International Journal of Stroke

Stroke recurrence after transcatheter PFO closure in patients with cryptogenic stroke
Goessinger B, Greisenegger S, Kastl S, Rosenhek R, Serles W, Hengstenberg C, Gabriel H and Schrutka L
Patent foramen ovale (PFO) closure is recommended for secondary prevention of cryptogenic stroke. However, data on long-term results are limited. We aimed to evaluate safety and efficacy of transcatheter PFO closure and predict neurologic recurrence.
International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis
Brakel BA, Rebchuk AD, Ospel J, Chen Y, Heran MK, Goyal M, Hill MD, Miao Z, Huo X, Sacco S, Yaghi S, Mai TD, Thomalla G, Boulouis G, Yamagami H, Hu W, Nagel S, Puetz V, Kristoffersen ES, Demeestere J, Qiu Z, Abdalkader M, Al Kasab S, Siegler JE, Strbian D, Fischer U, Coutinho JM, van de Munckhof A, Aguiar de Sousa D, Campbell B, Raymond J, Ji X, Saposnik G, Nguyen TN and Field TS
Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known.
Advancing stroke safety and efficacy through early tirofiban administration after intravenous thrombolysis: The multicenter, randomized, placebo-controlled, double-blind ASSET IT trial protocol
Tao C, Liu T, Sun J, Zhu Y, Li R, Wang L, Zhang C, Song J, Jing X, Nguyen TN, Nogueira RG, Saver JL and Hu W
Intravenous thrombolysis (IVT) is the cornerstone treatment for the acute ischemic stroke (AIS) within 4.5 h after onset. Current guidelines recommend administering antiplatelet medications 24 h after IVT. However, vascular reocclusion is a common occurrence after IVT. Tirofiban, a platelet glycoprotein IIb/IIIa antagonist, can help deter macrovascular reocclusion, prevent microvascular thrombosis, and enhance cerebral blood flow.
Prehospital blood pressure lowering in patients with ischemic stroke: A systematic review and meta-analysis of randomized controlled trials
Yuan X, Gan Q, Zhang Y, Wang P, Chong W, Hai Y and Fang F
Whether prehospital blood pressure control improves outcomes among patients with acute ischemic stroke is uncertain. This systematic review and meta-analysis aimed to evaluate the effect of prehospital blood pressure reduction treatment in patients with ischemic stroke.
Impact of time from symptom onset to puncture, and puncture to reperfusion, in endovascular therapy in the late time window (>6 h)
Sadeler A, Finitsis S, Olivot JM, Richard S, Marnat G, Sibon I, Calviere L, Cognard C, Mazighi M, Desilles JP, Lapergue B, Tamazyan R, Zuber M, Gory B and Maïer B
Increased time from symptom onset to puncture (TSOP) and time from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 h). However, these associations are less described in the late window (>6 h), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes.
ECG-based machine learning model for AF identification in patients with first ischemic stroke
Yu CC, Peng YQ, Lin C, Chiang CH, Liu CM, Lin YJ, Lin LY and Lo MT
The recurrence rate of strokes associated with atrial fibrillation (AF) can be substantially reduced through the administration of oral anticoagulants. However, previous studies have not demonstrated a clear benefit from the universal application of oral anticoagulants in patients with embolic stroke of undetermined source. Timely detection of AF remains a challenge in patients with stroke.
Anticoagulation Usage and Thrombolytic Therapy in Subjects with Atrial Fibrillation Associated Ischaemic Stroke
Harbison J, McCormack J, Brych O, Collins R, O'Connell N, Kelly PJ and Cassidy T
Atrial Fibrillation (AF) causes up to 20% of ischaemic strokes and 30% in some populations such as those over 80 years. Previous research in our population showed that widespread adoption of Direct Oral Anticoagulant (DOAC) prophylaxis had not been associated with a reduction in AF associated stroke prevalence but there was a considerable rate of breakthrough stroke in patients receiving anticoagulation and anticoagulation rate may be affected by increasing use of DOACs.
Telemedicine networks for acute stroke: An analysis of global coverage, gaps, and opportunities
Tunkl C, Agarwal A, Ramage E, Velez FS, Roushdy T, Ullberg T, Li L, Carbonera LA, Yusof Khan AHK, Ciopleias B, Law ZK, Katsanos AH, Heldner MR, Khan M, Matuja S, Alet MJ, Lagos-Servellón J, Minhas JS, Zuurbier SM, Mosconi MG, Lotlikar R, Elkady A, Gerner ST, Shreyan S, Krauss A, Gumbinger C, Srivastava P, Kiper P, Ohannessian R, Berberich A, Sampaio Silva G and Ranta A
Despite the proven efficacy of telestroke in improving clinical outcomes by providing access to specialized expertise and allowing rapid expert hyperacute stroke management and decision-making, detailed operational evidence is scarce, especially for less developed or lower income regions.
Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging - Results from the READAPT study
Ornello R, Foschi M, De Santis F, Romoli M, Tassinari T, Saia V, Cenciarelli S, Bedetti C, Padiglioni C, Censori B, Puglisi V, Vinciguerra L, Guarino M, Barone V, Zedde M, Grisendi I, Diomedi M, Bagnato MR, Petruzzellis M, Mezzapesa DM, Di Viesti P, Inchingolo V, Cappellari M, Zenorini M, Candelaresi P, Andreone V, Rinaldi G, Bavaro A, Cavallini A, Moraru S, Querzani P, Terruso V, Mannino M, Scoditti U, Pezzini A, Frisullo G, Muscia F, Paciaroni M, Mosconi MG, Zini A, Leone R, Palmieri C, Cupini LM, Marcon M, Tassi R, Sanzaro E, Paci C, Viticchi G, Orsucci D, Falcou A, Diamanti S, Tarletti R, Nencini P, Rota E, Sepe FN, Ferrandi D, Caputi L, Volpi G, La Spada S, Beccia M, Rinaldi C, Mastrangelo V, Di Blasio F, Invernizzi P, Pelliccioni G, De Angelis MV, Bonanni L, Ruzza G, Caggia EA, Russo M, Tonon A, Acciarri MC, Anticoli S, Roberti C, Manobianca G, Scaglione G, Pistola F, Fortini A, De Boni A, Sanna A, Chiti A, Barbarini L, Masato M, Del Sette M, Passarelli F, Bongioanni MR, Toni D, Ricci S, Sacco S and De Matteis E
According to the literature, about one third of patients with brain ischemic symptoms lasting <24 hours, which are classified as TIAs according to the traditional "time-based" definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke.
Beyond conventional imaging: A systematic review and meta-analysis assessing the impact of computed tomography perfusion on ischemic stroke outcomes in the late window
Elsherif S, Legere B, Mohamed A, Saqqur R, Fatima N, Saqqur M and Shuaib A
Non-contrast cranial computed tomography (NCCT) and CT angiogram (CTA) have become essential for endovascular treatment (EVT) in acute stroke. Patient selection may improve when CT perfusion (CTP) imaging is also added for patient selection. We aimed to analyze the effects of implementing CTP in acute ischemic stroke (AIS) patients' treatment to assess whether stroke outcomes differ in the late window.
Detection of atrial fibrillation after stroke due to large or small vessel disease: Systematic review and meta-analysis
Florentin M, Sagris D, Tasoudis P, Korompoki E, Veltkamp R, D'Anna L, Wachter R, Milionis H and Ntaios G
Emerging evidence indicates a frequent occurrence of atrial fibrillation (AF) detection among patients with established causes of ischemic stroke unrelated to AF. This systematic review and meta-analysis aimed to evaluate AF detection rates in stroke patients with large or small vessel disease, considering the AF detection modality and duration of cardiac rhythm monitoring.
Diagnosis and management of adult Moyamoya angiopathy: An overview of guideline recommendations and identification of future research directions
Rifino N, Hervè D, Acerbi F, Kuroda S, Lanzino G, Vajkoczy P and Bersano A
Despite the progress made in understanding the management and outcomes of Moyamoya angiopathy (MMA), several aspects of the disease remain largely unknown. In particular, evidence on the disease history and management of MMA is lacking, mainly due to methodological and selection biases in the available studies and the lack of large, randomized prospective studies. Therefore, the care of MMA patients remains limited to a few expert centers worldwide, and management is often based on local expertise and available resources. Over the years, recommendations or expert opinions have been written to provide guidance to physicians in the treatment of this condition with the goal of reducing the risk of stroke recurrence and long-term disability. However, there is no complete agreement between the available guidelines and recommendations due to differences in the articles addressed, methodologies, expertise, and validated approaches to literature review. This lack of consensus on the management of MMA may confuse clinicians and highlight some important issues and points. The aim of this comprehensive review article is to critically examine three recent guidelines and recommendations on MMA, discussing their differences and similarities and highlighting gaps in MMA care that need to be covered.
Plasma metabolites, systolic blood pressure, lifestyle, and stroke risk: A prospective cohort study
Zhang C, Li M, Yang M, Lin J, Huang J, Lin Y, Chen X, Liang Y, Yang Y, Yu Z, Hu D, Zhang M and Hu F
To estimate the associations of stroke risk with plasma metabolites, metabolic risk score (MRS), the combinations of MRS with hypertension or lifestyle, and lifestyle-related metabolic signature. To assess the improvement of the stroke risk prediction model through the incorporation of MRS.
Unveiling connections between venous disruption and cerebral small vessel disease using diffusion tensor image analysis along perivascular space (DTI-ALPS): A 7-T MRI study
Zhang X, Pei X, Shi Y, Yang Y, Bai X, Chen T, Zhao Y, Yang Q, Ye J, Leng X, Yang Q, Bai R, Wang Y and Sui B
Cerebral venous disruption is one of the characteristic findings in cerebral small vessel disease (CSVD), and its disruption may impede perivascular glymphatic drainage. And lower diffusivity along perivascular space (DTI-ALPS) index has been suggested to be with the presence and severity of CSVD. However, the relationships between venous disruption, DTI-ALPS index, and CSVD neuroimaging features remain unclear.
Elevated risk of end-stage kidney disease in stroke patients: A population-based observational study
Chun S, Han K, Kim B, Lee D, Cho IY, Choi HL, Park JH, Jeon J, Jang HR and Shin DW
Estimating the incidence of end-stage kidney disease (ESKD) in stroke survivors is important to assess and predict clinical course, improve post-stroke quality of life, and ultimately reduce health burden.
Real-world comparison of dual versus single antiplatelet treatment in patients with non-cardioembolic mild-to-moderate ischemic stroke: a propensity matched analysis
Foschi M, Ornello R, D'Anna L, De Matteis E, De Santis F, Barone V, Viola M, Mosconi MG, Rosin D, Romoli M, Tassinari T, Cenciarelli S, Censori B, Zedde M, Diomedi M, Petruzzellis M, Inchingolo V, Cappellari M, Candelaresi P, Bavaro A, Cavallini A, Piscaglia MG, Terruso V, Pezzini A, Frisullo G, Muscia F, Zini A, Leone R, Palmieri C, Cupini LM, Marcon M, Tassi R, Sanzaro E, Papiri G, Viticchi G, Orsucci D, Falcou A, Diamanti S, Tarletti R, Nencini P, Rota E, Sepe FN, Caputi L, Volpi G, La Spada S, Beccia M, Mastrangelo V, Invernizzi P, Pelliccioni G, De Angelis MV, Bonanni L, Ruzza G, Caggia EA, Russo M, Tonon A, Acciarri MC, Anticoli S, Roberti C, Scaglione G, Pistoia F, Alessi C, De Boni A, Sanna A, Chiti A, Barbarini L, Masato M, Del Sette M, Passarelli F, Bongioanni MR, De Michele M, Ricci S, Valente M, Gigli GL, Merlino G, Paciaroni M, Guarino M and Sacco S
Short-term dual antiplatelet treatment (DAPT) is superior to single antiplatelet treatment (SAPT) for secondary prevention in non-cardioembolic minor ischemic stroke and high-risk TIA. As the real-world use of DAPT is broader than in trials, it is important to clarify its benefit/risk profile in a diverse population.
Exercise to prevent stroke and dementia-World Stroke Day 2024
Markus HS
Significance of cerebral microinfarcts in antiphospholipid syndrome: A population-based study
Naftali J, Barnea R, Eliahou R, Saliba W, Bloch S, Findler M, Brauner R, Shochat T, Leader A and Auriel E
Acute ischemic stroke (AIS) or transient ischemic attack (TIA) is the most common neurological manifestations of patients with antiphospholipid syndrome (APS). Incidental diffusion-weighted imaging (DWI) positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMI), are microscopic ischemic lesions, detectable on MRI for 10-14 days only. We aimed to look at the prevalence of acute incidental CMI in a cohort of patients with APS and their association with subsequent AIS or TIA.
Stroke severity and outcomes in patients with intracerebral hemorrhage on anticoagulants and antiplatelet agents: An analysis from the Japan Stroke Data Bank
Arakaki Y, Yoshimura S, Toyoda K, Sonoda K, Wada S, Nakai M, Nakahara J, Shiozawa M, Koge J, Ishigami A, Miwa K, Torii-Yoshimura T, Miyazaki J, Miyamoto Y, Minematsu K and Koga M
Some patients with intracerebral hemorrhage are on antithrombotic agents at the time of the event and these may worsen outcome, but the relative risk of different oral anticoagulants and antiplatelet agents is uncertain. We determined associations between pre-onset intake of antithrombotic agents and initial stroke severity, and outcomes, in patients with intracerebral hemorrhage.
Clinically relevant findings on 24-h head CT after acute stroke therapy: The 24-h CT score
Zhang B, King AJ, Voetsch B, Silverman S, Schwamm LH, Ji X and Singhal AB
Routine head computed tomography (CT) is performed 24 h post-acute stroke thrombolysis and thrombectomy, even in patients with stable or improving clinical deficits. Predicting CT results that impact management could help prioritize patients at risk and potentially reduce unnecessary imaging.
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