Questo è quello che abbiamo trovato per te
Stroke, Volume 56, Issue 5, Page e149-e149, May 1, 2025.
Stroke, Volume 56, Issue 5, Page 1323-1336, May 1, 2025. Lifestyle behavioral change is a critical component for secondary prevention of stroke. Although evidence for the effectiveness of lifestyle behavior change is growing, methods to promote and maintain behavior change remain unclear. In this review, we aimed to synthesize the evidence for lifestyle behavior change interventions among patients living with stroke or transient ischemic attack. We searched 7 databases to identify studies, including randomized controlled trials, quasi-experimental, and longitudinal studies examining changes in cardiovascular risk factors. Data were extracted regarding participant characteristics, intervention attributes (eg, provider, behavior change techniques, and modality), and effectiveness for control of risk factors. From 4620 records identified, 73 studies were included. Information about the type of behavior change theory applied was reported in 36% of studies. The social cognitive theory and transtheoretical models were the most commonly cited frameworks. Changes in physical activity (64%) and blood pressure (63%) were the most frequently assessed outcomes. Fewer than half of the studies assessed changes in weight (41%), blood cholesterol (40%), diet (36%), smoking cessation (33%), alcohol consumption (19%), and blood glucose (18%). No studies assessed sleep as a risk factor. Most studies had mixed effects or no change for the risk factor measured. No studies reported negative effects. Interventions associated with improvements were more commonly delivered by a multidisciplinary team and informed by behavior change techniques. Further research is required to identify the most effective methods to promote and sustain lifestyle behavior change among people living with stroke or transient ischemic attack.
Stroke, Volume 56, Issue 5, Page 1115-1115, May 1, 2025.
Stroke, Volume 56, Issue 5, Page 1349-1350, May 1, 2025. According to Global Stroke Fact Sheet 2022, stroke is the second leading cause of death and a major cause of disability. Stroke treatment and care need immediate attention and fill the large existing gaps. This article focuses on the gaps in stroke prevention, management, and care. The author has highlighted 2 main facts, time window and watch-and-wait, which play a critical role in the management of patients upon stroke onset.
Stroke, Volume 56, Issue 5, Page e150-e150, May 1, 2025.
Stroke, Volume 56, Issue 5, Page 1351-1364, May 1, 2025.
Stroke, Volume 56, Issue 5, Page 1295-1297, May 1, 2025.
Stroke, Volume 56, Issue 5, Page 1337-1338, May 1, 2025.
Introduction
Dysphagia is one of the common complications of stroke. The use of high-frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) to stimulate the suprahyoid motor cortex, which has been an evidence-based treatment method for dysphagia. Intermittent theta burst stimulation (iTBS) is a newer type of rTMS. There are few studies comparing iTBS with 10 Hz rTMS in the treatment of post-stroke dysphagia (PSD). Therefore, our study describes the rationale and design of a randomised controlled trial to evaluate the effects of iTBS versus 10 Hz rTMS on swallowing function, serum indexes and functional fMRI in patients with PSD.
Methods and analysis
Fifty participants with PSD will be randomly assigned to the iTBS group (n=25) or the rTMS group (n=25). iTBS group: three 50 Hz pulses, repeated at 5 Hz, 100% intensity threshold, 600 pulses/time and sham rTMS. rTMS group: 10 Hz pulse, 100% intensity threshold, 1000 pulses/time and sham iTBS. The stimulation sites will be the suprahyoid motor cortex of affected hemisphere, once a day, 5 times a week for 4 weeks. Swallowing function and serum indexes will be evaluated at baseline, second week of treatment, fourth week of treatment and 4 weeks after the end of treatment. The fMRI will be evaluated at baseline and in the fourth week of treatment.
Ethics and dissemination
This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (number: KY2023406). The findings will be published in peer-reviewed journals and presented at academic conferences.
Trial registration number
ChiCTR2400079679.
Despite the small sample size, our findings suggest that prehospital application of RIPerC is safe and may confer clinical benefit, as indicated in the post hoc adjusted analysis. However, larger, adequately powered trials are required to validate these results, and to determine potential differential effects across underrepresented patient subgroups.
Stroke, Ahead of Print. BACKGROUND:Although many studies have suggested that white matter hyperintensity (WMH) severity predicts naming and aphasia severity in chronic poststroke aphasia, there are inconsistencies in the literature. WMHs are typically symmetrical in neurotypical controls, and measuring WMH in the contralateral hemisphere is likely the best option to estimate brain health independently from the stroke lesion and avoid measurement contamination from stroke-related gliosis. In this study, we aimed to clarify the discrepancies in the literature by testing whether WMH rating methods are related to clinical outcomes.METHODS:Ninety-five participants with chronic aphasia at least 12 months after their left-hemisphere stroke completed a baseline Western Aphasia Battery and the Philadelphia Naming Test. All participants then underwent 6 weeks of phonological and semantic naming treatments focused on improving lexical processing, and the Philadelphia Naming Test was readministered immediately following treatment. Using the Fazekas scale, WMH severity was independently rated on the whole brain and the right hemisphere only. Their relationship of WMH behavior was calculated by accounting for age, lesion volume, time poststroke, years of education, and sex.RESULTS:There were significant positive correlations between whole-brain and right-hemisphere ratings of WMH, but Wilcoxon signed-rank tests revealed that whole-brain ratings were consistently higher (whole brain M=3.337, right hemisphere M=2.899;P
Stroke, Ahead of Print. Endovascular thrombectomy (EVT) is a safe and effective treatment for acute ischemic stroke caused by large vessel occlusion. However, earlier randomized trials of endovascular thrombectomy did not include many patients with large infarctions, leading to their exclusion from this treatment. Recent randomized trials have shown that endovascular thrombectomy is superior to medical management alone in improving functional outcomes in ischemic stroke cases with large infarcts. This commentary provides an overview of these trials and discusses important considerations for implementing these results into clinical practice.
Stroke, Ahead of Print. BACKGROUND:Women less frequently receive secondary prevention medications at discharge poststroke than men. It is unclear whether similar sex differences exist in the long term poststroke, after accounting for age and clinical characteristics. We aimed to evaluate sex differences in medication prescription, initiation, and discontinuation poststroke or transient ischemic attack.METHODS:A retrospective cohort study using person-level linked data from the Australian Stroke Clinical Registry (42 hospitals; Victoria and Queensland; 2012–2016). We included all adults with first-ever ischemic stroke, intracerebral hemorrhage, or transient ischemic attack who survived >60 days post-discharge. For each major class of secondary prevention medication (antihypertensive, antithrombotic, or lipid lowering), we evaluated sex differences in prescription at hospital discharge, initiation within 60 days, and discontinuation within 2 years post-discharge. Sex differences were assessed using multivariable models, adjusted for sociodemographics and comorbidities. Where effect modification by age was found (Pinteraction≤0.05), age-specific odds ratios were reported.RESULTS:Among 8108 women (median age, 74.3 years) and 10 344 men (median age, 70.5 years) with first-ever stroke (≈8% intracerebral hemorrhage) or transient ischemic attack, women were less likely to be prescribed antihypertensive medications on discharge (odds ratio, 0.82 [95% CI, 0.74–0.91]). Women were less likely to initiate antihypertensive (odds ratio, 0.76 [95% CI, 0.69–0.84]) and antithrombotic (odds ratio, 0.89 [95% CI, 0.82–0.96]) medications within 60 days than men. While there was no overall difference in discontinuation between men and women, interactions were observed with age (Pinteraction, all
Stroke, Ahead of Print. BACKGROUND:2-Iminobiotin (2-IB) is a biotin analog with neuroprotective properties. It selectively inhibits neuronal and inducible nitric oxide synthase. The primary objective of this study was to assess the safety, tolerability, and pharmacokinetics of 2-IB in patients with ischemic stroke due to large-vessel occlusion treated with endovascular thrombectomy. The secondary objective was to investigate preliminary efficacy.METHODS:In this single-center, randomized, placebo-controlled phase 2a study, patients received continuous infusion of 2-IB or placebo for 24 hours. The primary outcome was safety and tolerability measured by vital parameters and pharmacokinetic parameters in the first 28 hours after treatment and serious adverse events up until 7 days. Secondary and additional outcomes included National Institutes of Health Stroke Scale score and infarct volume at 24 to 48 hours, mortality at 90 days, and (baseline-prognosis adjusted) modified Rankin Scale score at 90 days.RESULTS:In the modified intention-to-treat population, 40 patients were randomized, 20 per treatment group. Median age was 76 (interquartile range [IQR], 66–82) years and 40% were female. Baseline characteristics were similar between groups. Vital parameters during treatment did not differ between groups. In total, 17 serious adverse events occurred, 6 (30%) in 2-IB and 11 (55%) in placebo. Median 2-IB exposure (AUCavg_4 h) was 320 (IQR, 243–395) ng h/mL. Median National Institutes of Health Stroke Scale score at 7 days was 3 (IQR, 1–11) in 2-IB and 3 (IQR, 0–16) in placebo. Median infarct volume at 24 to 48 hours was 12.5 (IQR, 8.4–60.5) mL versus 13.7 (IQR, 4.0–94.5) mL. Median modified Rankin Scale at 3 months was 3 (IQR, 1–3) in the 2-IB group versus 3 (2–6) in placebo-treated patients. Mortality was 15% (3/20) in 2-IB versus 40% (8/20) in placebo.CONCLUSIONS:In patients with ischemic stroke with large-vessel occlusion treated with endovascular thrombectomy, 2-IB is safe and well tolerated. Pharmacokinetic parameters could be predicted well. The efficacy of 2-IB needs to be investigated further in a phase 2b/3 clinical trial.REGISTRATION:URL:www.onderzoekmetmensen.nl; Unique identifier: NL-OMON51194.
Annals of Internal Medicine, Ahead of Print.
Annals of Internal Medicine, Ahead of Print.
