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

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.

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 AWP220-AWP220, February 1, 2025. Background:Several studies have shown that tranexamic acid (TXA), an anti-fibrinolytic agent, may reduce hematoma expansion (HE) in intracerebral hemorrhage (ICH), but its therapeutic time window is unclear. We analyzed the efficacy and safety of TXA based on its time of administration after hemorrhage onset.Methods:We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs) published up to July 27, 2024 comparing TXA with placebo in ICH. We excluded trials that used TXA for longer than 3 days which causes delayed vasospasm, increasing the risk of cerebral ischemia. The primary outcomes were HE, 24-hour hemorrhagic volume change, 90-day mortality and poor functional outcome. We grouped the trials into 2 hours, 8 hours or 24 hours of TXA administration after hemorrhage onset. We pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) using Rstudio. Heterogeneity was examined with the I2 test.Results:We included 12 studies with 3,567 patients. Most of the studies used 1 g TXA in patients with Glasgow Coma Scale score ranging from 13-15. TXA reduced HE risk (OR 0.85; 95% CI 0.73 to 0.98; p= 0.03; I2= 0%). This reduction was observed in studies that administered TXA within 8 hours of ICH onset (OR 0.82; 95% CI 0.70 to 0.97; p= 0.02; I2= 0%). TXA slightly reduced 24-hour hemorrhagic volume (MD -1.30 mL; 95% CI -2.51; -0.09; p= 0.04; I2= 47%). This reduction was mainly seen in patients who were administered TXA within 8 hours of hemorrhage onset (MD -1.86 mL; 95% CI -3.15 to -0.58; p< 0.01; I2= 35%). There were no significant differences in poor functional outcome (OR 0.87; 95% CI 0.67 to 1.15; p= 0.34; I2= 24%), 90-day mortality (OR 1.00; 95% CI 0.84 to 1.19; p= 0.96; I2= 0%), major thromboembolic events (OR 1.22; 95% CI 0.82 to 1.82; p= 0.33; I2= 0%), neurosurgical intervention (OR 0.94; 95% CI 0.61-1.45; p= 0.78; I2= 0%) or length of hospital stay (MD -0.49 days; 95% CI -3.27 to 2.29; p= 0.73; I2= 0%).Conclusion:TXA reduced the risk of HE and slightly reduced 24-hour hemorrhagic volume in patients with ICH within 8 hours. Larger RCTs stratifying administration timing are required to establish these findings.

Stroke, Volume 56, Issue Suppl_1, Page ATP85-ATP85, February 1, 2025. Background and Purpose:Due to limitations associated with the symptom-based tools currently used for triage, up to 35% of strokes are missed at initial clinician contact in emergency medicine settings. As a result, there has been a decades-long push to identify blood biomarkers with utility for stroke recognition. Despite numerous studies reporting candidates with seemingly high levels of diagnostic performance, none have made their way into clinical use. It is possible this discrepancy is linked to translational limitations in how these prior biomarker discovery investigations have been designed and implemented. Thus, we performed a nontraditional systematic review and meta-analysis spanning 30 years of published acute stroke blood biomarker data in which we sought to explicitly quantify the effects of study design and reporting considerations on diagnostic performance estimates, and correct said estimates for such effects in order to provide better projections of how the candidate biomarkers that have been studied to date would perform in a true clinical use scenario.Methods and Results:A electronic database search was performed to identify previously reported human acute stroke blood biomarker investigations, which yielded 14,253 potential articles. 189 were included in our final analysis based on subsequent abstract and full-text screening. From each article, detailed methodological information for all reported diagnostic comparisons was manually extracted. Collectively, data from 705 different diagnostic comparisons involving 355 unique single analytes or multi-analyte panels were captured. The raw diagnostic performance estimates reported in the literature inferred that as high as 40% of previously investigated candidate biomarkers could be clinically useful for stroke recognition. However, multiple regression revealed that 47.2% of the variance in these diagnostic performance estimates could be attributed to a small number of confounding study design and reporting factors related to population sampling, timing of blood collection, blinding, and conflicts of interest. After using the model residuals to correct for these factors, not a single candidate biomarker displayed adequate evidence to suggest true clinical utility.Conclusions:Our results clarify the current state of the search for an acute stroke blood biomarker, and identify several translational limitations that need to addressed in future investigations if one is to be realized.

Stroke, Volume 56, Issue Suppl_1, Page ATP60-ATP60, February 1, 2025. Background:Due to limited diagnostic accuracy in the symptom-based tools currently used by paramedics, triage nurses, and emergency physicians, up to 35% of strokes are missed at initial clinician contact. As a result, there has been a push to identify blood biomarkers that could aid in stroke recognition at triage. There is evidence to suggest stroke is more frequently mistriaged in minority patients than White patients; to avoid perpetuating these disparities as stroke biomarkers move towards clinical use, it is important that involved investigations meaningfully account for race and ethnicity. However, it is unclear how commonly this occurs in practice.Purpose:This systematic review and meta-analysis aimed to quantify the degree that race and ethnicity information was reported in prior acute stroke blood biomarker investigations, and assess the effect of racial and ethnic heterogeneity on reported diagnostic performance.Methods:An electronic database search to identify published human acute stroke blood biomarker investigations yielded 14,253 articles. After abstract and full-text screening, 189 articles reporting 705 unique diagnostic comparisons were analyzed. For each diagnostic comparison, the reported primary diagnostic statistics were manually extracted, along with the racial and ethnic composition of the study sample if available. Diagnostic statistics were converted to a single diagnostic odds ratio, and race and ethnicity information was used to calculate a Gini diversity index value to represent the demographic heterogeneity of the sample.Results:Subject race or ethnicity was only described for 21.8% of diagnostic comparisons. For diagnostic comparisons reporting this information, study populations showed high homogeneity with median Gini diversity indices of 0.33 for race and 0 for ethnicity. We found a negative correlation between Gini diversity index for race and diagnostic odds ratio (Spearman’s rho= -0.17, p=0.14), indicating to some degree that that more homogenous study samples are more likely to produce higher diagnostic performance estimates.Conclusions:Findings from acute stroke biomarker investigations are at risk for poor generalizability to the diverse clinical populations that stroke triage serves. To reduce this risk, future work needs to address race and ethnicity more meaningfully in terms of both sampling methods and reporting.

Stroke, Volume 56, Issue Suppl_1, Page ATP25-ATP25, February 1, 2025. Background:Previous study found that compared with thrombolysis, antiplatelet did not improve outcomes but reduce the risk of symptomatic intracranial hemorrhage(sICH) for mild acute ischemic stroke(AIS) defined as National Institutes of Health Stroke Scale score 0 to 5. As relevant studies have been released recently, the benefits and risks of the two treatments are still unclear based on latest evidences.Objective:To compare the efficacy/effectiveness and safety of antiplatelet with thrombolysis for mild AIS in the first update of a living systematic review and meta-analysis.Methods:MEDLINE, Embase and Cochrane Library were systematically searched from July 2023 until August 2024. Randomized clinical trials(RCTs) and observational studies were selected and checked eligibility for inclusion based on the same criteria as before. The primary outcome was 90-day functional outcome measured by the modified Rankin Scale(mRS). Data extraction and certainty of evidence assessment were conducted in duplicate. This study was registered in the PROSPERO.Results:Since July 2023, two new studies were added, for a total of three RCTs and five observational studies with 5526 patients(3333 treated with antiplatelet and 2193 treated with thrombolysis). There were no significant differences between antiplatelet and thrombolysis in 90-day functional outcome(mRS 0-1, odds ratio, 0.96 [95% CI, 0.68 to 1.35]; mRS 0-2, odds ratio, 1.06 [95% CI, 0.73 to 1.51]), and stroke recurrence(odds ratio, 1.19 [95% CI, 0.73 to 1.93]). Compared with thrombolysis, antiplatelet was significantly associated with reduced risks on death(odds ratio, 0.36 [95% CI, 0.18 to 0.71]), and sICH(odds ratio, 0.21 [95% CI, 0.08 to 0.56]).Conclusions:In patients with mild AIS, antiplatelet was similar in functional outcomes and stroke recurrence against thrombolysis, but reduced the risks of death and sICH. Thrombolysis should be used with caution in such patients in clinical practice.

Stroke, Volume 56, Issue Suppl_1, Page AWP270-AWP270, February 1, 2025. Introduction:Patients experiencing a transient ischemic attack (TIA) or minor stroke have a high long-term risk of subsequent stroke that persists for over one year following presentation. While risk stratification tools like the ABCD2score have been used to identify patients at high risk of stroke in the short-term (within the first 90 days), less is known about factors that determine long-term risk. Some studies suggest that traditional predictors of early stroke risk may not be associated with long-term risk, while others have reported conflicting results. We aimed to summarize the association between clinical, demographic, imaging factors and the long-term risk of stroke in patients experiencing TIA or minor stroke.Methods:We searched MEDLINE, Embase, and the Web of Science from inception to June 2024, for observational studies that examined factors associated with subsequent stroke in patients experiencing TIA or minor stroke during a minimum follow-up of one year. Two reviewers independently performed study screening and data extraction. For the primary analysis, we included prognostic factors if they were derived from a multivariable Cox proportional hazards model and reported in at least 2 studies. We contacted the corresponding authors of the studies to obtain adjusted effect estimates when these values could not be extracted from the reported data. We conducted random effects meta-analyses of adjusted hazard ratios and report pooled effect estimates with 95% confidence intervals.Results:Of 13051 citations identified, we included 28 studies examining 85,328 patients including unpublished data from 8 studies that we directly obtained from study authors. Factors associated with an increased risk of stroke at one year or beyond included male sex, older age, hypertension, diabetes mellitus, atrial fibrillation, history of stroke or TIA before the qualifying event, history of coronary artery disease, presence of hemiparesis, aphasia, baseline ABCD2score of 4 or greater, acute infarct on brain imaging, large-artery atherosclerosis, and cardioembolism (Figure 1).Conclusion:We have identified important prognostic factors associated with long-term risk of stroke after a TIA or minor stroke. These findings provide a framework for evidence-based risk stratification of patients who may require extended treatment and vigorous monitoring.

Stroke, Volume 56, Issue Suppl_1, Page ATP45-ATP45, February 1, 2025. Introduction:Standardized cognitive assessments such as the Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) are generally administered using paper-and-pencil methods. Technological advancements have digitized these exams and expanded cognitive testing capabilities in the post-stroke population.Methods:Studies from 2010-2022 were identified from PubMed, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar to include digital cognitive assessments utilized for acute and chronic ischemic and hemorrhagic stroke patients. The research questions aim to evaluate technical aspects of digital tests, digital tool effectiveness, cognitive domains assessed, study population characteristics, patient usability, and exam feasibility. The methodological framework for this review included research question identification, relevant study collection, final study selection, data extraction, analysis, and summary. Covidence was used to compile relevant studies.Results:72 articles were included for final analysis. 8 different digital methods (e.g., tablet, computer, virtual reality) were used to assess cognition, with 26 studies creating a new cognitive test and 24 creating a cognitive test based on a standardized exam. Participants were tested in both acute and chronic phases (5 strictly in acute, 55 strictly in subacute/chronic, and 11 in both). 58% of articles assessed ischemic and hemorrhagic stroke participants, and 9 studies only tested aphasia patients. Exams consisted of a variety of cognitive domains, with the majority of studies testing multiple domains (e.g., executive functioning, attention, and visuospatial processing), and some studies testing only one cognitive domain. The average rate of digital test completion was 95%. Validation of the digital tool was compared with a standardized, paper-and-pencil test (e.g., MOCA, MMSE) in 48 articles (67%). An overall positive satisfaction with the digital test was seen in 8 articles that incorporated patient questionnaires.Conclusion:This review suggests that post-stroke digital cognitive assessments are feasible in the acute and post-acute settings across multiple domains similar to the MOCA and MMSE. Enhancements in these tools will expand access to testing and allow for increased identification of post-stroke cognitive impairment.

Stroke, Volume 56, Issue Suppl_1, Page AWP278-AWP278, February 1, 2025. Background:The elevation of high-sensitivity cardiac troponin T (hsTnT) in patients with atrial fibrillation (AF) is associated with adverse outcomes. However, the extent of this association for risk stratification is not clear.Hypothesis:This study aims to evaluate the association between hsTnT elevation and cardiovascular outcomes.Methods:We conducted a thorough literature search for relevant articles available until March 2024 on PubMed, Google Scholar, and Embase. Outcomes were pooled using the random effects DerSimonian-Laird model and reported as hazard ratio (HR) with a 95% confidence interval. A p-value of

Stroke, Volume 56, Issue Suppl_1, Page ATP15-ATP15, February 1, 2025. Introduction:Argatroban, a direct thrombin inhibitor, is currently being investigated as a potential adjunct to the standard of care for the treatment of acute ischemic stroke (AIS). However, data regarding its impact on functional neurological outcomes have been inconclusive. Our objective was to compare neurological outcomes at 90 days among individuals with AIS randomized to argatroban with standard of care versus standard of care alone.Methods:We systematically searched MEDLINE, EMBASE, and Cochrane CENTRAL databases from their inception to July 2024 for randomized controlled trials of argatroban. The primary outcome was excellent functional outcome, as defined by a modified Rankin Scale (mRS) score of 0-1 at 90 days. The secondary endpoints were favorable functional outcome, defined by a mRS score of 0-2 at 90 days, and repeat stroke or other vascular events within 90 days. Safety endpoints included symptomatic intracranial hemorrhage and parenchymal hematoma at 90 days. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB 2). Random-effects meta-analytic models were used to estimate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Our protocol was preregistered on Open Science Framework (https://osf.io/tygwx/).Results:Four randomized controlled trials were included. A total of 1,595 participants were randomized to receive either argatroban with standard of care (n=807) or standard of care alone (n=788). Participants were mostly male (67.1%), and their median/mean age ranged from 57 to 69 years. When data were pooled across trials, the impact of argatroban on the likelihood to have a mRS score of 0-1 was inconclusive due to a wide CI (RR: 1.12; 95% CI: 0.88-1.41; I2: 63%) (Figure 1). Similar trends were observed for the other predefined outcomes. The RRs were 1.00 (95% CI: 0.87-1.14) for a mRS score of 0-2 (Figure 2) and 0.79 (95% CI: 0.44-1.44) for stroke or other vascular events. The pooled RRs for symptomatic intracranial hemorrhage and parenchymal hematoma were 1.09 (95% CI: 0.73-1.63) and 0.84 (95% CI: 0.48-1.47), respectively.Conclusions:Results were inconclusive due to small sample sizes. Currently, there is insufficient data to support the addition of argatroban to standard of care for the treatment of AIS. Evidence from available trials in this area supports the conduct of larger trials to determine the clinical value of argatroban.

Stroke, Volume 56, Issue Suppl_1, Page AWP279-AWP279, February 1, 2025. Introduction:Neurological complications in patients with infective endocarditis (IE), such as ischemic and hemorrhagic stroke, are well-described, serious complications of IE; however, predicting which patients are most likely to experience stroke remains uncertain. The objective of this systematic review was to identify the factors associated with risk of stroke in patients hospitalized with IE.Methods:A systematic search of Ovid MEDLINE, EMBASE, and Web of Science was conducted between January 1990 and to July 2024. Articles evaluating risk of acute ischemic stroke (AIS) and/or intracranial hemorrhage (ICH) in patients with IE were included. Meta-analysis was feasible for only some predictive factors due to study heterogeneity. (PROSPERO protocol CRD42024571058).Results:Of 3558 studies identified, 35 were included: The review included 9 prospective and 26 retrospective cohort studies.Staphylococcus aureusinfection (odds ratio, 3.05 [95% CI, 1.96-4.73]; I2=77.2%; 9 studies) and 1 mm longer in vegetation size, on average (odds ratio, 1.26 [95% CI, 1.02-1.55]; I2=90.1%; 3 studies) were associated with a higher risk of AIS, adjusting for other covariates. Due to high heterogeneity among the studies, a meta-analysis was not feasible for the other predictive factors. High intensity signals on transcranial doppler, and comorbidities such as hypertension, atrial fibrillation, and hyperlipidemia were also found to have a higher risk of AIS. Risk of ICH was heightened by thrombocytopenia, mycotic aneurysms, prior ICH and/or AIS, and cerebral microbleeds.Conclusion:Physicians need to monitor numerous, diverse features of patients hospitalized with IE to mitigate the risk of ensuing stroke. While the causative microorganism, echocardiographic and neuroimaging findings may be particularly informative, underlying comorbidities and various laboratory values may also contribute to predicting IE-associated ischemic and hemorrhagic stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP58-ATP58, February 1, 2025. Background:Stroke is a leading cause of disability and death. The use of intravenous (IV) thrombolytics, such as alteplase and tenecteplase (TNKase), for acute ischemic stroke (AIS) is a standard of care. Tenecteplase has been recommended as an alternative agent to alteplase. In November 2020, the use of IV TNKase for AIS at a standard 0.25mg/kg dose was implemented at a small community hospital within a large integrated healthcare system. The use of TNKase without the required infusion may expedite admission to the intensive care unit (ICU).Purpose:The aim of this retrospective comparative review was to ascertain the effects of IV TNKase, compared to IV alteplase, on average length of stay (LOS) in the emergency department (ED) and time of ED to admission to the ICU (ED to floor).Methods:A total of 155 electronic patient charts were reviewed from January 2018 to June 2024. An unpaired t-test was used to determine thepvalue. Thepvalue of < 0.05 was considered statistically significant.Results:There were no significant differences in the age and sex between the alteplase and TNKase patients. The average LOS and ED to floor measure were also not significant between the two groups (3.24 versus 2.87 hours,p= 0.11; 79.7 versus 63.4 minutes,p= 0.20, respectively). When examining the ED to floor measure from a different perspective, there was a significant improvement in the percentage of patients admitted to the ICU within 60 minutes – 54.3% (2018 – 2020) to 72.7% (2021 – 2023) to 85.7% in 2024.Conclusion:There have been numerous trials and studies published on the use of IV TNKase for AIS with promising results. The single bolus IV TNKase dose given over 5 seconds is an attractive nursing workflow. Without the use an infusion, post-TNKase patients may be admitted sooner to ICU. Reducing ED LOS improved throughput in a small often overcrowded ED. Additional in-depth reviews and data analysis would be needed to examine patient characteristics and clinical conditions, variations in workflow, operational needs, staffing, and documentation accuracy contributing to ED LOS and ED to floor measure.

Stroke, Volume 56, Issue Suppl_1, Page AWP264-AWP264, February 1, 2025. Background:Medium vessel occlusion (MeVO) accounts for approximately one-third of all acute ischemic strokes and presents distinct management challenges, despite being less severe than large vessel occlusion (LVO). While endovascular treatment (EVT) has proven superior to best medical treatment (BMT) in LVO, its efficacy and safety in MeVO are not yet fully established. The recently published DUSK trial, which did not demonstrate significant benefits of EVT for MeVO, has not been included in prior reviews, making it essential to integrate and critically evaluate the implications of this new evidence.Aim:This meta-analysis aims to evaluate the efficacy and safety of EVT compared to BMT in patients with MeVO.Methods:We conducted a systematic search of PubMed, Embase, and the Cochrane Library up to August 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our analysis focused exclusively on peer-reviewed randomized controlled trials (RCTs) that compared the efficacy of EVT with BMT in patients with MeVOs. The primary outcomes were excellent functional outcome (defined as modified Rankin Scale [mRS] 0-1) and functional independence (defined as mRS 0-2) at 3 months. Effect sizes were computed as odd ratio (OR) with random-effect models.Results:Three RCTs with 862 patients (448 randomized into EVT vs. 414 randomized into BMT) were included. The pooled analysis demonstrated that EVT did not significantly increase the likelihood of achieving an excellent functional outcome (mRS 0-1: OR 0.89, 95% CI 0.67–1.18, p = 0.42) or functional independence (mRS 0-2: OR 0.93, 95% CI 0.62–1.40, p = 0.73) at 3 months compared to BMT. Additionally, EVT did not significantly elevate the risk of symptomatic intracranial hemorrhage (sICH: OR 1.13, 95% CI 0.55–2.33, p = 0.75) or mortality (mRS 6: OR 1.19, 95% CI 0.53–2.65, p = 0.67).Conclusions:Our systematic review and meta-analysis suggest that EVT for MeVO is not associated with a significant improvement in functional outcomes or an increased risk of adverse events such as sICH and mortality at 3 months, when compared to BMT. These findings underscore the need for further investigation, particularly with forthcoming RCTs to clarify the role of EVT in this patient population.

Stroke, Volume 56, Issue Suppl_1, Page ATP12-ATP12, February 1, 2025. Introduction:Preventing ischemic strokes in patients with atrial cardiopathy is particularly challenging due to the elevated risks associated with the condition. While numerous studies have established the efficacy of anticoagulants in preventing stroke, their benefits for patients with atrial cardiopathy are not clearly understood. Herein, this systematic review and meta-analysis aims to assess the efficacy of Apixaban in preventing ischemic stroke recurrence in patients with atrial cardiopathy.Methods:A database search of published studies at PubMed, Web of Science, Cochrane, and Scopus was performed. Randomized clinical trials and observational studies comparing the administration of Apixaban with a placebo in adult patients were included. Risk ratio (RR) was used for binary endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I2statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.Results:5 studies and 2593 patients were included. Among them, 1401 (54%) were allocated to receive Apixaban and 1192 (46%) were allocated to receive a placebo. The number of female and male patients was similar, with 1331 (51,3%) women and 1262 (48,7%) men. The recurrence of ischemic stroke (RR 0.89; 95% CI 0.64 to 1.23; P=0.479406; I2=0%) did not present a statistically significant difference between groups. Similarly, mortality (RR 1.36; 95% CI 0.92 to 2.02; P=0.121981; I2=0%) and recurrent fatal stroke (RR 0.31; 95% CI 0.07 to 1.38; P=0.123799; I2=0%) also showed no statistical significant difference between Apixaban and control group.Conclusion:In this systematic review and meta-analysis, we analyzed patients with ischemic stroke and evidence of atrial cardiopathy. Apixaban did not present significant reduction in recurrent stroke risk, recurrent fatal stroke incidence or mortality when compared with a placebo. Despite this, potential efficacy of early initiation of Apixaban should be clarified from new larger randomized clinical trials.

Stroke, Volume 56, Issue Suppl_1, Page ATP10-ATP10, February 1, 2025. Introduction:Early neurological deterioration (END) is an adverse outcome of acute ischemic stroke that affects up to one-third of patients and is linked to poorer functional outcomes. Tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor blocker, is widely used in the treatment of atherosclerotic heart disease and percutaneous coronary intervention. Herein, we sought to assess whether Tirofiban reduces the severity of outcomes and improves stroke patient recovery through a systematic review and meta-analysis.Methods:We systematically searched Pubmed, Cochrane, Web of Science and Scopus for randomized clinical trials and observational studies. The studies compared the effects on the administration of Tirofiban or control on END in individuals with acute ischemic stroke. Risk ratio (RR) was used for binary outcomes and mean difference (MD) for continuous endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I2statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.Results:Seven studies and 2163 patients were included. Among them, 1132 (52,34%) were allocated to receive Tirofiban and 1031 (47,66%) received a placebo. The number of male patients was higher than females, with 1401 (64,80%), while 762 (35,20%) were women. The outcomes of END (RR 0.43; 95% CI 0.21 to 0.87; P=0.018715; I2=50%), 7th day National Institutes of Health Stroke Scale (NIHSS Score) (MD -1,03; 95% CI -2.03 to -0.02; P=0.045408; I2=72%) and score of 0 to 2 on the Modified Rankin Scale (mRS) for functional independence (MD -1.05; 95% CI -1.71 to -0.39; P=0.001916; I2=95%) presented statistical significance favoring the Tirofiban group. The following outcomes showed no statistical significance: mortality (RR 0.94; 95% CI 0.57 to 1.55; P=0.810315; I2=39%) and symptomatic intracerebral hemorrhage (RR 1.27; 95% CI 0.32 to 5.04; P=0.738112; I2=47%).Conclusion:Even though there was no significant difference between the groups in all outcomes, such as mortality and symptomatic intracerebral hemorrhage, Tirofiban induced a favorable impact on functional outcome and improved the prognosis in patients with acute ischemic stroke. This systematic review and meta-analysis suggest that Tirofiban is efficient in preventing early neurological deterioration and improving the mRS and NIHSS scores, however, new RCTs are needed to clarify our results.

Introduction
The majority of patients with coronary heart disease (CHD) are at high sedentary levels, which severely affects patient prognosis and outcome. Despite the proven benefits of reducing sedentary behaviour (SB), intervention studies’ effectiveness has been limited. Thus, the factors influencing SB change in patients with CHD need to be explored. This scoping review aimed to identify barriers and facilitators to improved SB in CHD patients and map these factors to the Capability–Opportunity–Motivation-Behaviour model.

Methods
We conducted a scoping review in accordance with the Arksey and O’Malley framework. Eligibility criteria included qualitative and quantitative studies on SB in patients with CHD. Nine databases were searched (PubMed, Medline, Embase, CINAHL, Web of Science Core Collection, Scopus, CNKI, WanFang and VIP) from inception through 31 December 2023, following the scoping review methodology.

Results
A total of 24 studies, including two qualitative and 22 quantitative studies, were included, with 15 847 patients. Barriers to improved SB in CHD patients included capability (eg, physical characteristics, lack of knowledge to improve SB), opportunity (eg, lack of partnership support, lack of resources to carry out activities) and motivation (eg, maintaining the habit of SB, impaired belief in activities). Facilitators included capability (eg, exercise session, improving understanding of SB), opportunity (eg, utilisation of support, tele-rehabilitation guidance, diversification of living environments) and motivation (perceived benefit).

Conclusions
Patients with CHD have unique barriers and facilitators to improving SB. Future research should adequately reduce barriers and promote facilitators to increase the effectiveness of interventions.