditional consent practices. The era of platform adaptive trials will likely add further complexity to acute stroke consent. Therefore, we sought to survey the literature for any empirical studies documenting research participants’ preferences around what content is most important to include in consent forms.Methods:We conducted a systematic review of the literature to identify empirical studies reporting patients’ opinions about what content is most important to include in consent forms for research participation. Eligible studies included surveys, focus groups, or interviews. Based on a review of consent form templates, we identified 18 elements that commonly appear in consent forms, and used these to guide our extraction of potential content.Results:Of the 1,444 studies screened by title and abstract, 35 were sent to full text review, and data were extracted from 17 studies. To determine the ubiquity of the importance of these topics, we counted if each of these topics appeared in the 17 papers. The most commonly mentioned items included risks (65%, 11/17 studies), potential benefits (53%, 9/17 studies), study procedures e.g. blood draws and imaging (47%, 8/17 studies), confidentiality (47%, 8/17 studies), study rationale (41%, 7/17 studies), and voluntariness (41%, 7/17 studies). The least important elements included information about the condition and investigator conflicts of interest.Conclusion:In the era of adaptive platform trials for acute stroke, there is the potential for consent forms to become incredibly lengthy and complex. This is the first systematic review of which we are aware that seeks to identify what information is most important to be included in consent forms to participate in research studies. Unfortunately, data are limited but they suggest that consent form optimization is possible. Only risks and potential benefits were identified as important in a majority of studies.

Stroke, Volume 56, Issue Suppl_1, Page ATP113-ATP113, February 1, 2025. Background:Persistent gait impairments affect nearly half of stroke survivors six months post-stroke, despite standard rehabilitation. Intermittent theta burst stimulation (iTBS), a specialized form of repetitive transcranial magnetic stimulation (TMS), has shown promise in enhancing neural circuit activity and promoting long-term potentiation. While traditionally targeting the primary motor cortex, recent studies suggest that cerebellar iTBS may further improve gait and balance by modulating cerebello-cortical pathways.Aim:This meta-analysis aims to evaluate the efficacy of cerebellar iTBS in improving gait and balance in stroke patients.Methods:We conducted a systematic search in PubMed, Embase, and the Cochrane Library until August 2024, following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Included studies were peer-reviewed randomized controlled trials (RCTs) that assessed the effects of cerebellar iTBS on balance, assessed using the Berg Balance Scale; gait, measured through 3D gait analysis and the Timed Up and Go (TUG) test; and activities of daily living, assessed via the Barthel Index, in post-stroke patients with persistent gait and balance impairments. Meta-analyses were performed using a random-effects model.Results:Seven RCTs involving a total of 230 post-stroke patients (iTBS group, n=115) were included in this meta-analysis. The analysis revealed a significant improvement in balance (standardized mean difference [SMD] = 1.20, 95% confidence interval [CI] 0.12 to 2.29, p = 0.03). However, the TUG test did not demonstrate a significant change (SMD = 0.04, 95% CI: -0.37–0.46, p = 0.83), potentially reflecting variability in baseline gait performance. The 3D gait analysis showed a favorable but non-significant trend towards step length improvement (SMD = 0.71, 95% CI: -0.82–2.23, p = 0.37). Notably, a significant enhancement was observed in activities of daily living (SMD = 1.24, 95% CI: 0.49–1.98, p = 0.001).Conclusions:This meta-analysis suggests that cerebellar iTBS significantly enhances activities of daily living in post-stroke patients, with a potential but less consistent impact on balance and gait. These findings highlight the promise of cerebellar iTBS as an adjunctive therapy in stroke rehabilitation, though further high-quality RCTs are needed to clarify its specific therapeutic benefits.

Stroke, Volume 56, Issue Suppl_1, Page ATP153-ATP153, February 1, 2025. Background:According to the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhages (SAH), early treatment of ruptured aneurysms reduces the risk of repeated bleeds and facilitates treatment of delayed cerebral ischemia. Efficient aneurysm securement in the hospital setting is critical to survival; however, analysis of aneurysm timing and care in the pre-hospital setting is difficult. In this quality improvement study, we reviewed hospital data to improve our outcomes for patients with aneurysmal SAH.Methods:We conducted a retrospective analysis of hospital outcomes and stroke metrics for 72 patients with last known well times who underwent securement for aneurysmal SAH at a comprehensive stroke hospital in upper Midwest from Jan 2016 to Jul 2024. Data were compiled from multiple resources including Get-With-The-Guidelines®, chart abstraction, and internal healthcare databases. We compared 0-24 hours (n=49) and >24 hours (n=23) ‘Onset to Treatment’ groups using appropriate statistical tests and significance was determined using a two-sided alpha of 0.05.Results:Demographics (age, sex), cerebrovascular risk factors (hypertension) were similar between both groups. No differences were noted in the size or location of aneurysm. Interestingly, the symptom presentation (altered level of consciousness [48% (0-24), 26% ( >24)]) and severity were higher in 0-24 group, including the NIH stroke scale (p-0.04), Hunt and Hess score (p-0.06), and Glascow Coma Scale (p-0.05). Modified Rankin scale (mRS) least favorable outcomes (5 and 6) were higher in 0-24 group (33% [0-24],17.3% [ >24]) and more external ventral drains were placed (70% [0-24], 57% [ >24]), though no change in overall hospital outcomes was noted, including mRS at discharge and discharge disposition between the groups. No differences were noted in ‘Door to Treatment’ times between the groups (12 [0-24] vs 14 hours [ >24], p-0.16).Conclusion:At our hospital, there were no significant differences in overall outcomes for patients treated before or after 24 hours of symptom onset for aneurysmal SAH. Additionally, no impact of ‘onset to door’ times on hospital metrics for securement was noted. Lastly, an interesting trend in patients who arrived within 24 hours of symptom onset had a higher severity of symptoms, greater complications, and an increase in least favorable outcomes, suggesting the importance of early recognition and education regarding SAH presentations.

Stroke, Volume 56, Issue Suppl_1, Page ADP6-ADP6, February 1, 2025. Introduction:Stroke represents a major global public health challenge, with 12.2 million new cases, 6.5 million deaths, and over 143 million disabilities occurring annually, leading to significant economic and social repercussions. Structural racism deleteriously influences stroke care and outcomes, making it essential to integrate multicultural considerations throughout the stroke care continuum to enhance outcomes and reduce disparities. A document analysis was conducted to assess the extent to which stroke guidelines address cultural diversity in stroke care.Method:A document review of international stroke guidelines was employed based on the framework established by Steinberg et al. A Google search was conducted to identify international stroke care guidelines published in English within the last five years (2019 – 2024). The quality of these guidelines was assessed using the Appraisal of Guidelines for Research&Evaluation (AGREE-II) tool. Paired reviewers independently screened the guidelines and identified recommendations related to multicultural stroke care, defined as ‘practices aimed at ensuring care delivery is culturally competent, sensitive, safe, equitable, and adaptable’.Results:A total of twenty-five guidelines were included, with the majority originating from Western countries such as Australia, the United States, the United Kingdom, Canada, and various European societies. Only four of the twenty-five guidelines explicitly addressed multicultural considerations. Most of the recommendations were based on low levels of evidence or consensus and related to dietary and cultural considerations, and the management of diverse patient needs in stroke care.Conclusion:A paucity of recommendations for multicultural considerations in stroke care were identified. Current stroke care guidelines fail to address multiculturalism adequately, which may reflect the maturity of the available evidence to inform guideline recommendations. Further research is needed to identify enablers and barriers to incorporating multicultural considerations in stroke care and the development of future guidelines. New evidence is needed in this regard to improve clinical outcomes of diverse populations.

Stroke, Volume 56, Issue Suppl_1, Page A58-A58, February 1, 2025. Background:Acute ischemic stroke (AIS) is a leading cause of disability worldwide. While intravenous thrombolysis is recommended within 4.5 hours of symptom onset, many patients present beyond this window. Tenecteplase (TNK) has shown to be non-inferior to tissue plasminogen activator (tPA) in early treatment window. However, its efficacy and safety in the extended 4.5 to 24-hour window remain unclear.Methods:We conducted a systematic review and meta-analysis of published clinical trials investigating TNK administration in AIS patients between 4.5 to 24 hours of symptom onset. PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov were searched from inception through June 23rd, 2024. Inclusion criteria were: (1) clinical trials, (2) published in English, (3) full-text available, and (4) TNK administration in AIS or transient ischemic attack patients within 4.5-24 hours of onset. Primary outcomes assessed were functional independence at 90 days (defined as a modified Rankin Scale [mRS] score of 0-2) and ordinal shift in the mRS. Safety outcomes included symptomatic intracranial hemorrhage (sICH). Random-effects models were used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).Results:Five clinical trials met inclusion criteria with a total of 1,197 patients (599 TNK, 598 best medical therapy). Mean age was 71 years, with 61.7% males and a median baseline NIHSS of 10. Studies varied in imaging selection criteria, using either MRI DWI/FLAIR mismatch or CTP imaging with different perfusion cut-off values. Additionally, the proportion of patients receiving EVT post-randomization varied among studies. TNK treatment was associated with increased functional independence at 90 days (OR 1.33, 95% CI 1.04-1.70, p=0.02), but no significant difference in overall mRS (standardized mean difference: 0.01, 95% CI -0.37 to 0.39, p=0.969). A trend towards increased sICH with TNK was observed, though not statistically significant (OR 2.16, 95% CI 0.96-5.05, p=0.06).Conclusion:This meta-analysis suggests that TNK might be safe and effective for AIS patients in the 4.5 to 24-hour time window, potentially offering improved functional outcomes without significant increase in sICH. Future research should focus on conducting large, multicenter randomized controlled trials with refined patient selection criteria and standardized imaging protocols, to more precisely access the risk-benefit profile of TNK in extended time window.

Stroke, Volume 56, Issue Suppl_1, Page A153-A153, February 1, 2025. Background:The efficacy and safety of thrombectomy compared to medical therapy in patients with acute ischemic stroke irrespective of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) has been debated.Method:We systematically searched EMBASE, PubMed and Scopus for randomized controlled trials (RCTs) and observational studies evaluating the efficacy and safety of thrombectomy compared to medical therapy in patients with acute ischemic stroke irrespective of the ASPECTS score with primary outcomes of modified rankin scale (mRS) score 0-3 at 90 days, functional independence mRS score 0-2 at 90 days and symptomatic intracranial hemorrhage (sICH).Results:We included 20 RCTs and 6 observational studies containing 6580 patients comparing thrombectomy with medical therapy in patients with acute ischemic stroke irrespective of the ASPECTS scores. The pooled results showed that mRS score 0-3 at 90days (RR = 2.10; 95% CI [1.59; 2.77]; I2= 71%; p < 0.001; Figure 1A) and mRS score 0-2 at 90 days (OR = 2.48; 95% CI [1.97; 3.12]; I2= 64%; p < 0.001; Figure 1B) were significantly improved by thrombectomy compared to the medical therapy. Early neurologic worsening (RR = 0.93; 95% CI [0.57; 1.51]; I2= 63%; p = 0.770; Figure 1C) was not significantly different between groups. The safety outcome, sICH within 48hrs (RR = 1.82; 95% CI [1.25; 2.64]; I2= 50%; p = 0.002; Figure 2A) was significantly higher in thrombectomy group. The National Institutes of Health Stroke Scale (NIHSS) score at 24hrs (MD = -2.84; 95% CI [-4.11; -1.58]; I2= 65%; p < 0.001; Figure 2B) and mean change in infarct volume from baseline at 24hrs (MD = -26.10; 95% CI [-40.18; -12.02]; I2= 97%; p < 0.001; Figure 2C) were significantly reduced by thrombectomy. However, decompressive craniotomy (RR = 1.17; 95% CI [0.78; 1.75]; I2= 20%; p = 0.453; Figure 2D) did not show any difference between groups. Death within 90 days (OR = 0.71; 95% CI [0.61; 0.81]; I2= 22%; p < 0.001; Figure 3A) was significantly reduced by thrombectomy. The early neurologic improvement (SMD = 3.43; 95% CI [2.39; 4.93]; I2= 37%; p < 0.001) and median EuroQol Group 5 Dimension (EQ-5D) index at 90days (MD = 0.15; 95% CI [0.07; 0.23]; I2= 84%; p < 0.001; Figure 3C) were also improved by thrombectomy.Conclusion:Compared with medical therapy, thrombectomy may improve functional outcomes in patients with acute ischemic stroke irrespective of the ASPECTS scores, despite associated with an increased risk of sICH.

Stroke, Volume 56, Issue Suppl_1, Page AWP11-AWP11, February 1, 2025. Introduction:Stroke is a leading cause of disability and mortality worldwide, with thrombolysis as a critical treatment. Patients in Low- and Middle- Income countries (LMIC) are disproportionately affected, however, the effectiveness and outcomes of thrombolysis in these regions have been less explored.Objective:To assess the safety and efficacy of thrombolysis in patients with ischemic stroke in LMIC.Design/Methods:A systematic search was performed in PubMed, Embase, SCOPUS, WOS and Global Index Medicus for studies conducted up to April 2024. Studies aiming to assess the outcomes of thrombolysis after ischemic stroke in LMIC were selected. Outcomes of interest included functional independence (90-day mRS 0-2), symptomatic intracerebral hemorrhage (sICH) and all-cause mortality at 90 days. Quality assessment was performed using Cochrane Risk of bias 2 tool for randomized trials and NewCastle-Ottawa scale for observational studies. A single-arm and a random effects model meta-analysis of proportions were conducted, using the I2 statistics to measure the statistical heterogeneity.Results:A total of 1,865 studies were screened, of which 96 studies met the inclusion criteria, representing 849,280 patients who received thrombolysis for ischemic stroke. Seven randomized controlled trials (RCTs) were included and analyzed independently. The majority of the studies used Alteplase as the thrombolytic agent, followed by Tenecteplase, Recombinant human prourokinase and Reteplase. Eight studies evaluated low dose compared to the standard dose of alteplase. For the meta analysis, articles that included the administration of standard dose of 0.9 mg/kg alteplase within a 4.5-hour time window, were considered. The pool proportion of patients with functional independence at 90 days was 58% CI 95% [51%, 64%]. Pooled proportions for sICH (ECASS III definition) and 90-day mortality were 5% CI 95% [4%,6%] and 10% CI 95% [8%,12%], respectively. However, results show high heterogeneity. Quality assessment showed low to medium risk of bias.Conclusions:Thrombolysis in LMIC may have similar safety and effectiveness outcomes when used with standard dose and treatment within 4.5 hours.

Stroke, Volume 56, Issue Suppl_1, Page ATP189-ATP189, February 1, 2025. Objective:To determine the association between intracerebral hemorrhage mortality and statin therapy, aiming to provide effective methods to prevent intracerebral hemorrhage and reduce the mortality rate.Background:Intracerebral hemorrhage (ICH) poses significant challenges due to its high mortality and disability rates, especially among Asian populations. Contributing factors such as hypocholesterolemia and hypertension amplify the risk of ICH and subsequent hematoma expansion, underscoring the urgent need for effective interventions. Despite the lack of established pharmacological treatments for ICH, statins have emerged as promising candidates for neuroprotection, attributed to their pleiotropic effects beyond lipid-lowering properties.Methods:This study meticulously conducted a systematic search of various databases until February 2024 to identify relevant literature on statin therapy following ICH. The inclusion criteria encompassed randomized controlled trials (RCTs) and observational cohort studies, ensuring a comprehensive analysis of the available evidence. Data extraction was performed rigorously, involving screening, extraction, and cross-checking by two independent investigators utilizing a predefined table. Quality assessment was carried out using the Newcastle-Ottawa Scale, a recognized tool for evaluating observational studies.Results:The analysis of 14 studies comprising 86,838 patients revealed a substantial reduction in mortality associated with statin therapy post-ICH, with an odds ratio (OR) of 0.37 and a 95% confidence interval (CI) of 0.25-0.57 (p < 0.00001). However, heterogeneity was observed in studies assessing outcomes such as intraventricular hemorrhage and Glasgow Coma Scale (GCS), indicating variability in populations or methodologies.Conclusion:One of the significant life-threatening condicions is ICH, and patients are associated with poor prognosis. There is no effective pharmacological treatment to decrease ICH mortality, While statin therapy demonstrates promising potential in mitigating post-ICH mortality, this study underscores the necessity for further research to elucidate optimal treatment duration and address existing heterogeneity. Standardized studies are imperative to inform evidence-based clinical decisions and improve outcomes for individuals afflicted with intracranial hemorrhage.

Stroke, Volume 56, Issue Suppl_1, Page AWP312-AWP312, February 1, 2025. Background:The left atrial septal pouch (LASP) is a blind-ended structure resulting from incomplete fusion of the septum primum and septum secundum during embryonic development, unlike a patent foramen ovale that leaves an interatrial channel open. Recent studies have suggested that LASP could serve as a site for thrombus formation, although its role as an independent risk factor for thromboembolic stroke remains unclear. The aim of this systematic review and meta-analysis was to evaluate and summarize the evidence that the presence of a LASP is a risk factor for cryptogenic stroke.Methods:We searched PubMed and EMBASE to identify relevant studies. The association between LASP and cryptogenic stroke was estimated by the odds ratio (OR) and 95% confidence interval (CI). Heterogeneity was assessed by χ2-based Q-test.Results:Eight studies with 2,357 participants from the USA, Europe, and Asia were used in the meta-analysis. We found a significant association between cryptogenic stroke and the presence of LASP (OR 1.60, 95% CI 1.27 to 2.02, p < 0.001). No evidence of heterogeneity was found (Q=6.33, p = 0.50).Conclusions:This systematic review and meta-analysis adds supports a relationship between LASP and cryptogenic stroke. Further studies are needed to characterize how LASP may impact the risk of recurrent stroke, as well as identification of optimal stroke prevention strategies in the presence of LASP.

Stroke, Volume 56, Issue Suppl_1, Page AWP309-AWP309, February 1, 2025. Background:Patent foramen ovale (PFO) is commonly diagnosed in patients over 60-65 years with cryptogenic stroke. Despite robust evidence and guidelines supporting PFO closure in individuals aged 18-60, the efficacy of this intervention in preventing recurrent ischemic strokes in elderly patients ( >60 years) with PFO and cryptogenic stroke remains uncertain, as existing evidence is inconclusive.Objective:We aimed to synthesize findings from observational studies until July 2024 to evaluate the long-term efficacy and safety of PFO closure in elderly patients over 60 years of age, with the primary outcome focused on its impact on reducing the composite risk of recurrent ischemic stroke/transient ischemic attack (TIA).Methods:We analyzed data using RevMan 5.4 with a random effects model, employing the inverse variance method pooling outcomes as odds ratios (OR) with 95% confidence intervals (CI). Our study protocol is registered in PROSPERO (CRD42024564171).Results:Our study included 9 observational studies comprising 3,525 subjects, of whom 1,572 were elderly patients aged over 60 years. The average follow-up period ranged from 2.5 to 14 years. Upon pooled analysis comparing the primary composite outcome of recurrent ischemic stroke/TIA after PFO closure, the elderly cohort (aged >60 years) demonstrated a significant reduction in risk compared to the non-elderly (18-60 years), with an OR of 3.47 (95% CI: 2.01 to 5.99, p < 0.00001), and no significant heterogeneity was observed. Secondary outcomes revealed a statistically significant reduction in all-cause mortality among the elderly following PFO closure (OR: 7.83, 95% CI: 2.59 to 23.65, p = 0.0003), as well as a decreased incidence of recurrent strokes (OR: 3.97, 95% CI: 1.58 to 9.97, p = 0.003). Furthermore, there was no statistically significant difference in the occurrence of post-procedure new-onset atrial fibrillation between elderly and younger patients (OR: 1.31, 95% CI: 0.67 to 2.57, p = 0.43).Conclusion:PFO closure in elderly patients may be as effective and safe as in younger patients. However, there is a pressing need for further multicenter large randomized controlled trials to specifically include patients over 60 years of age. These trials should evaluate the safety and long-term efficacy of PFO closure, with the goal of reassessing and refining current treatment guidelines to optimize outcomes for elderly patients with PFO and cryptogenic stroke.

Stroke, Volume 56, Issue Suppl_1, Page ANS5-ANS5, February 1, 2025. Background and purpose:The aim of this study is to assess the impacts of digital health interventions on quality of life and mental status in stroke patients. Stroke is one of the leading causes of death and disability worldwide, and patients are often associated with emotional problems such as depression and anxiety during recovery, hence, it is important to explore effective interventions. Digital health intervention technologies, including virtual reality (VR), telemedicine, and robotic assistance, are the focus of this study because of their innovation and potential effects.Methods:Following predefined protocols, the study searched four databases up to November 2023, screened for relevant randomized controlled trials (RCTs), and extracted data on quality of life and psychological status, including depression/anxiety. A total of 17 studies involving 1437 participants were included. The study used different digital health interventions, including VR, robotic-assisted and telemedicine, and standardized mean differences (SMD) and 95% confidence intervals (CI) were used to assess intervention effectiveness.Results:The data show that digital health interventions are more effective than conventional treatments in improving the quality of life of stroke patients and reducing the incidence of psychological disorders. In particular, significant differences were observed in the intervention groups for VR (SMD = 0.90, 95% CI = [0.07, 1.73]), robotic-assisted (SMD = -0.65, 95% CI = [-1.11, -0.19]) and telemedicine (SMD = 0.27, 95% CI=[0.11, 0.44]). In addition, the study found that digital health interventions were effective in reducing the incidence of depression in stroke patients, thereby improving their psychological well-being.Conclusions:Digital health interventions have been shown to be effective in improving the quality of life and psychological well-being of stroke patients. However, it is worth noting that anxiety levels did not significantly improve among patients with digital health interventions. This suggests that future research should adjust its focus to explore whether specific factors associated with stroke patients correlate with the effectiveness of digital interventions in improving anxiety states. It is also necessary to assess the long-term effects of digital health interventions. Further exploration is needed to optimize the approach, intensity, and frequency of digital health interventions for stroke patients.

Stroke, Volume 56, Issue Suppl_1, Page AWMP29-AWMP29, February 1, 2025. Purpose:Recruiting participants for acute ischemic stroke trials is challenging due to difficulties in obtaining written informed consent in urgent settings. Alternative consent methods, like deferred consent and Exemption from Informed Consent (EFIC), have been proposed to facilitate timely intervention and improve trial feasibility. This review examines the impact of these methods on recruitment efficiency in both ischemic stroke and ICH trials.Methods:A scoping review of trials on acute ischemic stroke and ICH interventions (enrollment ≤24 hours from onset) published between January 2013 and March 2023 was conducted. Studies were categorized by consent methods, and trial characteristics were analyzed to compare recruitment efficiency. The review protocol was pre-registered on the Open Science Framework (https://osf.io/5rkc2).Results:A total of 170 trials met our inclusion criteria. Of these, 118 trials used conventional written informed consent (Conventional group), while 52 trials (30.6%) adopted alternative consent methods including deferred consent and EFIC (Alternative group). In univariable analysis, the Alternative group had a significantly shorter maximum allowable time from onset/LKW to randomization/enrollment compared to the Conventional group (6 hours [IQR 4-12] vs. 9 hours [IQR 5-24], p=0.03). There were no significant differences between the groups in terms of the number of participating countries, sites, or overall enrollment duration. However, the number of withdrawals (in counts) was significantly higher in the Alternative group (2.8 ± 5.8 vs. 9.3 ± 13, p

Stroke, Volume 56, Issue Suppl_1, Page AWMP70-AWMP70, February 1, 2025. Background:There is controversy in the literature regarding the role of pelvic venous abnormalities screening through Magnetic Resonance Venogram (MRV) in patients with Embolic Stroke of Undetermined Source (ESUS) and a Patent Foramen Ovale (PFO). Pelvic DVT is thought to occur uncommonly, however studies have shown that around 20% of patients can have isolated pelvic vein DVTs without evidence of lower extremity DVTs. We aimed to describe diagnostic yield of pelvic MRV in ESUS patients.Review summary: A systemic search was carried out using PubMed following PRISMA guidelines. We retrieved 6 cross sectional and cohort studies, 2 case series, as well as 9 case reports with a total of 1319 patients and a mean age of 51 years. The diagnostic yield of Pelvic MRV in all included ESUS patients was 10% (95% CI: 8-12). In ESUS patients with a negative lower extremity DVT, the diagnostic yield was 9% (95% CI: 7-10). Patients with ESUS and PFO had significantly higher prevalence of abnormal pelvic MRV findings, OR=3.63 (95% CI: 1.53-8.61, P

Stroke, Volume 56, Issue Suppl_1, Page AWP334-AWP334, February 1, 2025. Background:There is an emerging understanding of stroke risk in patients with immune thrombocytopenia purpura (ITP) and immune thrombotic thrombocytopenia purpura (iTTP). We aimed to determine the prevalence of acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) in patients with ITP and iTTP in a systematic review and meta-analysis.Methods:We used PubMed, Embase, Cochrane, Web of Science, and Scopus using text related to ITP, iTTP, stroke, AIS, and ICH from inception to 11/3/2023. Our primary outcome was to determine prevalence and chronicity of AIS and/or ICH in a cohort of ITP or iTTP patients (age >18). Our secondary outcomes were to determine stroke associated with thrombopoietin receptor agonists (TPO-RAs) in ITP patients and risk factors associated with stroke in ITP and iTTP patients.Results:We included 42 studies with 118,019 patients (mean age=50 years, 45% female). Of those, 27 studies (n=116,334) investigated stroke in ITP patients, and 15 studies (n=1,685) investigated stroke in iTTP patients. In all ITP patients, the prevalence of AIS and ICH was 2.1% [95% Confidence Interval (CI) 0.8%-4.0%] and 1.5% (95% CI 0.9%-2.1%), respectively. ITP patients who experienced stroke as an adverse event from TPO-RAs had an AIS prevalence of 1.8% (95% CI 0.6%-3.4%) and an ICH prevalence of 2.0% (95% CI 0.2%-5.3%). Prevalence of stroke did not significantly differ between all ITP patients and those treated with TPO-RAs. iTTP patients had a prevalence of AIS and ICH of 13.9% (95% CI 10.2%-18.1%) and 3.9% (95% CI 0.2%-10.4%), respectively.Subgroup analysis revealed the prevalence of AIS and ICH was greater in iTTP patients vs. all ITP patients (p

Stroke, Volume 56, Issue Suppl_1, Page AWMP72-AWMP72, February 1, 2025. Introduction:Emerging technologies, such as Cone-Beam CT (CBCT), may improve workflows in acute ischemic stroke (AIS). Direct-to-angiography workflow relies on CBCT to exclude intracranial hemorrhage (ICH) to determine treatment eligibility for intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT). Prior studies evaluated CBCT for ICH detection using small, selected cohorts and variable diagnostic metrics yielding a wide range of sensitivity and specificity values. Our purpose was to synthesize available evidence to determine the diagnostic accuracy of CBCT for ICH detection, with particular focus on specific hemorrhage types: intraparenchymal (IPH), subarachnoid (SAH), and intraventricular (IVH).Methods:We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Our protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Systematic searches were last performed on April 1, 2024 in EMBASE, PubMed, Web-of-Science, Scopus, and CINAHL databases. Inclusion criteria: (1) Studies reporting diagnostic metrics of CBCT for ICH; (2) Studies using a reference standard to determine ICH. Exclusion criteria: (1) Case reports, abstracts, and reviews; (2) Studies without patient-level data. Pooled estimates and 95% confidence intervals (CI) were calculated for the Log diagnostic Odds ratio (DOR), sensitivity, and specificity for ICH and hemorrhage types using random-effects and common-effects models.Results:Seven studies were included in the meta-analysis yielding 466 patients (Fig 1). Pooled Log DOR, sensitivity, and specificity (95%CI) for ICH were 5.28 (4.11,6.46), 0.88 (0.79,0.97), and 0.99 (0.98,1.0), respectively (Fig 2,3). Pooled sensitivity (95%CI) for IPH, SAH, and IVH were 0.98 (0.95,1.0), 0.82 (0.57,1.0), and 0.78 (0.55,1.0). Pooled specificity (95%CI) for IPH, SAH, and IVH were 0.99 (0.98,1.0), 0.99 (0.97,1.0), and 1.0 (0.98,1.0).Conclusion:CBCT had high specificity for ICH and hemorrhage types. However, sensitivity was lower and varied with the highest sensitivity for IPH followed by SAH and IVH. These findings indicate that CBCT may be reliable for exclusion of ICH in determining MT eligibility in AIS patients who are not IVT candidates. However, the high false-negatives of CBCT for SAH and IVH requires caution for IVT decision-making, where missing a small hemorrhage could result in devastating outcomes.