Risultati per: Stroke

Objective
Understanding future population needs is key for informing stroke service planning. This study aims to evaluate scenarios for future trends in stroke age-specific incidence and case fatality, and estimate their impact on projected stroke and poststroke dementia prevalence in Ireland.

Design
This is an epidemiological modelling study based on a probabilistic Markov model. We extrapolated trends in age-specific stroke incidence and case fatality from 1990 to 2019 and applied these to 2016 to 2046. We defined trend scenarios based on stability and low and high decline, broadly based on the lower and upper bounds of evidence for trends to date. We also examined nonlinear trends involving decelerating decline over time and varying trends by age.

Setting/participants
The study is conducted on the Irish population aged 40–89 years in the period 2022–2046. We used multiple data sources, including systematic review and observational evidence.

Interventions
Not applicable.

Primary and secondary outcome measures
We projected the incidence and prevalence of stroke (International Classification of Disease (ICD) codes I60–I61, I63–I64), poststroke dementia (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria) and poststroke disability (modified Rankin Scale 3–5).

Results
The stable scenario indicated a projected 85 834 stroke survivors in 2046 (95% uncertainty interval (UI)=82 366–89 655), an increase of 45.7% from 2022. Assuming a high incidence decline and low case-fatality decline indicated a 5.4% increase in prevalence. Intermediate scenarios based on lower rates of decline, or decline rates slowing over time, implied an increase between 25.8% and 40.3%. Results did not differ substantially when we varied trends by age.
In the stable scenario, we projected 16 978 poststroke dementia prevalent cases in 2046 (95% UI 14 958–19 157), an increase of 58.9% from 2022. In the high decline scenario, the increase would be 24.5%, with intermediate scenarios implying an increase between 41.3% and 56.3%.

Conclusions
Future stroke healthcare needs will vary substantially depending on epidemiological trends. There is an urgent need to both invest in prevention strategies and plan for likely increases in future stroke care needs.

Objectives
To determine patient-reported symptoms and clinical factors associated with mimics and differences in health-seeking behaviour versus stroke.

Design
This is a post-hoc analysis of a cross-sectional survey of interviews on patient-reported factors in patients admitted with suspected stroke. Patients were categorised as genuine stroke or mimic. The surveys were conducted from February 2018 to January 2019.

Setting
Two non-comprehensive stroke centres in Denmark.

Participants
Patients≥18 years (no upper age limit) admitted with symptoms of stroke to one of the non-comprehensive stroke centres or transferred from a comprehensive- or primary stroke centre were eligible for inclusion. 592 patients were included.

Outcome measures
Symptoms or clinical factors associated with stroke mimics. Logistic regression analysis was performed to identify factors associated with mimics. Secondarily, the number of strokes versus mimics presenting at a healthcare facility within 3 hours contacted the emergency medical service (EMS) and arrived by ambulance.

Results
Of 592 suspected patients with stroke, 113 (19.1%) were mimics; most frequently peripheral vertigo (24.7%) and migraine (11.5%). Factors associated with a higher likelihood of mimics were female sex (OR 1.79, 95% CI 1.14 to 2.79), high Scandinavian Stroke Scale scores (OR 1.05, 95% CI 1.02 to 1.09, per point increase), and vertigo (OR 1.86, 95% CI 1.18 to 2.95). Factors associated with a lower likelihood of mimics were increasing age (OR 0.96, 95% CI 0.95 to 0.98 per year increase), reported limb weakness (OR 0.52, 95% CI 0.30 to 0.89) and difficulty steering (OR 0.51, 95% CI 0.28 to 0.93).
There was no difference between groups in the proportion of patients for whom time from symptom onset to healthcare services contact exceeded 3 hours (52.2% vs 53.7%, p=0.78). Fewer mimics contacted the EMS first, were accepted at a primary stroke centre and arrived by ambulance (p

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 178, Issue 2, Page JC18, February 2025.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 178, Issue 2, Page JC15, February 2025.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 178, Issue 2, Page JC16, February 2025.

Circulation, Volume 151, Issue 5, Page 331-333, February 4, 2025.

Introduction
Stroke is a major cause of acquired disability globally, yet the neural mechanisms driving motor recovery post-stroke remain elusive. Recent research has underscored the growing significance of subcortical pathways in neural plasticity and motor control. Among these, the cortico-reticulospinal tract (CRST) has gained attention in rehabilitation due to its unique ascending and descending structural features as well as its cellular properties which position it as an excellent candidate to compensate for inadequate motor control post-stroke. However, the optimal strategies to harness the CRST for motor recovery remain unknown. Non-invasive modulation of the CRST presents a promising though challenging, therapeutic opportunity. Acoustic startle priming (ASP) training and intermittent theta burst stimulation (iTBS) are emerging as potential methods to regulate CRST function. This study aims to investigate the feasibility of segmentally modulating the cortico-reticular and reticulospinal tracts through ASP and iTBS while evaluating the resulting therapeutic effects.

Methods and analysis
This is a randomised, blinded interventional trial with three parallel groups. A total of 36 eligible participants will be randomly assigned to one of three groups: (1) iTBS+ASP group, (2) iTBS+non-ASP group, (3) sham iTBS+ASP group. The trial comprises four phases: baseline assessment, post-first intervention assessment, assessment after 3 weeks of intervention and a 4-week follow-up. The primary outcomes are the changes in the Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale after the 3-week intervention. Secondary outcomes include neurophysiological metrics and neuroimaging results from diffusion tensor imaging and resting-state functional MRI.

Ethics and dissemination
The trial is registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2400085220) and Medical Ethics Committee of Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology (Registration No.TJ-IRB20231109). It will be conducted in the Departments of Rehabilitation Medicine and Radiology at Tongji Hospital in Wuhan, China. The findings will be disseminated through peer-reviewed journal publications and presentations at scientific conferences.

Trial registration number
ChiCTR2400085220.

Stroke, Volume 56, Issue Suppl_1, Page ATP324-ATP324, February 1, 2025. Background and Purpose:Antiphospholipid antibody syndrome (APS) is a rare cause of cerebral infarction, but the effect of antiphospholipid antibodies (aPL) on the acute phase of ischemic stroke in each stroke subtypes is still unclear, especially in the elderly patients. To clarify this, we compared antiphospholipid antibody levels in patients with acute cerebral infarction with or without recurrence, expansion, or hemorrhagic transformation of infarct in each stroke subtype.Methods:Consecutive ischemic stroke patients in a comprehensive stroke center were screened between April 2013 and April 2024. Inclusion criteria were: 1) admitted 24 hours from the onset, 2) more than 60 years-old on the admission, 3) who had follow-up MRI/CT around one week from the onset, and 4) whose aPL (anti-cardiolipin-beta2-glycoprotein I complex antibody [β2-GPI], anti-cardiolipin antibody [aCL] and lupus anticoagulant [LAC]) measured during the admission for suspected APS. Then, we dichotomized the patients with and without recurrence (R), expansion (E), or hemorrhagic transformation (HT) of infarct upon follow-up MRI/CT findings. We compared clinical features including aPL between the groups by each stroke subtypes based on TOAST classification. Sensitivity and specificity were calculated from receiver operating characteristic (ROC) curve of aPL for predicting R, E, and HT.Results:We screened 2,528 consecutive ischemic stroke patients and 271 patients met the inclusion criteria (60 [22%] cardioembolism (CE), 43 [16%] large-artery atherosclerosis, 29 [11%] small-vessel occlusion and 139 [51%] others). In enrolled patients, 30 (11%) patients showed R, 43 (16%) patients for E and 65 (24%) patients for HT. In CE, CL aCL and LAC were higher in patients with R compared without R (aCL 9.5 vs. 8.0 U/mL,p=0.047; LAC 1.15 vs. 1.01,p=0.006) while aPL were not significantly different in other stroke subtypes. Also, aPL were not significantly different between the patients with and without E or HT. In CE, R increased as LAC became higher (1st tertile vs. 2nd tertile vs. 3rd tertile of LAC: 0 (0%) vs. 1 (6%) vs. 6 (33%),p=0.004). In ROC analysis, the optimal cutoff of LAC for predicting R in CE was 1.12 (area under curve 0.83 [95% confidence interval 0.71-0.94],p=0.006; sensitivity 0.86, specificity 0.82).Conclusions:In CE, LAC was associated with acute recurrence of infarct. LAC should be measured in cardioembolic stroke with recurrence in acute phase.

Stroke, Volume 56, Issue Suppl_1, Page ATP314-ATP314, February 1, 2025. Introduction:Blood pressure (BP) control after a stroke is crucial in lowering the risk of stroke recurrence. Our prior work found that over 60% of patients recently discharged from a regional health system with stroke did not achieve BP control according to current guidelines. Less is known about the impact of insurance type and co-morbidities on post-stroke BP control.Objective:To analyze the relationship between insurance type, comorbidities and post-stroke BP control among patients within a regional health system.Methods:This report is an observational cohort study. Patients were admitted between 2013-2021 for ischemic and hemorrhagic stroke and had seen a PCP/PCAPP (primary care physician/primary care advance practice provider) in a regional health system or affiliated outpatient clinics using the EPIC electronic health record. We excluded patients who died during hospitalization, were lost to follow-up, or were on dialysis.Results:The analysis included 2,750 patients. Six months after hospital discharge, the insurance coverage among stroke survivors with uncontrolled BP ( >130/80 mm Hg) was 61.1% for public, 35.8% for private, 1.9% for other/unknown, and 1.3% for self-pay. In comparison, among those with controlled BP (

Stroke, Volume 56, Issue Suppl_1, Page ATP312-ATP312, February 1, 2025. Background/Objectives:Perioperative stroke is a significant cause of morbidity and mortality in patients undergoing cardiac, vascular, and neurosurgical procedures. We assessed the rate, characteristics, risk factors and survival outcomes of perioperative stroke following surgical resection of glioma.Design:This is a retrospective chart review of a single quaternary care center of patients with glioma between 2005-2021 who underwent resection. Stroke within 30 days of surgical resection was identified based on the radiology read of MRI brain for ischemic stroke and CT brain for hemorrhagic stroke that was obtained as part of clinical care. This was then confirmed retrospectively by a neurologist who reviewed imaging and medical records, excluding expected post-operative changes. Descriptive analysis and logistic regression were conducted. Overall survival was estimated with Kaplan-Meier methods from the date of surgery to death and compared with the log rank test.Results:Out of 738 patients who underwent surgical resection of their glioma and underwent brain MRI or CT head, 20 (2.71%) had radiographic evidence of strokes, with the mean (SD) time from surgery to stroke 5.4 (16.2) days. Of these, 13 (65%) had ischemic strokes, 7 (35%) had hemorrhagic strokes. Out of all perioperative strokes, 9 (45%) were symptomatic (total incidence of 1.2%), and 11 (55%) were asymptomatic. Patients who had a stroke were older [mean (SD); 60.4 (13.7) vs. 52.8 (15.0) years; p=0.026], had a higher rate of atrial fibrillation (p= 0.002), and had comorbid hyperlipidemia (p=0.039) and hypertension (p=0.047). Descriptive analysis of this cohort is summarized in Table 1. Older age, carrying a diagnosis of atrial fibrillation, and having hyperlipidemia were associated with higher odds of having a perioperative stroke (Table 2). In an attempt to generate a multivariate logistic model, stepwise selection yielded no significant results likely due to the low number of strokes in this cohort. The median survival for patients with stroke was 24.6 months (95% CI:21.8-32.1), which was lower than for patients who did not suffer a stroke (29.3 months, 95% CI: 25.6-32.9) (p=0.052).Conclusion:Older age, atrial fibrillation, hyperlipidemia, and hypertension were associated with perioperative stroke risk after glioma resection. Future studies should evaluate underlying mechanisms and stroke etiologies to better identify high risk patients.

Stroke, Volume 56, Issue Suppl_1, Page AWP187-AWP187, February 1, 2025. Introduction:3 to 5% of patients undergoing endovascular thrombectomy present impossible catheter access to the occlusion site from transfemoral access (TFA), largely attributed to complex arterial anatomy. Radial access can be an effective bailout strategy, but intraprocedural delays may negatively impact outcomes. Novel image processing algorithms allow for advanced characterization of vascular pathways from baseline neuroimaging, enabling the exploration of predictive models of impossible TFA before arterial puncture.Methods:A retrospective cohort of patients with an anterior large vessel occlusion who received thrombectomy from TFA between 2017 and 2023 were included in this study. A previously described automatic vascular analysis software was used to generate centerline graphs from the aorta to the intracranial occlusion site from baseline CTA. ArterialGNet, a graph neural network based on graph attention designed to integrate descriptors of centerline pathways extracted at three different distance scales, was trained for impossible TFA prediction. Five-fold cross validation was used for model derivation. The method was compared to a previously introduced random forest ensemble model with extreme gradient boosting (XGBRF) based on six vascular tortuosity descriptors of the aortic and supra-aortic regions.Results:A total of 745 patients (aged 78 years IQR 68-85, 56% women) were included in this study. Patients treated between 2017 to 2022 (n=568, 3.2% with impossible TFA) were used for model training and validation. Patients treated in 2023 (n=177, 3.4% with impossible TFA) were held out for testing. In validation, the best-performing configuration of ArterialGNet achieved a C-statistic of 0.82 (95%CI 0.74-0.90), similar to the baseline model (0.82, 95%CI 0.77-0.88). Comparable outcomes were observed in the final testing for ArterialGNet (0.84, 95%CI: 0.82–0.86). In contrast, the XGBRF model exhibited signs of overfitting (0.65, 95% CI: 0.53–0.78). In final testing, ArterialGNet predicted impossible TFA with a sensitivity of 0.80 (95%CI 0.66-0.94) and a specificity of 0.84 (95%CI 0.76-0.91). Median processing time for ArterialGNet was below 4 min.Conclusions:A novel model for impossible TFA prediction was validated with a large dataset. Impossible TFA prediction before arterial puncture may assist in decision support for initial access selection in thrombectomy, reducing intraprocedural delays and potentially improving clinical outcomes.