Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

Circulation, Ahead of Print. BACKGROUND:Patients with acute myocardial infarction and angiographically obstructive non-culprit lesions are at high risk for recurrent major adverse cardiac events (MACEs). However, it remains largely unknown whether events are due to stenosis severity or due to the underlying high-risk lesion morphology.METHODS:Between January 2017 and December 2021, 1312 patients with acute myocardial infarction underwent optical coherence tomography of all the 3 main epicardial arteries after successful percutaneous coronary intervention. Patients and lesions were categorized according to the presence or absence of (1) 1 or more non-culprit angiographic obstructive stenoses with a visual diameter stenosis of ≥50% and (2) 1 or more lesions with an underlying high-risk morphology defined as an optical coherence tomography thin-cap fibroatheroma (TCFA). Patients were followed for up to 5 years (median 4.1 [interquartile range: 3.0–5.0] years). MACEs comprised cardiac death, non-fatal myocardial infarction, and unplanned coronary revascularization.RESULTS:Overall, 492 patients had at least 1 obstructive non-culprit lesion, 352 had a single lesion, and 140 had multiple obstructive non-culprit lesions. The presence and number of angiographic obstructive non-culprit lesions correlated with the proportion and number of optical coherence tomography–derived TCFAs. At the lesion level, the prevalence of TCFA was twice as high in obstructive lesions compared with nonobstructive lesions. Patients with obstructive non-culprit lesions had an increased risk of overall MACEs (17.7% versus 12.8%; hazard ratio, 1.39 [95% CI, 1.02–1.91]) and non-culprit lesion–related MACEs (8.7% versus 3.9%; HR, 2.13 [95% CI, 1.26–3.59). Results were similar when patients were categorized on the basis of the underlying TCFA. A proportionally higher rate of overall and non-culprit lesion–related MACEs was observed as the number of obstructive stenoses or TCFAs in non-culprit segments increased. The lesion-specific HRs for obstructive lesion and TCFA were 2.03 (95% CI, 1.06–3.89) and 2.39 (95% CI, 1.29–4.43), respectively. Optical coherence tomography–derived TCFA, but not angiographic obstructive stenosis, was independently predictive of recurrent MACEs in both patient-level and lesion-level multivariable models in which these 2 characteristics were introduced simultaneously.CONCLUSIONS:The long-term prognostic implications of the presence and extent of angiographic obstructive non-culprit lesions in patients with acute myocardial infarction are primarily due to their correlation with the underlying high-risk morphology, which confers an increased risk of recurrent MACEs.

Il lockdown ha frenato la diffusione del Covid. In risposta in Commissione al senatore Borghi

Stroke, Volume 56, Issue Suppl_1, Page ATMP40-ATMP40, February 1, 2025. Introduction:Stroke patients experience higher levels of social isolation (SI) compared to their age matched healthy cohorts which is associated with poor quality of life and increased morbidity and mortality. However, frequency and associates of SI among patients with intracerebral hemorrhage (ICH) have not been described.Methods:Data for adult ( >18 years) primary non-traumatic ICH patients with prospectively collected Patient-Reported Outcomes Measurement Information System (PROMIS) measures and modified Rankin scores (mRS) on 1-year follow up were extracted from a stroke outcomes registry for a 7-hospital stroke certified healthcare system. Socioeconomic deprivation was measured using the state-level Area Deprivation Index (ADI; high deprivation defined as ADI > 7). Comorbidity burden was graded by Charlson Comorbidity Index (CCI). The PROMIS short form v2.0 social isolation 4a score was used to assess SI, with SI considered positive at T-scores above 54.9 and further categorized into mild (55-60) and moderate-severe (≥60). Patients with mRS ≥ 3 were considered functionally dependent. Descriptive statistics are provided as proportions (%) and medians with interquartile ranges (IQR). Demographic and comorbidity differences were assessed using chi-squared and Mann-Whitney U tests.Results:The cohort included 110 ICH patients (age median [IQR]: 60 [47-71], 43.6% female), of whom 20% were Hispanic and had a racial distribution of 59.0% White, 27.2% Black, 8.2% Asian, 5.5% other (Table 1). Overall, 24 (21.8%) patients experienced some degree of social isolation (54.2% mild, and 45.8% moderate-severe). Among patients with 1-year SI, 33.3% were initially discharged home, 33.3% to rehab, 16.7% to long-term acute care (LTAC), 12.5% to skilled-nursing facility, and 4.2% other. SI patients had higher comorbidity burden (vs non-isolation group; 95.8% vs. 68.6%, p=0.025), higher rates of functional dependence (70.8% vs. 30.8%, p=0.001), and higher rates of diabetes (33.3% vs 12.8%, p=0.040). Finally, patients with moderate-severe SI showed a significantly greater proportion of high socioeconomic deprivation (vs mild; 54.5% vs 7.7%, p=0.039) (Table 2).Conclusion:More than 1 in 5 ICH patients may experience long-term SI particularly those with higher comorbidity burden. Furthermore, long-term dependency is associated with higher likelihood of SI among ICH patients. .SI risk stratification for ICH patients is a critical gap in improving post-ICH outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATMP37-ATMP37, February 1, 2025. Introduction:Limited studies have examined racial disparities in long-term survival after acute ischemic stroke (AIS) with inconsistent findings. We examined these disparities among Medicare fee-for-service (FFS) beneficiaries in U.S.Methods:We analyzed data on 1,997,487 Medicare FFS beneficiaries aged ≥65 years hospitalized with incident AIS (ICD-10 code I63) and survived >30 days from January 1, 2000 to December 31, 2017, and were followed-up until December 31, 2022. Cox proportional hazard models estimated the adjusted hazard ratio (aHR, 95% CI) and adjusted survival curves by race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), Hispanic and Other). Models were adjusted for age, sex, and comorbidities.Results:The median age at AIS hospitalization was 78 years (IQR 72.0-84.0); 57.0% were women; 81.8%, 10.8%, 4.8% and 2.6% were White, Black, Hispanic and Other, respectively. Over a median follow-up of 4.9-years (IQR 1.7-8.8), there were 1,738,452 all-cause deaths. Adjusted 5-year survival after AIS improved from 2000-2004 to 2015-2017 for White (46.5% (95% CI 46.4-46.6) to 50.9% (50.7-51.1)), and Black (46.0% (45.8-46.3) to 48.9% (48.3-49.2)). For Hispanic and Other, survival remained largely unchanged: 54.4% (54.1-54.8) to 54.2% (53.6-54.8)) for Hispanic and 55.9% (55.4-56.4) to 54.7% (54.0-55.5) for Other. A clear pattern of long-term survival after AIS emerged by race/ethnicity showing similar survival between Hispanic and Other and between White and Black people (Figure). Stroke mortality risk was ~25% higher for White and Black compared to Hispanic and Other (aHR 1.25 (1.24-1.26)). This pattern was consistent across age groups and sex.Conclusions:Long-term survival after AIS has improved for White and Black Medicare FFS beneficiaries over time, while it remained largely unchanged for Hispanic and Other groups. This indicates persistent racial disparities in stroke outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP323-ATP323, February 1, 2025. Introduction:Hypertension is one of the leading causes of mortality. The direction and strength of the association between death from hypertensive and hypertensive renal disease and stroke mortality during the COVID-19 pandemic among different U.S. ethnic groups is unclear.Hypothesis:Hypertensive and hypertensive renal disease mortality is positively correlated with increased stroke death overtime during the COVID-19 pandemic. We aim to examine the correlation between mortality from Hypertensive and hypertensive renal disease and stroke before and after the COVID-19 pandemic among U.S. Hispanic and non-Hispanic populations.Methods:A database query from the U.S. Centers Disease for Control and Prevention (CDC) Wonder was retrieved. A yearly age-adjusted mortality from hypertension or hypertensive renal disease from 2017 to 2022 was correlated with the mortality from stroke by Pearson’s correlation coefficient. Further analyses were performed by stratified data before and after 2019 as well as among Hispanic and non-Hispanic subgroups.Results:Age-adjusted mortality from hypertension and hypertensive renal disease trended down before the COVID-19 pandemic (from 9 to 8.91 deaths per 100,000 populations) but trended up after the pandemic (from 10.08 to 10.29 deaths per 100,000 populations). A similar trend occurred in age-adjusted mortality from stroke (from 37.59 to 36.59 deaths per 100,000 populations during pre-pandemic and from 38.84 to 39.53 deaths per 100,000 populations during post-pandemic). Those overall cause-specific mortalities are highly correlated with the correlation coefficient of 0.9697 (Figure 1). The correlation remained but slightly attenuated among Hispanics, while more pronounced among non-Hispanics (0.9649 and 0.9680, respectively; Figures 2 and 3). Stratified by time-related to the COVID-19 pandemic, age-adjusted mortality from hypertension and hypertensive renal disease and stroke trended down before the COVID-19 pandemic but trended up after the pandemic. The correlation was 0.9866 before the pandemic and up to 0.9988 during the pandemic (Figures 1, 2, and 3).Conclusions:Hypertensive and hypertensive renal disease mortality as well as stroke mortality have trended up and increased during the COVID-19 pandemic, particularly among the non-Hispanic population. Further investigations are required to mitigate health and ethnic disparities, especially during high demand for limited resources.

Stroke, Volume 56, Issue Suppl_1, Page A82-A82, February 1, 2025. Background:Spontaneous intracerebral hemorrhage (sICH) is a neurological condition characterized by the rupture of blood vessels within the brain, resulting in the formation of a hematoma and subsequent brain injury. Tobacco use is a major modifiable risk factor for sICH and is associated with worsened outcomes following the occurrence of sICH. Tobacco use is also correlated with worsened outcomes following sICH. Previously, we observed that prior chronic exposure to nicotine results in increased hematoma volume following collagenase-induced sICH when compared to saline-exposed animals. This study aims to evaluate the effect of prior chronic nicotine exposure on long-term outcomes post-sICH.Hypothesis:Prior chronic nicotine exposure will result in more significant brain damage following an autologous blood injection-induced sICH.Methods:Young male and female (estrous matched) rats were randomly assigned to a saline (control) or nicotine-exposed group. Rats received nicotine or saline via. osmotic pumps for 2-3 weeks. The pump was removed before the induction of sICH by the stereotaxic injection of autologous blood into the striatum. The autologous blood injection-induced sICH model was used to obtain equal hematoma volume in all experimental groups. Rats then underwent perfusion fixation, and brains were harvested for histopathological analysis. Paraffin-embedded brain blocks were cut into 10 µm coronal sections between bregma -2.0 to +2.0, stained with hematoxylin and eosin, scanned with a high-resolution scanner, and analyzed using ImageJ to measure lesion area. Student’s t-test was used to determine significant differences in mean lesion volume between treatment groups. Two-way ANOVA was used to assess the interaction effect between sex and lesion volume.Results:For the male group, the brain lesion volume in nicotine-exposed rats was significantly (p

Stroke, Volume 56, Issue Suppl_1, Page ATMP27-ATMP27, February 1, 2025. Background:In 2022, stroke shifted from the fourth to the fifth leading cause of death in the U.S. as COVID-19 temporarily took its place. Despite this change, stroke remains a significant cause of mortality and long-term disability in the U.S. This study analyzes trends in in-hospital mortality among stroke-related hospitalizations in California from 2016 to 2022, with a particular focus on the pandemic years.Methods:This retrospective analysis utilized patient discharge data from the California Department of Health Care Access and Information, screening nearly 25 million inpatient events for stroke-related ICD-10-CM diagnosis codes (I60-I63) among individuals 20 and older. Multivariate logistic regression (MLR) analysis assessed the impact of the pre- and post-COVID-19 periods on in-hospital mortality, adjusting for confounders such as age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).Results:The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). Initially, the age-and-sex-adjusted in-hospital mortality rate decreased from 28.88 per 100,000 in 2016 to 27.38 in 2019. However, with the onset of COVID-19 in 2020, the rate increased to 27.94, peaking in 2021 at 30.78 during the pandemic’s height. In 2022, the rate slightly declined to 28.30 but remained above pre-pandemic levels.Similar trends from 2016 to 2022 were observed in age-adjusted rates for males, which increased from 27.77 to 29.73, and for females, which decreased from 29.91 to 26.98. The gap between male and female mortality rates widened significantly during the pandemic, with male mortality peaking in 2021 with a difference of 3.75.MLR analysis revealed a 22.6% increase in in-hospital mortality during the post-COVID period compared to the pre-COVID period (AOR=1.23, p

Stroke, Volume 56, Issue Suppl_1, Page ATP122-ATP122, February 1, 2025. Background:Classification of etiologic ischemic stroke subtype guides post-stroke care and secondary prevention. Etiologic ischemic stroke subtypes are often not clearly documented in post-stroke care plans especially when transferring from one facility to another. In 2021, AHA/ASA published updated secondary stroke prevention guidelines recommending identifying etiologic ischemic stroke subtypes when possible. The impact of this on post-stroke care is unknown.Methods:Charts of all patients ages 18 and up, admitted from 1/1/20 to 5/23/21 and from 1/1/22 to 5/23/23 to 3 long-term acute care (LTAC) facilities, on antiplatelet therapy, and with an ascertainable history of stroke within 90 days of admission, were retrospectively reviewed to assess for documentation of ischemic stroke subtype at discharge/transfer to an LTAC facility and to assess for appropriateness of secondary stroke prevention therapies. Care plans from those two time periods were compared to assess for any impact the 2021 guidelines may have had on discharge practices.Results:Subtypes were not defined for the majority of ischemic strokes. Classification by etiologic subtype was observed in 33% of cases. Classification by territory or location was more common (Fig. 1). One-quarter of patients were on dual antiplatelet therapy (DAPT) and 75% of patients were on single antiplatelet therapy (SAPT) with more patients on DAPT in the latter time period (Fig. 2A). Rationale for DAPT were not provided for the majority of patients and NIHSS and ABCD2 scored were also not commonly provided for patients on DAPT (Fig. 2B). Close to 90% of patients were treated with antihypertensives and statin therapy at discharge to LTAC; 71% of patients were treated with diabetic therapies at discharge; stroke education at discharge to LTAC was documented for 43% of patients; and LDL was documented in 56% of patients (Fig. 3).Conclusions:Etiologic ischemic stroke subtypes were not documented for the majority of patients transferred to LTACs. Despite recent guideline revisions, an increase in documentation of stroke subtype was not observed. Optimal secondary stroke prevention strategies were difficult to assess without this information including appropriate antiplatelet regimens. Our findings highlight the importance of the need to improve post-stroke care plans at discharge and transfer including documentation of etiologic ischemic stroke subtypes to facilitate optimal post-stroke care across all transitions.

Stroke, Volume 56, Issue Suppl_1, Page ATP369-ATP369, February 1, 2025. Introduction:The cholinergic anti-inflammatory pathway regulates immune responses through the alpha7 nicotinic acetylcholine receptor (α7nAChR), found in neurons, macrophages, and monocytes. α7nAChR activation via agonists or Vagus nerve stimulation (VNS) reduces pro-inflammatory cytokines in disease models. In young mice, pharmacological activation or stimulation of the Vagus nerve has been shown to mitigate ischemic stroke injury by reducing brain and peripheral inflammation and oxidative stress. However, the role of α7nAChR in long-term stroke outcomes remains unclear.Methods:Young (8-12 weeks) male wild-type (WT) and α7nAChR knockout (KO) mice underwent middle cerebral artery occlusion (MCAO) for 60 minutes. After 24 hours, brain acetylcholine levels and α7nAChR expression were assessed by mass spectrometry and western blot respectively. Microglia, macrophage counts, and TNF-α expression were evaluated using flow cytometry. Long-term behavioral tests included the Barnes maze (days 7 and 30), novel object recognition (day 10), and object location tests on day 20. A second cohort was euthanized on day 7 for brain-infiltrated immune cell analysis.Results:At 24 hours post-MCAO, brain α7nAChR expression decreased significantly without changes in acetylcholine levels. WT MCAO mice showed reduced microglia, increased microglial TNF-α expression, and fewer α7nAChR-positive microglia compared to shams (p

Stroke, Volume 56, Issue Suppl_1, Page ATP337-ATP337, February 1, 2025. Background and Purpose:Our previous studies in a rat model of ischemic stroke identified that intraperitoneal (IP), but not intracerebroventricular (ICV) administration of IGF-1 reduced stroke-induced gut leakiness and peripheral inflammation in the acute phase and attenuated stroke-induced impairment in acyclic middle-aged female rats. These data suggest that the gut may be implicated in IGF-1-mediated effects on stroke-induced cognitive impairment. To directly assess whether the effect of IGF-1 on behavioral improvement is mediated by the gut, study utilized a novel tet-inducible rAAV construct to block IGF1R specifically in the gut.Methods:Female Sprague Dawley rats (9-11 mo) were intragastrically gavaged with either recombinant rAAV construct containing IGFR-shRNA (IGFR-sh) downstream of the IESC promoter Lgr5 in a Tet-inducible system or rAAV-empty vector (Scr-sh) 4 weeks prior to experimental ischemia. Animals were subjected to endothelin-1 induced MCAo. Doxycycline was administered 4h later and IGF-1 was given ip at 4 and 24 h post-stroke. Sensorimotor function as well as peripheral inflammation (in serum samples) was assessed at 5d post-stroke and long-term cognitive impairment was evaluated after 60 days.Results:The mCherry reporter in the rAAV construct was observed in the intestinal crypt, indicating appropriate delivery of the construct. Sensorimotor function evaluated by vibrissae evoked forelimb placement task was significantly impaired in the ipsilateral paw after stroke in IGFR-Sh+IGF-1 compared to Scr-sh+IGF-1(p

Stroke, Volume 56, Issue Suppl_1, Page A16-A16, February 1, 2025. Background:Colchicine has shown to reduce major adverse cardiovascular events and stroke among patients with coronary artery disease. However, its efficacy with short and long use and risk of stroke has not been well studied with conflicting results till date.Objective:We sought to evaluate the short and long term efficacy of Colchicine for prevention of stroke and major adverse cardiovascular events (MACE).Methods:We performed a systematic literature search on PubMed, EMBASE, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until July 20th, 2024. Odds ratios (OR) were pooled using a random-effect model, and a p-value of

Stroke, Volume 56, Issue Suppl_1, Page A37-A37, February 1, 2025. Background:In the Carotid or Middle cerebral artery Occlusion Surgery Study (CMOSS), we found no significant difference between the bypass surgery group and the medical group with respect to the primary composite outcome of stroke or death within 30 days or any subsequent ipsilateral ischemic stroke within 2 years of follow-up. We now extend the long-term follow-ups to 10 years.Methods:We randomly assigned symptomatic patients with hemodynamically compromised internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion to extracranial-intracranial (EC-IC) bypass surgery plus medical treatment or medical treatment alone at 13 centers in China. We extended the follow-ups from the original 2 years to 10 years to assess long-term outcomes. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days after randomization.Results:324 patients were assigned to the surgery (n=161) or medical group (n=163); the median duration of follow-up was 7.6 years (interquartile range [IQR], 2.3 to 9.2). The primary outcome occurred in 18 of 161 patients (11.2%) in the surgical group, significantly lower than that in the medical group (32 out of 163 patients [19.6%]; relative risk [RR], 0.57; 95% confidence interval [CI], 0.33 to 0.97; P=0.04). The risk of any stroke was 16.1% in the surgical group vs 23.3% in the medical group (RR, 0.76; 95% CI, 0.52 to1.13; P=0.15); the all-cause mortality was 8.1% in the surgical group vs. 8.6% in the medical group (RR, 0.94; 95% CI, 0.46 to 1.94]; P=0.93).Conclusions:Among symptomatic ICA or MCA occlusion patients with hemodynamic insufficiency, the addition of extracranial-intracranial bypass surgery to medical treatment was safe and led to a lower risk of recurrent stroke through 7 years of follow-up than medical treatment alone. (ClinicalTrials.gov number, NCT01758614.)

Stroke, Volume 56, Issue Suppl_1, Page A162-A162, February 1, 2025. Background:Preceding respiratory tract infections (RTIs) caused by bacteria or viruses are associated with worse stroke outcomes, likely due to an exaggerated inflammatory immune response, endothelial dysfunction, platelet activation, and coagulopathy. Recent studies have revealed increased plasma von Willebrand factor (VWF) levels and reduced ADAMTS13 activity (the risk factors for stroke) in patients with RTIs, including COVID-19. However, it remains unclear whether an imbalance in the VWF–ADAMTS13 axis plays a causative role in the pathophysiology ofS. aureus- or COVID-19-associated stroke severity or is merely an associative marker of disease status.Objective:To examine whether an imbalance in the VWF–ADAMTS13 axis is a causal link between RTIs and stroke severity.Methods:Wild-type (WT) mice (3–4 months old) were infected intranasally with sublethal doses ofS. aureus(on days 0, 2, and 5) or mouse-adapted SARS-CoV-2 (on day 0). On day 6 (S. aureus) or day 3 (SARS-CoV-2), the infection was confirmed to be localized in the lungs (but not in the brain) and the plasma VWF levels and ADTMTS13 activity were quantified. In another set of experiments, WT,Vwf−/−, andAdamts13−/−mice (3–4 months old) with respective littermate controls were subjected to transient (30 or 45 min) cerebral ischemia (filament stroke model) followed by reperfusion. For theS. aureusexperiments, brain infarcts were assessed on day 2 post-reperfusion and functional outcomes (corner test, wire hanging test, modified neurological severity score, and rotarod test) on week 1 and 4 post-reperfusion. For the SARS-CoV-2 experiments, brain infarcts and functional outcomes (the Bederson score) were assessed on day 1 post-reperfusion.Result:We demonstrated thatS. aureusor SARS-CoV-2 infection localized to the lungs in the WT mice resulted in increased (2–3 fold) plasma VWF levels and reduced ADAMTS13 activity, concomitant with larger infarcts and worse functional outcomes (P

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 AWP43-AWP43, February 1, 2025. Objective:Recanalized aneurysms may still recanalize despite a second coiling to prevent rupture. Factors related to recanalization following a second coiling for recanalized aneurysms have not yet been fully explored. This study examined a large multicenter dataset accumulated over a 20-year period to identify factors related to major recanalization following a second coiling for recanalized aneurysms.Methods:A total of 185 patients with 188 aneurysms who underwent second coiling for saccular unruptured cerebral aneurysms at three institutions between November 2003 and December 2023 were retrospectively reviewed. Patients were categorized into a group with major recanalization (R group) and a group without major recanalization (NR group). To identify factors related to major recanalization, clinical, anatomic, and procedural factors were comparable between groups by multivariate logistic regression analysis and stepwise selection.Results:During the follow-up period (mean, 62.3 ± 51.2 months), 72 (38.3%) of 188 recanalized aneurysms developed major recanalization. Compared with the NR group, the R group had significantly larger aneurysm size, neck size, and aneurysm volume at initial coiling and significantly lower rates of stent-assisted coiling, use of an intermediate catheter, and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis identified neck size at initial coiling (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.03–1.32) as an independent risk factor for major recanalization and stent-assisted coiling (OR 0.34; 95%CI 0.14–0.85), use of an intermediate catheter (OR 0.38; 95%CI 0.17–0.86), and complete occlusion at second coiling (OR 0.16; 95%CI 0.034–0.72) as independent protective factors for major recanalization.Conclusions:Second coiling of recanalized aneurysms may decrease the risk of major recanalization by using a stent in combination with an intermediate catheter to achieve complete occlusion.

Stroke, Volume 56, Issue Suppl_1, Page AWP39-AWP39, February 1, 2025. Background:Moyamoya disease (MMD) is a cerebrovascular disorder marked by the progressive steno-occlusion of the bilateral internal carotid arteries and the formation of abnormal collateral vessel networks at the base of the brain. Previous studies have attempted to identify risk factors predictive of postoperative complications to improve patient management. This study aims to identify pretreatment factors associated with symptomatic stroke in MMD patients.Methods:This study is a multicenter retrospective analysis conducted across 13 academic institutions in North America. A total of 518 patients with MMD were included. Data collected included patient demographics, disease characteristics, and follow-up duration. Stroke-free survival was analyzed using Kaplan-Meier curves. Univariate and multivariable Cox regression analyses were used to identify risk factors for symptomatic stroke.Results:The median age of the patients was 43 years (IQR, 34–52 years), and 370 (71%) were females. Hypertension was present in 255 (49%) patients, diabetes mellitus in 144 (28%), and 192 (37%) were smokers. Multivariable Cox regression identified advanced age (HR 1.03, 95% CI 1.01–1.05, p = 0.011), female sex (HR 2.03, 95% CI 1.00–4.11, p = 0.049), diabetes mellitus (HR 2.03, 95% CI 1.14–3.63, p = 0.016), smoking status (HR 2.27, 95% CI 1.27–4.05, p = 0.006), and incidental findings (HR 0.37, 95% CI 0.15–0.93, p = 0.034) as significant factors associated with symptomatic stroke.Conclusion:Advanced age, female sex, diabetes mellitus, and smoking status were significant predictors of symptomatic stroke in MMD patients. Patients with incidental findings had a reduced risk of stroke. These findings emphasize the importance of managing modifiable risk factors and the potential benefits of early detection in improving clinical outcomes for MMD patients. Further prospective studies are needed to validate these findings.