Risultati per: Approcci terapeutici per il cancro al seno: review

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 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.

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 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 AWP127-AWP127, February 1, 2025. Introduction:Cognitive impairment, mood disorders, and reduced serum BDNF levels are common in stroke patients. Previous studies suggest that aerobic exercise improves these outcomes by enhancing oxygenation. Herein, the authors compare the effectiveness of high-intensity interval training (HIIT) with low (LIT) and moderate (MIT) intensities and usual activity (UA) in stroke patients.Methods:We systematically searched PubMed, Cochrane, Embase, and Scopus databases for studies comparing HIIT with LIT, MIT, or UA in stroke patients. We evaluated change from baseline in cognitive improvement, mood disorders including anxiety and depression, and serum BDNF levels. Subgroup analyses were conducted based on stroke onset and exercise intensity, and separate analyses compared HIIT with each control group to assess cognitive improvement at different intensity levels.Results:A total of ten non-randomized and randomized studies were included in the analysis. Seven studies involving 373 patients showed no statistically significant difference in cognitive improvement between HIIT and the control group (std. MD 0.09; 95% CI -0.13 to 0.30; p=0.43). Separate analyses also revealed no significant differences between HIIT and LIT (std. MD -0.06; 95% CI -0.54 to 0.41; p=0.60), HIIT and MIT (std. MD 0.03; 95% CI -0.30 to 0.37; p=0.85), and HIIT and UA (std. MD 0.20; 95% CI -0.13 to 0.53; p=0.23). Subgroup analysis for chronic stroke did not show significant differences either (std. MD 0.07; 95% CI -0.19 to 0.34; p=0.58). Additionally, an analysis of four studies involving 281 patients found no significant difference in mood disorders (std. MD -0.21; 95% CI -0.62 to 0.21; p=0.33). A separate analysis of four studies with 130 patients also revealed no significant difference in serum BDNF levels between the two groups (std. MD 3.65; 95% CI -0.37 to 7.67; p=0.08). However, subgroup analysis indicated that serum BDNF levels were 3.32 ng/mL higher in the MIT group compared to the HIIT group.Conclusion:High-intensity-interval training does not demonstrate a significant advantage in cognitive improvement, mood disorders, or serum BDNF levels when compared to different exercise intensities. However, MIT is associated with increased serum BDNF levels compared to HIIT. Future robust RCTs are needed to compare different exercise intensities and durations to provide more conclusive results.

Stroke, Volume 56, Issue Suppl_1, Page AWMP98-AWMP98, February 1, 2025. Background:The use of oral anticoagulation (OAC) for stroke prevention in embolic stroke of undetermined source (ESUS) is hypothesized to be beneficial over conventional antiplatelet use. However, large randomized controlled trials (RCTs) have not found clear benefits, even when assessing cardioembolic enriching features. Therefore, this study aimed to perform a meta-analysis exploring the efficacy and safety of direct oral anticoagulants (DOACs) following ESUS.Methods:PubMed, Scopus, and Cochrane Central were systematically searched for studies comparing DOACs versus aspirin after ESUS. The primary outcome was stroke recurrence, and the safety outcome was major bleeding. A random-effects model was used for the analyses. Statistical analysis was performed using Review Manager Web 8.0.0 (RevMan Web).Results:14,582 patients were included from 9 studies, of which 4 were RCTs. 7,341 (50.3%) received DOACs as secondary prevention. For stroke recurrence, there was noted non-statistically significant trends towards benefit for DOACs (OR 0.93; 95% CI 0.81 – 1.06; p = 0.29; I2 = 34%). No differences were found for major bleeding (HR 1.57; 95% CI 0.86 – 2.86; p = 0.15; I2 = 63%). Among the atrial cardiomyopathy subgroup, no benefit was observed (OR 0.88; 95% CI 0.50 – 1.55; p = 0.67; I2 = 39%).Conclusion:There is insufficient evidence to recommend the use of DOACs instead of aspirin following ESUS for the prevention of stroke recurrence. Nevertheless, the fears of increased bleed risks were also not seen. Further efforts should be directed towards identifying potential embolic sources and the specific population that could benefit from OAC.

Stroke, Volume 56, Issue Suppl_1, Page AWP292-AWP292, February 1, 2025. Background:Intracranial atherosclerosis (ICAS) is a common stroke cause, with a recurrent stroke risk of up to 18% per year despite treatment advances. Although lipid-lowering therapies reduce cardiovascular events, their effect on stroke risk in ICAS remains unclear.Objective:To perform a systematic review and meta-analysis assessing the efficacy of lipid-lowering therapies in improving stroke outcomes among patients with ICAS.Methods:A systematic search of PubMed, Embase, Web of Science, Cochrane, and other databases was conducted from inception to November 2023. Eligible studies compared lipid-lowering therapies (Statins and PCSK9i) to standard care or placebo in patients with ICAS. The primary outcome was the incidence of stroke. Pooled relative risks (RR) with 95% confidence intervals (CI) were calculated using a random-effects model, and forest plots were constructed. Chi-square and I 2 statistics were used to assess heterogeneity.Results:Seven observational studies and two randomized controlled trials involving 1,902 ICAS patients were included. Of these, 801 received lipid-lowering therapy, and 1,101 received standard care or placebo. The weighted mean follow-up was 17.6 months (IQR 9.75-25.5). The weighted mean age was 63.7 years (range 55-68) for the lipid-lowering group and 64.0 years (range 50-66) for controls. Females comprised 42% of both groups. Hypertension was present in 74% of the intervention group and 71% of controls. A history of stroke was reported in 32% of the intervention group and 29% of controls. The weighted mean baseline LDL level was 105 mg/dL in the intervention group and 107 mg/dL in controls. The weighted mean change in LDL pre- and post-treatment in the intervention group was -47.18 mg/dL, compared to -12.39 mg/dL in controls. The incidence of ischemic stroke was 5.0% (40/801) in the lipid-lowering group versus 13.0% (143/1,101) in controls (RR 0.40; 95% CI 0.24-0.64; P

Stroke, Volume 56, Issue Suppl_1, Page ATP285-ATP285, February 1, 2025. Introduction:Previous studies have observed an increased risk of stroke in head and neck cancer (HNC) survivors. However, whether this risk is amplified with exposure to various treatment modalities including radiotherapy is less certain, as are any potential mechanisms by which this increase in risk is mediated. This study aims to investigate the risk of stroke in patients with HNC and whether cancer type and treatment modalities have varying effects.Methods:This PRISMA-adherent systematic review involved a systematic search of PubMed, SCOPUS and Embase for studies reporting stroke incidence in patients with HNC and without prior strokes since inception to April 25,2024. The study protocol was registered prospectively on PROSPERO. The hazard ratios extracted from the studies were pooled for meta-analyses. Random effects meta-analyses and meta-regressions were used for primary analysis. Subgroup analyses and meta-regression were performed to determine if key categorical and hierarchical variables influenced the results. Risk of bias was performed using the Newcastle Ottawa Scale.Results:22 studies [EL1] with 5,093,445 patients were included. The meta-analyses of nine studies showed that the risk of stroke was increased in patients with HNC compared to healthy controls (HR=1.45; 95%CI: 1.27-1.65, I2: 20%). Subgroup analyses demonstrated that the risk of stroke was significantly increased in HNC patients treated with radiotherapy alone compared to those treated with surgery alone (HR=1.66; 95%CI: 1.35-2.03, I2: 0%). Subgroup analyses also revealed an increased risk of stroke in HNC patients who had undergone any radiotherapy compared to HNC patients who had not undergone radiotherapy in the past (HR=1.47; 95%CI: 1.29-1.68, I2: 60%).Additionally, HNC patients who had undergone definitive chemoradiotherapy had increased risk of stroke compared to HNC patients who had undergone definitive surgery with or without adjuvant chemoradiotherapy (HR=1.28; 95%CI: 1.09-1.49, I2: 86%).Conclusion:We report an increased risk of stroke in HNC patients, which is consistently raised when compared with the general population. This risk is more significant in patients who had undergone radiotherapy. Future research should aim to understand the pathogenesis of stroke in HNC patients and the effect of different treatment modalities on stroke risk to develop effective preventive strategies, thereby guiding the management for patients with HNC.

Stroke, Volume 56, Issue Suppl_1, Page ATP244-ATP244, February 1, 2025. Introduction:Although older patients with subarachnoid hemorrhage (SAH) are often preferentially treated with coiling, in practice, there are insufficient data to support a clear benefit of coiling in this population. We aimed to do a meta-analysis comparing clipping with coil embolization for treatment of SAH in elderly people.Methods:We systematically searched Pubmed, Embase and Cochrane databases for studies that compared clipping with coiling for treatment of patients ≥ 60 years old with SAH. Our main endpoint was a compound unfavorable outcome that included Modified Rankin Score (mRS) >2, Glasgow Outcome Scale (GOS) < 4, death or dependency. Other endpoints were an unfavorable outcome in the GOS, mortality and a favorable outcome in the mRS separately. Heterogeneity was assessed with I2statistics.Results:We included 25 studies, two randomized, with a total of 49,540 patients, of whom 19,263 (38.8%) were treated with coil embolization. In pooled analysis, there was no statistical difference in the compound unfavorable outcome (RR 1.06; 95%CI 0.79-1.01; p = 0.15; I2=56%), GOS (RR 0.88; 95%CI 0.68- 1.14; p = 0.02; I2= 55%) and mRS (RR 0.97; 95%CI 0.88- 1.08; p = 0.61; I2= 20%). However, all-cause mortality was more common in patients treated with coiling (RR 1.14; 95%CI 1.01- 1.28; p = 0.03; I2= 35%). In randomized studies, although not significant, the point estimate seems to favor coiling whereas in observational studies it happened to clipping.Conclusions:The results of our meta-analysis suggest that clipping is a better treatment for SAH in elderly patients regarding all-cause mortality. Otherwise, the endpoints GOS, mRS and compound unfavorable outcome didn't show significant difference between the groups.

Stroke, Volume 56, Issue Suppl_1, Page ATP246-ATP246, February 1, 2025. Introduction:Mechanical thrombectomy (MT) is a primary treatment for acute ischemic stroke due to large vessel occlusions. While effective, 20-40% of patients experience hemorrhagic transformation (HT), and around 50% fail to achieve favorable functional outcomes. Transcranial Doppler (TCD) is a non-invasive and cost-effective method for real-time monitoring of hemodynamic status following MT. However, the prognostic value of TCD parameters in predicting HT and poor functional outcome is unclear. We performed a systematic review and meta-analysis of 4 TCD parameters (mean flow velocity (MFV), MFV index, peak systolic velocity (PSV), and pulsatility index (PI) in patients with and without HT and favorable vs poor functional recovery (modified Rankin Scale (mRS) 0-2 vs 3-6).Methods:PubMed, Embase, and Scopus were searched on July 25, 2024 to identify observational studies in which TCD parameters were measured within 48 hours from successful MT (Thrombolysis in Cerebral Infarction 2b–3) of anterior circulation. Risk of bias assessment was performed using a standardized tool tailored for TCD studies. The standardized mean difference (Hedges’ g) with 95% CI and risk ratios (RRs) with 95% CI were calculated using random-effects models. The review was prospectively registered on PROSPERO (registration number CRD42024575381).Results:Eleven studies met inclusion criteria. No study had high risk of bias. MFV and MFV index were higher in patients with HT+ compared with HT- (Hedges’ g = 0.42 and 0.54, p = 0.015 and 0.005, respectively). Patients with MFV index ≥1.3 showed a higher risk of all HT (RR = 2.01, 95% CI = 1.27–3.17, p = 0.003), symptomatic HT (RR, 4.68; 95% CI,1.49–14.65, p=0.008), and poor functional recovery at 90 days (RR, 1.66; 95% CI,1.32–2.08, p

Stroke, Volume 56, Issue Suppl_1, Page ATP242-ATP242, February 1, 2025. Background:Symptomatic intracranial hemorrhage (sICH) is the most dreaded complication after reperfusion therapy for acute ischemic stroke. We performed a meta-analysis of randomized controlled trials to estimate and compare risks of sICH after mechanical thrombectomy (MT) depending on the location of the large vessel occlusion, concomitant use of intravenous thrombolysis, timing of treatment, and core size.Methods:Randomized controlled trials were included following a comprehensive search strategy on different databases from inception to March 1, 2024. Random-effect models in a meta-analysis were employed to get the pooled risk ratios (RRs) and their corresponding 95% confidence intervals (95% CI) for sICH with MT, compared to other reperfusion treatment regimens, including best medical treatment and intravenous thrombolysis (IVT).Results:MT in the anterior circulation was associated with a significantly higher risk of sICH as compared with no-MT (RR: 1.46; 95%CI: 1.03-2.07; P = 0.037). Risk of sICH was comparable between the MT and MT+IVT groups (RR: 0.77; 95%CI: 0.57-1.03; P = 0.079). There was no difference in sICH risk with MT as compared with no-MT within 6 hours of last known well (RR: 1.14; 95%CI: 0.78-1.66; P = 0.485) and beyond that time (RR: 1.29; 95%CI: 0.80-2.08; P = 0.252); the risk of sICH was also comparable between MT conducted within 6 hours of last known well and MT conducted beyond that time (P = 0.512). The sICH risk for MT in the posterior circulation (RR: 7.48; 95%CI: 2.27-24.61) was significantly higher than for MT in the anterior circulation (RR: 1.18; 95%CI: 0.90-1.56) (P = 0.003). MT was also associated with a significantly higher sICH risk than no-MT among patients with large-core strokes (RR: 1.71; 95%CI: 1.09-2.66, P = 0.018).Conclusion:When evaluating cumulative evidence from randomized controlled trials, the risk of sICH is increased after MT compared with patients not treated with MT. Yet, the difference is largely driven by the greater risk of sICH in patients treated with MT for posterior circulation occlusions and, to a lesser degree, large core strokes. Concomitant use of intravenous thrombolysis and the use of MT in the extended therapeutic window do not raise the risk of sICH.

Stroke, Volume 56, Issue Suppl_1, Page ATP295-ATP295, February 1, 2025. Background:It is suggested that survivors of different types of cancer may have an increased risk of stroke. Our study aims to evaluate cancer patients and non-cancer controls by analyzing stroke events in each group. Previous studies concluded that certain types of cancer increased stroke risk, however, their results had significant heterogeneity and statistical concerns.Methods:Medline, Embase, and Cochrane databases were systematically searched until February 18th, 2024, assessing stroke in cancer survivor patients compared to the global population. Data were examined using the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed using I2statistics. Review Manager 5.4 was used for statistical analysis.Results:A total of 18 studies were included, and stroke was reported in both cancer and non-cancer groups. Breast cancer (HR 1.09; 95% CI 1.02-1.17; p=0.01; I2= 0%), Central Nervous System cancers (HR 2.47; 95% CI 1.01-6.01; p=0.05; I2= 78%), cervical cancers (HR 1.58; 95% CI 1.19-2.09; p=0.001; I2= 0%), head and neck cancers (HR 1.34; 95% CI 1.07-1.68; p=0.01; I2= 59%), lung cancers (HR 1.60; 95% CI 1.40-1.83; p

Stroke, Volume 56, Issue Suppl_1, Page ATP269-ATP269, February 1, 2025. Background:Patients with active cancer and ischemic stroke have significantly higher morbidity and mortality compared to stroke patients without cancer. Elevated d-dimer levels are a key finding for determining cancer coagulopathy as the likely etiology for stroke. Studies that examined d-dimer as a surrogate marker of outcomes in cancer-associated stroke are limited by small sample sizes. Our objective was to conduct a systematic review&meta-analysis for the prognostic value of serum d-dimer measured at the time of ischemic stroke in cancer patients. We hypothesize that high d-dimer is associated with high rates of recurrent stroke, death,&poor functional outcomes.Methods:MEDLINE, Embase, and the Web of Science were searched (until July 2024) for cohort studies of patients with cancer-associated ischemic stroke that assessed the prognostic value of elevated d-dimer levels (measured at the time of stroke onset) for recurrent stroke, mortality, and poor functional outcome (modified Rankin Scale [mRS] score of 3-6). For the primary analysis, we conducted meta-analyses of median differences in d-dimer levels between patients with vs. without the outcomes of interest, using the random-effects method. Meta-analyses of studies reporting odds ratios or hazard ratios could not be performed due to the variable d-dimer cutoffs used across the studies; associations from these studies are summarized narratively.Results:From 4522 titles, there were 19 eligible studies. Elevated serum d-dimer was significantly associated with an increased risk of recurrent stroke (pooled median difference 14.54 [95% CI, 2.09 to 26.99], p=0.022), and mortality (pooled median difference, 11.18 [95% CI, 9.67 to 12.70], p

Stroke, Volume 56, Issue Suppl_1, Page ATP253-ATP253, February 1, 2025. Background:Angiographic shape of occlusion, like the clot meniscus sign and the claw-sign, have been reported to potentially impact recanalization rate and clinical outcome in patient undergoing mechanical thrombectomy for acute ischemic strokes.Method:Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, and Web of Science databases. Patients were grouped into clot meniscus/claw sign positive and negative groups based on the definitions obtained from each study. Primary outcomes included technical success, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95% confidence intervals (Cl).Results:We included seven studies recruiting 1572 patients. The results indicated that the positive and negative groups had comparable first-pass effect (OR: 1.95; 95%CI: 0.76 – 5.01; P = 0.167) and final recanalization (OR: 1.36; 95%CI: 0.81 – 2.27; P = 0.248) rates. However, the rate of having a favorable functional outcome was significantly higher in the positive than negative sign groups (OR: 1.91; 95%CI: 1.25 – 2.92; P < 0.003). Within the sign-positive population, the use of contact aspiration was associated with a significantly higher rate of recanalization compared to using a stent retriever (OR: 0.18; 95%CI: 0.07 – 0.49; P < 0.001). This result did not translate into a clinical impact, as both stent retriever and contact aspiration showed comparable rates of functional independence at three months (OR: 0.22; 95%CI: 0.02 – 2.33; P = 0.210).Conclusion:The presence of the clot meniscus/claw sign is not associated with recanalization outcomes after thrombectomy. However, it might be a good sign to predict which thrombectomy technique might be associated with better recanalization, although current evidence might need further confirmation.

Stroke, Volume 56, Issue Suppl_1, Page ATP251-ATP251, February 1, 2025. Background:Transradial access has become increasingly favored over the traditional transfemoral approach for neurointerventional procedures, however radial artery spasm (RAS) and radial artery occlusion (RAO) pose challenges to this approach. RAS is one of the most common complications associated with the transradial approach that can impede procedural success and cause significant pain to patients. A promising strategy to mitigate RAS is the use of hydrophilic-coated (HC) introducer sheaths. The lubricious surface facilitates smoother insertion and manipulation within the radial artery, potentially reducing friction that contributes to RAS. Prior studies have reported conflicting results regarding the utility of HC sheaths in reducing the risk of RAS. Thus, the clinical benefit of HC sheaths is not fully understood.Objective:The purpose of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing HC introducer sheaths with non-coated (NC) introducer sheaths during transradial procedures and their impact on RAS, RAO, periprocedural pain, and complications.Methods:PubMed, Embase, and Cochrane Library were searched for RCTs utilizing HC sheaths in their intervention arm and NC sheaths in their control arm in patients undergoing a transradial procedure. Outcomes included incidence of RAS, RAO, pain/discomfort during the procedure, pseudoaneurysm, and hematoma. RevMan 5.4 software was used to calculate pooled risk ratios and mean differences with 95% confidence intervals.Results:Seven RCTs were included in this study. HC sheaths were associated with a significant reduction in the risk of RAS and periprocedural pain/discomfort compared to NC sheaths (RR = 0.38, 95% CI [0.24, 0.60], I2= 19% and RR = 0.45, 95% CI [0.34, 0.60], I2= 14%, respectively). The use of HC sheaths had no significant effect on the risk of RAO, hematoma, or pseudoaneurysm.Conclusion:The use of HC sheaths is associated with a reduced risk of RAS and periprocedural pain/discomfort compared to NC sheaths with no significant effect on RAO, procedure duration, hematoma, or pseudoaneurysm. HC sheaths improve the overall patient experience and reduce the risk of spasm. These findings may provide valuable insights for neurointerventionalists seeking to optimize transradial techniques and improve patient care.