Detection of undiagnosed atrial fibrillation (AF) after ischemic stroke through extended cardiac monitoring is important for preventing recurrent stroke. We evaluated whether a tool that displays clinically predicted AF risk to clinicians caring for stroke patients was associated with the use of extended cardiac monitoring.

We prospectively included hospitalized ischemic stroke patients without known AF in a preintervention (October 2018 - June 2019) and intervention period (March 11, 2021 - March 10, 2022). The intervention consisted of an electronic health record (EHR)-based best-practice advisory (BPA) alert which calculated and displayed 5-year risk of AF. We used a multivariable Fine and Gray model to test for an interaction between predicted AF risk and period (preintervention vs intervention) with regards to incidence of extended cardiac monitoring. We compared the incidence of extended cardiac monitoring within 6-months of discharge between periods, stratified by BPA completion.

We included 805 patients: 493 in the preintervention cohort and 312 in the intervention cohort. In the intervention cohort, the BPA was completed for 180 (58%) patients. The association between predicted clinical risk of AF and incidence of 6-month extended cardiac monitoring was not different by time period (interaction HR = 1.00 [95% Confidence Interval (CI) 0.98; 1.02]). The intervention period was associated with an increased cumulative incidence of cardiac monitoring (adjusted HR = 1.32 [95% CI 1.03-1.69]).

An embedded EHR tool displaying predicted AF risk in a poststroke setting had limited clinician engagement and predicted risk was not associated with the use of extended cardiac monitoring.

NCT04637087.

This study was aimed to investigate the relationship between neuron-specific enolase (NSE) and swallowing dysfunction in patients with acute ischemic stroke (AIS) and evaluate the impact of early enteral nutrition intervention on NSE levels.

A retrospective study was conducted involving 445 AIS patients admitted to the neurology department of the Affiliated Hospital of Jiaxing University between September 2015 and August 2022. Data collected included gender, age, water-swallowing test (WST) score upon admission, and NSE examination results on admission, the 5th day, and the 10th day.

Among 445 enrolled AIS patients, 42.0% (187/445) exhibited swallowing dysfunction. Key findings revealed: (1) Positive correlation between WST severity and serum NSE levels across all timepoints (P < 0.05). (2) Dysphagia patients demonstrated elevated NSE levels versus controls (P < 0.05). (3) Early enteral nutrition intervention (n = 98) significantly reduced NSE levels by day 10 compared to non-intervention group (P < 0.05), though no intergroup differences were observed at admission or day 5 (P > 0.05).

NSE measurement is a simple supplement to the WST. There existed a significant correlation between NSE and swallowing dysfunction, making NSE a potential preliminary screening indicator for evaluating in ischemic stroke patients. And early implementation of enteral nutrition intervention could effectively reduce NSE levels in patients with ischemic stroke.

Epidemiological evidence suggests that following a Transient Ischemic Attack (TIA), there are residual impairments which threaten quality of life. Despite these consequences, studies addressing post-TIA care remain limited. TIA patients' needs were summarized into 3 domains: Information, Stroke prevention, and Holistic care. Therefore, this scoping review will evaluate the existing reported care programs with the aim of identifying the scope of the care and its adequacy in fulfilling the patients' needs. Based on a question "Do available post-TIA care programs sufficiently cover the needs for information, stroke prevention and holistic care?" and using keywords related to TIA and care, this scoping review was conducted in accordance with an established 5-step framework. Searched databases included Scopus, PubMed, Cochrane Library, and EBSCOhost to retrieve potentially relevant studies. Sixteen studies were selected from 1003 relevant articles published between the years 2014 and 2022. We found that all 16 studies included stroke secondary prevention, involving medical treatment, advice on lifestyle changes and exercises, and counseling to post-TIA patients. However, only 4 studies included education and information sharing about post-TIA impairments, while only one study reported the effects of the care on post-TIA impairment namely fatigue. We found no studies which looked into the care impacts on the patients' overall quality of life. There is a gap in the existing literature regarding holistic care for post-TIA patients, with the management of residual impairments being missed. Further studies targeting a holistic management approach for post-TIA patients are warranted.

App. 25 % of stroke survivors develop post-stroke spasticity (PSS) over the first year after a stroke, and they also experience motor weakness, which may prevent effective recovery by restricting mobility and participating in exercise programmes. Patients generally experience rapid improvement with Botulinum Toxin Type A (BoNT-A) therapy for PSS. Unfortunately, clinical trials demonstrating benefits from BoNT-A treatment are of short duration. Consequently, it is not known if treatment-related improvements in mobility could also contribute to lowering the risks of secondary cardiovascular (CV) events and all-cause death. To assess if BoNT-A injections could also have an impact on long-term outcomes, we developed a 10-year survival model comparing the effects of AbobotulinumtoxinA (aboBoNT-A) injections and rehabilitation therapy (aboBoNT-A+RT) with rehabilitation therapy (RT) alone. The Functional Independence Measure (FIM) appeared to be the only functional outcome allowing us to model the effect of aboBoNT-A injections on all-cause mortality. Stroke survivors who reported better improvement in FIM score during rehabilitation had lower risk of all-cause mortality during follow-up. Patients treated with aboBoNT-A injections + RT showed better improvement in FIM score than patients treated without aboBoNT-A injections. Our modelling results showed that the addition of aboBoNT-A injections to RT led to a reduction of 8.8 % in the risk of all-cause mortality, and a relative increase of 12.8 % in discounted life-years. The addition of aboBoNT-A injections to RT led to an increase in total costs of £42.329 over 10 years (based on National Health Service (NHS) UK cost collection 2018/2019). In the base-case scenario, incremental costs were driven by the increased number of hours of home care and RT for patients treated with aboBoNT-A injections compared with RT alone. Assuming an incremental cost-effectiveness ratio (ICER) threshold of £30.000, the probabilistic sensitivity analysis found a 73 % likelihood that aboBoNT-A + RT demonstrated cost-effectiveness compared with RT alone. Our work advocates for the need to consider and to capture the impact of BoNT-A injections on all-cause mortality and secondary events, such as CV events and recurrent stroke, which are prevalent in stroke survivors.

Clinical practice guidelines recommend initiation of anticoagulation within 2 weeks after stroke with atrial fibrillation. It is unknown whether there is an optimal starting day within the 14-day period that balances the risks of recurrent embolic events against serious hemorrhagic events.

To determine if there is an optimal delay time to initiate treatment with a direct oral anticoagulant after atrial fibrillation-related stroke that minimizes the risk of a composite outcome of ischemic or hemorrhagic events.

This phase 2, pragmatic, response-adaptive randomized clinical trial was conducted between June 2017 and June 2023 at acute care hospitals in Texas and included patients who had a mild to moderate ischemic stroke (minimum lesion diameter of 1.5 cm) with atrial fibrillation and were prescribed a direct oral anticoagulant within 2 weeks from stroke onset.

Within 3 to 4 days after atrial fibrillation-associated ischemic stroke, patients were randomized to a group for treatment start date (group 1 was day 3 or 4 after stoke onset; group 2 was day 6; group 3 was day 10; and group 4 was day 14) with a direct oral anticoagulant for secondary stroke prevention.

The composite primary outcome was an ischemic (stroke or systemic embolism) or hemorrhagic (symptomatic intracranial hemorrhage or major systemic hemorrhage) event observed within 30 days from the index stroke time of onset. Posterior probabilities were used to estimate which timing groups were optimal for treatment initiation and were recalculated at predefined intervals. The randomization allocations were adjusted to favor the groups with higher probabilities.

The trial enrolled and randomized 200 patients (50% were female; the median age was 75 years [IQR, 65-81 years]; 17.5% were Asian, Black, or >1 race; 16.5% were Hispanic; the median National Institutes of Health Stroke Scale score was 6.5 [IQR, 4-14]; and the median lesion diameter was 3.1 cm [IQR, 2.0-4.4 cm]). No ischemic events were observed for group 1, 3 events were observed for group 2, 2 events were observed for group 3, and 2 events were observed for group 4. One hemorrhagic event was observed for group 1, 1 event was observed for group 2, 1 event was observed for group 3, and 0 events were observed for group 4. Group 1 had a posterior probability of 0.41 for being the optimal day for treatment initiation and it was 0.26 for group 2, 0.17 for group 3, and 0.15 for group 4. The use of response-adaptive randomization was feasible and favored groups with earlier initiation times for use of a direct oral anticoagulant.

A clearly superior day to initiate use of a direct oral anticoagulant for secondary stroke prevention in patients with atrial fibrillation was not identified, but the evidence suggests that initiating use of a direct oral anticoagulant earlier is better than at later times within the first 2 weeks after stroke onset.

ClinicalTrials.gov Identifier: NCT03021928.

Whether the long-term benefit of stroke prevention when stenting is added to medical therapy (MT) over MT alone for symptomatic severe intracranial artery stenosis offsets the perioperative risks of the stenting has not been directly evaluated in a randomized trial. We aimed to compare the long-term (>3 years) effect of stenting versus MT alone in patients with symptomatic severe intracranial artery stenosis in a randomized trial.

We extended the follow-up of 358 subjects enrolled in a multicenter, open-label, randomized trial conducted at 8 centers in China. Patients with transient ischemic attack or stroke attributed to severe intracranial stenosis (70% to 99%) were recruited between March 5, 2014, and November 10, 2016. The primary outcome was a composite of stroke or death within 30 days or stroke in the territory of the qualifying artery beyond 30 days. Other secondary outcomes included stroke in the territory of the qualifying artery, as well as disabling stroke or death after enrollment.

A total of 358 patients (stenting 176 versus MT 182) were recruited from March 5, 2014, and followed up till January 22, 2024. The median duration of follow-up was 7.4 years (interquartile range, 6.0-8.0). The primary outcome was not significantly different (stenting 14.8% versus MT 14.3%; hazard ratio, 1.02 [95% CI, 0.58-1.77]; P=0.97). No significant difference was found between groups for the secondary outcomes: stroke in the territory of qualifying artery (14.8% versus 14.3%; hazard ratio, 1.02 [95% CI, 0.58-1.77]; P=0.97), disabling stroke or death (16.5% versus 14.3%; hazard ratio, 1.12 [95% CI, 0.66-1.91]; P=0.70), and death (9.1% versus 7.1%; hazard ratio, 1.22 [95% CI, 0.58-2.58]; P=0.60).

This study provides compelling evidence that, even over prolonged observed periods, the addition of stenting to MT does not confer additional benefits to MT alone in patients with symptomatic severe intracranial artery stenosis. These results underscore the importance of MT as the cornerstone of long-term stroke prevention in this patient population.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01763320.

Obstructive Sleep Apnea (OSA) affects up to 70 % of post-stroke patients, complicating recovery and rehabilitation. This study aimed to evaluate the utility of the Odds Ratio Product (ORP), a continuous EEG-derived metric of sleep depth, in predicting conventional respiratory and arousal measures in stroke patients. We hypothesized that ORP metrics will predict conventional measures in patients with a history of stroke or Transient ischemic attack (TIA).

A retrospective analysis was conducted on 113 stroke/TIA individuals who underwent in-laboratory polysomnography (PSG). ORP metrics, including ORPnrem, ORPrem, ORP9, and Wake Intrusion Indices (WIIs), were analyzed using multivariate linear regression models. Models were stratified by OSA status. Standardized coefficients were used to assess associations with the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and arousal indices.

ORP metrics demonstrated statistically significant associations with conventional respiratory and arousal measures, with varying predictive strength across models. Specifically, ORPnrem and WIIs exhibited strong predictive effects across all models. ORP9 significantly predicted respiratory and arousal measures in the overall sample and the OSA subgroup, but its predictive value diminished in the non-OSA subgroup. ORPrem was statistically significantly associated with respiratory and arousal measures; however, its associations with arousal measures were weaker in participants with OSA compared to those without OSA.

ORP metrics have the potential to refine OSA diagnoses and improve therapeutic strategies in post-stroke/TIA populations. Their integration into sleep assessments could facilitate early intervention and potentially optimize stroke recovery outcomes, addressing gaps in current evaluation methods.

Hypertension is the most important modifiable risk factor for secondary stroke prevention; however, blood pressure (BP) remains uncontrolled for at least 50 % of stroke survivors following an incident stroke. Accurate in-clinic assessment of BP is important for appropriate medication titration. We evaluated misclassification of clinic BP control in a racially diverse stroke clinic population using two BP measurement methods.

We followed ischemic stroke, intracerebral hemorrhage, and transient ischemic attack patients after hospital discharge in a comprehensive stroke clinic. Casual BP was obtained using a standard office automated machine, attended by a medical assistant. BP was also measured with an unattended automated office BP (AOBP) machine and was categorized as concordant control, concordant uncontrolled, pseudoresistant hypertension, and masked uncontrolled. Multinomial logistic regression was used to assess relationships between demographic/clinical variables and misclassification categories, controlling for confounders. Among 216 patients, mean age was 59.5 (SD 12.9); 57 % were male, and by race, 50.5 % were non-Hispanic Black/ African American, 21.3 % Hispanic, and 25.5 % non-Hispanic White. BP control was misclassified by casual office BP for 27.3 % of patients. Race was significantly associated with misclassification in regression analysis. The odds ratio for masked uncontrolled compared to concordant controlled BP was 12.2 (95 % CI 1.5, 99.2) for non-Hispanic Black/ African American and 9.9 (95 % CI 1.1, 87.4) for Hispanic compared to non-Hispanic White patients.

These findings highlight barriers to assessment of BP control using standard office measurements among stroke survivors. Accurate BP measurement tools, including AOBP, home BP, and ambulatory BP monitoring, should be utilized to optimize BP treatment after stroke.

Although acute minor stroke often presents with mild symptoms, such as unilateral limb weakness, mild aphasia, dizziness, or mild cognitive impairment, untreated outcomes could be poor, and optimal treatment methods are still debated.

We aimed to identify the optimum treatment for minor strokes with a network meta-analysis.

Studies from Embase, Ovid, and Cochrane Library were considered. Randomized controlled trials and prospective cohort studies on ischemic stroke with a National Institutes of Health Stroke Scale score no more than 5, explicit intravenous thrombolysis, or antiplatelet therapy were included. Efficacy outcome was measured by 3-month modified Rankin scale (mRS), with primary outcome defined as mRS score of 0 to 1 and secondary outcome defined as mRS score of 0 to 2. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 3 months.

Nine studies encompassing 10 665 patients were meta-analyzed. Aspirin plus clopidogrel (n = 4283) was more strongly associated with primary outcome than aspirin (n = 2128; odds ratio [OR], 1.26; 95% CI, 1.04∼1.54) and recombinant tissue plasminogen activator (rt-PA; n = 1840; OR, 1.23; 95% CI, 1.00∼1.50). Aspirin plus clopidogrel (n = 3933) also had a lower sICH risk than rt-PA (n = 2538; OR, 0.11; 95% CI, 0.04∼0.30) and tenecteplase (n = 194; OR, 0.15; 95% CI, 0.03∼0.68), as well as a lower mortality than aspirin alone (n = 830; OR, 0.27; 95% CI, 0.10∼0.71). Patients treated with aspirin (n = 815) also had a lower sICH risk than rt-PA (n = 2538; OR, 0.20; 95% CI, 0.04∼0.95).

Dual antiplatelet therapy based on aspirin and clopidogrel offers balanced efficacy and safety, positioning it as a potentially optimal treatment for minor stroke. rt-PA showed comparable efficacy, while its associated risks were more pronounced.

Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease (sICAD), an elevated rate of restenosis remains an important issue for the conventional bare-metal stent (BMS). Recent evidence from observational studies suggests that applying drug-coated balloons (DCB) in sICAD may decrease restenosis occurrence. Additional large randomised studies are warranted to provide firmer evidence and to determine which patients would benefit most from DCB.

To design a randomised trial to examine DCB angioplasty (Taijieweiye intracranial paclitaxel-coated balloon catheter) versus BMS stenting (Wingspan intracranial stent system) in patients with sICAD.

This is a multicentre, prospective, randomised, open-label, blinded end-point study to assess whether DCB angioplasty reduces the risk of restenosis compared with BMS stenting in sICAD patients with high-grade stenosis (≥70%-99%). Our goal is to randomly assign 198 eligible individuals at a 1:1 ratio to undergo DCB angioplasty (intervention group) or BMS stenting (control group).

The primary efficacy outcome is restenosis at 6 months post treatment, that is, >50% stenosis in or within 5 mm of the treated segment and >20% absolute luminal loss. The primary safety outcome is stroke or death within 30 days post treatment.

The DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease trial aims to produce strong evidence on the efficacy and safety of DCB angioplasty as a promising therapeutic option for sICAD cases with high-grade stenosis.

This article presents the case of a male patient who sustained blunt myocardial injury following a traffic accident. A series of diagnostic imaging procedures were conducted on the patient, including electrocardiography, echocardiography, computed tomography angiography, and cardiac magnetic resonance imaging, which demonstrated edema in a portion of the myocardium and the formation of a ventricular aneurysm with thrombus in the left ventricular apex. After 6 months and 1 year, echocardiography demonstrated no detection of thrombus, but the apical left ventricular aneurysm was not significantly different from the anterior film, leading to a final clinical diagnosis of blunt cardiac injury (BCI).

Atrial fibrillation is a frequent cardiac arrhythmia and is associated with an increased risk of cardioembolic stroke. The left atrial appendage is a finger-like extension originating from the main body of the left atrium and the main location of thrombus formation in patients with atrial fibrillation. Surgical or percutaneous left atrial appendage occlusion (LAAO) aims at preventing clot formation in the left atrial appendage. Here, we describe available surgical and percutaneous approaches to achieve LAAO and discuss the available evidence for LAAO in patients with atrial fibrillation. We discuss the role of LAAO and its role in stroke prevention in frequent scenarios in cerebrovascular medicine: LAAO as a potential alternative to oral anticoagulation in patients with a history of intracranial hemorrhage, and LAAO as a promising add-on therapy to direct oral anticoagulant therapy in patients with breakthrough stroke despite anticoagulation. Finally, we provide an outlook on currently ongoing trials that will provide further evidence in the next years.

Late presenters with ST-elevation myocardial infarction pose a considerable challenge in the field of cardiovascular medicine. These individuals, who delay seeking medical attention after the onset of ST-elevation myocardial infarction symptoms, often face substantial difficulties in treatment. The coronavirus disease 2019 pandemic led to a significant increase in the number of late presenters. By increasing the frequency of complications such as thromboembolic events in the course of left ventricular thrombus, the pandemic necessitated the refinement of existing management strategies.

In this paper, we present two White male patients of Central European (Polish) descent (50 and 64 years old) who, although reported to have had acute ST-elevation myocardial infarction, turned out to be ST-elevation myocardial infarction latecomers. In both cases, we were dealing with the presence of left ventricular thrombus and complications related to the central nervous system. On the basis of these two patients, we discuss the role of revascularization in latecomer ST-elevation myocardial infarction patients. We present the position of direct oral anticoagulants in the left ventricular thrombus treatment and show that, in limited cases of a huge thrombus, cardiac surgery is a treatment of choice.

As left ventricular thrombus is still relatively common in ST-elevation myocardial infarction latecomers, we present the current state of knowledge on this topic, emphasizing the need for further research in this area.

We summarize and review the clinical and genetic characteristics of four adolescents with Hyperhomocysteinemia. Four cases of adolescent-onset Hyperhomocysteinemia diagnosed at Qingdao University Affiliated Hospital were selected as research subjects. Clinical data, whole exome sequencing and Sanger sequencing information of the patients were collected, and gene variation analysis and literature review were conducted. The pathogenic variants carried by the four patients were MAT1A c.895C>T(p.Arg299Cys), CBS c.374G>A(p.Arg125Glu), CBS c.785C>T(p.Thr262Met), and MMACHC c.482G>A(p.Arg161Glu) and c.658_660del(p.Lys220del) along with other site mutations. There were three cases with epileptic seizures as initial manifestation, three cases with varying degrees of intellectual disability, two cases with lens dislocation, one case with cervical artery occlusion leading to cerebral infarction, and one case with extensive white matter lesions. Four patients showed relief of symptoms after treatment with vitamin B and necessary antiepileptic drugs. We combined the cases and relevant literature to retrospectively analyze the characteristics and treatment related to the disease. The onset of Hyperhomocysteinemia in adolescents is early, and the clinical manifestations are broad and atypical. At the same time, it has a significant impact on the growth and development of adolescents and can affect future life for a long time. Early detection and diagnosis have an important impact on prognosis.

This study aimed to explore the expression characteristics of miRNAs in cardiovascular diseases (CVD) and depression within a plateau environment, to better understand their potential role in Plateau Psycho-CVD. A prospective study design was employed to analyze circulating small RNAs from 20 subjects using high-throughput sequencing technology. Participants were divided into four groups (C, PPC, PP, PC) for comparative analysis. Differentially expressed miRNAs were selected for further functional enrichment analysis. The findings revealed that hsa-miR-1976 and hsa-miR-4685-3p were significantly upregulated in patients with Plateau Psycho-CVD and mental health issues. These miRNAs were closely associated with key pathways relevant to cardiovascular and mental health, including the PI3K-Akt and neurotrophin signaling pathways. Additionally, the downregulated miRNAs in the PPC group were linked to increased expression of AKT1 and STAT3, genes associated with bipolar disorder and inflammatory pathways, indicating a potential impact on neural function. This study identifies hsa-miR-1976 and hsa-miR-4685-3p as novel biomarkers for plateau stress dual heart disease, with AKT1 and STAT3 emerging as potential therapeutic targets. These insights pave the way for further research and clinical applications in related fields.

Stroke remains the fifth leading cause of mortality in the United States, with significant geographical and racial disparities in outcomes. Understanding trends in location of death for ischemic stroke patients is crucial for improving end-of-life care and addressing healthcare inequities.

This retrospective study used Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data to examine ischemic stroke mortality, stratified by urbanization level and race. Age-adjusted mortality rates were calculated using the 2000 US standard population. Age-adjusted ischemic stroke mortality rates increased across all urbanization levels since 2009, with the most pronounced rises in non-metropolitan areas. An increasing proportion of deaths occurred at home, shifting from inpatient medical facilities. Significant disparities were observed in access to specialized end-of-life stroke care, particularly for racial minorities and rural residents. Black/African American individuals and those in rural settings were more likely to die in less specialized environments due to healthcare access barriers.

The findings highlight a critical shift in the patterns of mortality and end-of-life care preferences among ischemic stroke patients over the past two decades. These findings highlight significant shifts in the patterns of mortality and location of death among ischemic stroke patients over the past two decades, with notable differences across urbanization levels and racial groups. The increasing proportion of home deaths and persistent disparities in location of death suggest a need for further research to understand the underlying factors driving these trends and their implications for end-of-life care quality and access.

This study aimed to investigate the shared molecular mechanisms underlying cardioembolic stroke (CS) and ischemic stroke (IS) using integrated bioinformatics analysis.

Microarray datasets for the CS (GSE58294, blood samples from CS and controls) and IS (GSE16561, blood from IS and controls; GSE22255, peripheral blood mononuclear cells from IS and matched controls) were acquired from the Gene Expression Omnibus database. Differential expression analysis and weighted gene co-expression network analysis were utilized to identify shared genes between the two diseases. Protein-protein interaction (PPI) network and topology analyses were conducted to identify the core shared genes. Three machine learning algorithms were employed to detect biomarkers from the core shared genes, and the diagnostic value of the hub genes was evaluated by establishing a predictive nomogram. Immune infiltration was evaluated using single-sample gene set enrichment analysis (ssGSEA), and pathways were analyzed with gene set enrichment analysis.

There were 125 shared up-regulated genes and 2 shared down-regulated between CS and IS, which were mainly involved in immune inflammatory response-related biological functions. The Maximum Clique Centrality algorithm identified 25 core shared genes in the PPI network constructed using the shared genes. ABCA1, CLEC4E, and IRS2 were identified as biomarkers for both CS and IS and performed well in predicting the onset risk of CS and IS. All three biomarkers were highly expressed in both CS and IS compared to their corresponding controls. These biomarkers significantly correlated with neutrophil infiltration and autophagy activation in both CS and IS. Particularly, all three biomarkers were associated with the activation of neutrophil extracellular trap formation, but only in the IS.

ABCA1, CLEC4E, and IRS2 were identified as potential key biomarkers and therapeutic targets for CS and IS. Autophagy and neutrophil infiltration may represent the common mechanisms linking these two diseases.

Cryptogenic stroke (CS) in young adults may be associated with the presence of a patent foramen ovale (PFO). This case report presents a woman in her 40s admitted with sudden left hemiplegia. Imaging confirmed an ischaemic stroke in the right middle cerebral artery territory and occlusion of the right internal carotid artery. Further investigations identified a large PFO associated with an atrial septal aneurysm. An in-depth assessment revealed a distal deep vein thrombosis (DVT). Initial anticoagulation therapy was interrupted due to severe metrorrhagia, necessitating the placement of an inferior vena cava (IVC) filter. Subsequent extensive thrombosis of the IVC led to initiation of low molecular weight heparin followed by long-term direct oral anticoagulants. This case highlights the complexity of managing CS with PFO, emphasising the importance of thorough aetiological evaluation to distinguish pathogenic from incidental PFO, and the need for a personalised and multidisciplinary therapeutic strategy to balance thromboembolic and haemorrhagic risks effectively.

Non-valvular atrial fibrillation (NVAF) significantly increases ischemic stroke and systemic embolism (SE) risks. Despite the proven efficacy of oral anticoagulants (OAC) in reducing these risks, their underutilization highlights a gap in clinical practice. This study examined OAC utilization patterns within the first year after NVAF diagnosis in patients without prior OAC use and the association between the timing of OAC initiation and the risk of all-cause and stroke/SE-specific hospitalizations.

A retrospective cohort study was conducted using data from the Premier Healthcare Database and linked claims from 1/1/2017-3/31/2021. Patients newly diagnosed with NVAF, without prior OAC use, were included.

Of 23,148 adults with newly diagnosed NVAF, 11,059 (47.8%) initiated OAC within one year. OAC users predominantly had cardiovascular disease and risk factors, whereas non-OAC users had higher rates of malignancy and dementia. Early OAC initiation (74.9% during the index visit) was linked to lower hospitalization risks compared to those initiating later (29.2% vs. 45.9% for all-cause, p-value < 0.001 and 1.3% vs. 2.6% for stroke/SE-specific, p-value < 0.001). Adjusted odds ratios for all-cause and stroke/SE hospitalization favored early initiation were 0.35 (95% CI: 0.32-0.39) and 0.34 (95% CI: 0.24-0.47), respectively.

This study highlights OAC underutilization in NVAF patients and suggests early initiation may lower hospitalization rates. The findings emphasize the need for further research into real-world compliance with OAC guidelines and call for further research to confirm the benefits of early initiation. Personalized management strategies that consider individual patient profiles are recommended.

Ischemic stroke is one of the most common neurological disorders. Oxidative stress, inflammation, and the reduction of Brain-Derived Neurotrophic Factor (BDNF) are implicated in cell death during ischemic stroke. Several studies suggest that Coenzyme Q10 (CoQ10) has antioxidant, anti-inflammatory, neuroprotective properties and can increase BDNF levels. This study investigated the effects of oral CoQ10 supplementation on oxidative stress biomarkers Total Antioxidant Capacity (TAC), Superoxide Dismutase (SOD), Malondialdehyde (MDA), Total Thiol Groups (TTG) - as well as serum levels of Interleukin-6 (IL-6) and BDNF in ischemic stroke patients.

Fifty patients hospitalized for acute ischemic stroke were randomly divided into two groups: placebo (n = 25) and CoQ10 (600 mg/day) supplementation (n = 25). The intervention began 24 hours after stroke onset and continued for 30 days.

Significant reductions in serum MDA and IL-6 levels, alongside increased SOD and BDNF levels, were observed in the CoQ10 group. No significant differences were found in TAC or TTG levels between the groups.

A 30-day regimen of CoQ10 (600 mg/day) resulted in reduced oxidative stress and inflammation, alongside increased BDNF, suggesting potential neuroprotective benefits for post-stroke rehabilitation. CoQ10 May be considered a therapeutic option for enhancing neuroprotection and rehabilitation in stroke patients.

Left ventricular thrombus (LVT) is a serious complication of both ischemic and non-ischemic cardiomyopathies, with a high risk of morbidity and mortality due to systemic embolism. We present the case of a 73-year-old man with a history of myocardial infarction who subsequently developed an apical thrombus. Seven years after the initial event, this thrombus caused a splenic infarction complicated by an abscessed hematoma. This case underlines the critical role of advanced medical imaging in the diagnosis of LVT and highlights the emerging therapeutic potential of direct oral anticoagulants. It also highlights the challenges of diagnosing and managing LVT and the importance of reviewing the latest evidence to refine and optimize therapeutic strategies.

Uncontrolled hypertension is a risk factor of heart attack, stroke, dementia, and other conditions. In outpatients with hypertension, blood pressure (BP) may be controlled at only 30%-50% of visits depending on the population studied. Hospital admission is ideal for achieving guideline-directed BP targets, given the resource-intensive environment. We evaluated the relationship between BP control performance during neurocritical care and hospital admission and rates of uncontrolled hypertension at discharge and over the subsequent 2 years.

This two-center retrospective cohort included adults admitted with any neurologic illness to an neurosciences intensive care unit (NeuroICU) from April 2016 to December 2022, transferred to a neurology general care unit, and then discharged to home or rehabilitation. Hypertension was defined as systolic BP (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg. The primary outcomes were rates of hypertension at hospital discharge through 2 years after discharge. Multivariable logistic and generalized additive models were developed to assess the association between NeuroICU BP control and persistent hypertension, adjusting for baseline covariates, NeuroICU length of stay, performance measures quantifying BP goals, and antihypertensive medication intensity on transferring from the NeuroICU.

Of 13,711 admissions, 10,836 met inclusion criteria and 3,075 (28.3%) were hypertensive at hospital discharge. Each 10-mm Hg SBP increase at NeuroICU transfer was associated with 1.60-fold increased odds of uncontrolled hypertension at discharge (95% CI 1.56-1.64). In multivariate analysis controlling for covariates, hypertension at transfer remained independently associated with hypertension at discharge (adjusted odds ratio 3.85, 95% CI 3.47-4.28). The association persisted through 24 months after discharge, even among those without a history of hypertension, among those admitted to the hospital normotensive, or when adjusting for antihypertensive therapy intensity. The association persisted across a range of principal diagnoses and across institutions, although practice-pattern variation yielded significant differences between institutions.

Hypertension at NeuroICU transfer was independently associated with uncontrolled hypertension through hospital discharge and the subsequent 2 years, independent of patient diagnosis, medical history, institution, and treatment intensity. The initial hospitalization represents an opportunity to achieve and maintain guideline-directed BP targets to reduce secondary cerebrovascular events, dementia, and cardiovascular complications. Further studies are needed to determine whether improving rates of BP control at NeuroICU transfer and discharge leads to long-term improvements in BP control.

Stroke survivors present limited levels of physical activity (PA) and participation in everyday activities although the specific interaction between PA and participation in these individuals is still uncertain. This study aimed to analyse the relationship between PA and participation in everyday activities among Spanish mild stroke survivors.

A total of 130 mild stroke survivors (61.3 ± 12.4 years, 35% female) with preserved walking ability and without cognitive and communication impairments participated in this cross-sectional study involving several rehabilitation centres from Spain. Self-reported levels of PA were reported by the International Physical Activity Questionnaire - short form (IPAQ-SF). Objective PA measures were monitored with the wristband Fitbit Inspire 2, recording the average steps/day and kilocalories/day. Participation and activity satisfaction levels were measured with the Satisfaction with Daily Occupations-Occupational Balance (SDO-OB) and participation retention through Activity Card Sort (ACS).

ACS total score showed a weak correlation with self-reported PA (rho = 0.324) and moderate correlations with kilocalories/day and average steps/day (rho ≥ 0.581), while stronger correlations were found for the ACS subdomain of instrumental activities (rho ≥ 0.640) compared to the subdomains of leisure activities and social participation (rho ≤ 0.454). SDO-OB participation showed moderate correlations with kilocalories/day, and average steps/day (rho ≥ 0.647), and a weak correlation with self-reported PA (rho = 0.303). Weaker correlations were found for SDO-OB satisfaction with objective PA measures (rho = 0.407) and self-reported PA (rho = 0.254). Relationships between variables were explored by calculating Spearman correlation coefficients.

The objective and self-reported measures of PA in mild stroke survivors have a bilateral relationship with their current participation levels and the retained instrumental activities of daily living. However, the weaker correlations with leisure and social participation may suggest that promoting PA alone without integrating it into daily activities relevant to the stroke survivor may be insufficient to achieve comprehensive goals during rehabilitation programs.

Introduction Atrial fibrillation (AF) is a common type of heart rhythm disorder that considerably elevates the risk of stroke. Identifying risk factors and their association with stroke in AF patients is essential for effective prevention strategies. Methodology This cross-sectional study was conducted at the Cardiology Department of Khyber Teaching Hospital, Peshawar, Pakistan, from October 2024 to March 2025. A total of 345 patients with diagnosed AF were enrolled using a non-probability purposive sampling technique. The CHA₂DS₂-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, Prior Stroke or transient ischemic attack (TIA) or thromboembolism, Vasculardisease, Age 65-74 years, Sex category) score was used to assess stroke risk, and associations with various risk factors were analyzed using the Chi-square test. Results Stroke or transient ischemic attack (TIA) was reported in 13% of patients. Significant associations were found between stroke risk and smoking, obesity, chronic kidney disease, thyroid disease, and physical inactivity. No significant correlation was found with alcohol consumption, likely due to cultural and religious practices. Conclusion This study highlights a notable stroke prevalence among AF patients and underscores the importance of managing modifiable risk factors to reduce stroke risk.

Although imaging tools are crucial in identifying features of atherosclerotic plaque, there remains a lack of consensus on the use of serological markers for assessing high-risk plaques.

Patients diagnosed with CAS who met the criteria for CEA were categorized as the operation group, while those without CAS were designated as the control group. Multi-modal imaging was conducted pre- and post-CEA to evaluate plaque features, such as the volume of calcification and LRNC, intra-plaque hemorrhage, and the degree of carotid stenosis. Serum chemokine levels were measured in both groups before CEA and on the 7th day post-surgery. Morphological features of carotid artery specimens were assessed using H&E and IHC (CD68 and α-SMA) staining to evaluate plaque stability.

No significant differences in the degree of CAS between the operation and control groups. Among the operation group, 26 out of 52 patients were identified as vulnerable plaques. The volume of LRNC was significantly higher in vulnerable plaque, whereas the volume of calcification was significantly lower in vulnerable plaque compared to stable plaque confirmed by multi-modal imaging. Vulnerable plaque exhibited a thin fibrous cap covered an LRNC, intra-plaque hemorrhage, and macrophage infiltration. Stable plaque were characterized by small lipid cores covered by a thick fibrous cap, with minimal macrophage infiltration. Chemokine levels were significantly elevated in CAS patients compared to controls, and decreased significantly on the 7th day post-CEA. In patients with vulnerable plaque, lower levels of CX3CL1, CXCL12, CCL19, and CCL21, but higher levels of CCL2 and CCL5, were observed compared to patients with stable plaque. Correlation analysis further indicated that CX3CL1 and CXCL12 levels were positively associated with calcification volume. While CCL2 and CCL5 levels were positively associated, and CCL19 and CCL21 negatively associated, with LRNC volume. Multivariate analysis suggested that CXCL12 was an independent protective factor and LRNC volume as an independent risk factor for plaque vulnerability. The combination with multi-modal imaging and serological markers enhanced both the sensitivity (87.31%) and specificity (92.31%) in predicting plaque stability, with an AUC of 0.9001.

Combining multi-modal imaging with serological markers provides a more comprehensive evaluation of atherosclerotic plaque features.

Thrombotic events, such as strokes and deep vein thrombosis, remain a significant global health burden, with traditional diagnostic methods often failing to capture the complex, patient-specific nuances of thrombosis risk. This Perspective explores the revolutionary potential of microengineered vessel-on-chip platforms in thrombosis research and personalized medicine. We discuss the evolution from basic microfluidic channels to advanced 3D-printed, patient-specific models that accurately replicate complex vascular geometries, incorporating all elements of Virchow's triad. Integrating these platforms with cutting-edge sensing technologies, including wearable ultrasonic devices and electrochemical biosensors, enables real-time monitoring of thrombosis-related parameters. Crucially, we highlight the transformative role of artificial intelligence and digital twin technology in leveraging vast patient-specific data collected from these models. This integration allows for the development of predictive algorithms and personalized digital twins, offering unprecedented thrombosis risk assessment, treatment optimization, and drug screening capabilities. The clinical relevance and validation of these models are examined, showcasing their potential to predict thrombotic events and guide personalized treatment strategies. While challenges in scalability, standardization, and regulatory approval persist, the convergence of vessel-on-chip platforms, advanced sensing, and AI-driven digital twins promises to revolutionize thrombosis management. This approach paves the way for a new era of precision cardiovascular care, offering noninvasive, predictive, and personalized strategies for thrombosis prevention and treatment, ultimately improving patient outcomes and reducing the global burden of cardiovascular diseases.

Intracranial stenting with the Neuroform Atlas Stent is an emerging option for patients with symptomatic intracranial atherosclerotic stenosis (sICAS) who do not respond to intensive medical treatment. However, the efficacy, safety, and risk factors associated with postoperative stroke recurrence remain controversial.

A total of 326 consecutive patients with sICAS treated with intracranial stenting using the Neuroform Atlas Stent were retrospectively analyzed to evaluate the efficacy and safety of the procedure. Patients were randomly assigned to a training set and a validation set in a 7:3 ratio. Significant variables in the univariate logistic analyses were included in the final multivariate logistic regression analyses in the training set. Subsequently, we developed a predictive nomogram for sICAS treated with a Neuroform Atlas Stent to predict the likelihood of stroke recurrence at 6 months.

The overall mean stenosis rate of the target artery was 88.85% ± 6.53% before the stenting (T0), 47.58% ± 9.94% at the end of the procedure (T1), and 40.21% ± 7.77% at the 6-month follow-up (T2). The stenosis rate was statistically significant between T0 and T1 (p < 0.01) and between T0 and T2 (p < 0.01). At 6 months postoperatively, 36 patients had a stroke recurrence linked to the target artery. Diabetes, acute ischemic stroke (AIS), plaque burden on vessel wall MRI, enhancement ratio on vessel wall MRI, and stenosis (T1) were independent predictors of stroke recurrence. A predictive nomogram was developed, showing strong predictive capability with the area under the curve of 0.933 for the training set and 0.949 for the validation set.

Intracranial stenting with the Neuroform Atlas Stent is a potentially safe and effective treatment for sICAS. Risk factors for recurrent stroke post-procedure include diabetes, current smoker, current drinker, AIS, plaque burden, enhancement ratio, and stenosis (T1).

Background: Stroke is the third most common cause of death in Lebanon. With many preventive strategies identified, stroke remains a national burden, especially in developing countries, where risk factors and epidemiological states are understudied. This study aims to investigate the association of sociodemographic factors and health-related risk factors with age at first ischemic stroke and its recurrence in the Lebanese population. Methods: A retrospective study including 214 ischemic stroke cases was carried out. Sociodemographic characteristics and health-related risk factors were assessed, in addition to disability levels (modified Rankin score (mRS)), age at first ischemic stroke incidence, and number of ischemic strokes. Data were analyzed using SPSS software version 25, including descriptive, bivariate, and multivariate analyses. Results: This study showed that stressful factors were significantly associated with a younger age at first ischemic stroke, such as having no partner (p < 0.001), having employment (p < 0.001), and having migraines (p < 0.001). However, metabolic risk factors were associated with an older age of ischemic stroke, such as hypertension (p < 0.001) and hyperlipidemia (p < 0.001). Moreover, having a partner (OR: 2.136), having a family history of stroke (OR: 2.873), having hyperlipidemia (OR: 3.71), and having atrial fibrillation (OR: 2.521) were associated with ischemic stroke recurrence. Conclusions: Many modifiable factors are associated with age at first ischemic stroke and its recurrence. This study sheds light on the necessity of increasing knowledge and awareness of well-known risk factors in the Lebanese population. These results suggest implementing targeted preventive strategies and highlight the importance of complying with early detection and follow-up measures.

Care following transient ischaemic attack (TIA) and minor stroke is variable and often leaves patients feeling abandoned and uncertain. We developed a theoretically-informed, multifaceted intervention which comprised nurse-led, structured follow-up at 4 weeks after TIA/minor stroke to identify and address patient needs. This study evaluated the feasibility and acceptability of both the intervention and procedures to inform a future randomised controlled trial.

We conducted a multicentre, randomised feasibility study with mixed-methods process evaluation (ISRCTN registry reference: ISRCTN39864003). We collected patient reported outcome measures (PROMs) at 1, 12 and 24 weeks and clinical data at baseline and 24 weeks. The process evaluation comprised qualitative interviews with a sub-sample, feedback questionnaires, and observations of intervention delivery.

We recruited 54 patients over 12 months, achieving 90% of the target sample size (n = 60). PROMs return rates were 94.4% (51/54), 85.2% (46/54) and 71.1% (27/38) at 1, 12, and 24-weeks, respectively. Intervention fidelity was high and the intervention largely aligned with the theoretical underpinnings. The process evaluation illustrated how patients benefitted from the intervention through support they would not have received through usual care. This included direct referral or signposting to support services, information and education, actionable advice, and reassurance about and normalisation of recovery. The trial design was feasible and acceptable for both patients and clinicians.

Nurse-led, structured follow-up after TIA and minor stroke is feasible, acceptable and valued by patients and clinicians. Our intervention can identify and help address unmet needs. A definitive randomised trial to evaluate intervention effectiveness and cost-effectiveness is feasible and acceptable.

Patent foramen ovale (PFO) is among the most common congenital heart defects. Over the last two decades, the number of research publications on PFO has increased. This study aims to identify and describe the current state, hotspots, and emerging trends in PFO research over the previous 20 years using bibliometric analysis and visual mapping.

The Web of Science Core Collection was searched for all publications on PFO research, which were then included in the study. CtieSpace, VOSviewer, and Excel software were used to visualize general information, publication output, countries/regions, authors, journals, influential papers, and keyword trends in this field.

This comprehensive analysis included 14,495 publications from 6,190 institutions across 115 countries. The United States dominated with the highest number of publications (2,407) and international collaborations. Mas JL made significant contributions to the PFO field, while Meier B emerged as a leading author, publishing 81 articles during the past 20 years. There were strong international collaborations among countries, institutions, and authors. Stroke, Circulation, and the New England Journal of Medicine were the most cited journals, with 13,124, 10,136, and 9,867 citations, respectively.

This bibliometric study revealed that recent research frontiers primarily focused on the diagnosis and clinical management of patients with PFO. Future studies are expected to delve deeper into the biological mechanisms by which PFO contributes to stroke, the efficacy and limitations of PFO closure techniques, and the exploration of genetic variations associated with PFO and their roles in disease susceptibility.

The C1q/Tumor Necrosis Factor-related Protein 9 (CTRP9) is a relatively novel adipokine having showed protection on cerebrovascular system. However, its clinical values have not been well established. This work is to evaluate CTRP9 as predictors of onset risk and outcome of ischemic stroke.

One thousand one hundred and twenty-three patients undergoing first-ever ischemic stroke and 835 controls were enrolled. Serum CTRP9 was determined within 24 h after the onset. One thousand and twenty-six patients were successfully followed up for all-cause and cardiovascular deaths. Stepwise regression was conducted to screen the independent factors of stroke onset in the whole sample and mortality in the patient subgroup. Survival curves were plotted to evaluate the effect of baseline serum CTRP9 on 3-year all-cause and cardiovascular mortalities of stroke patients.

At baseline, prevalence of first-ever onset of ischemic stroke in high CTRP9 group was significantly lower than that in low CTRP9 group (p < 0.05) in non-hyperlipidemic subjects. Accumulative all-cause and cardiovascular mortality of patients with high baseline CTRP9 was significantly lower for the first year post stroke onset (p < 0.05). Baseline low CTRP9 was one of the independent risk factors of 3-year all-cause mortality (p < 0.05) of ischemic stroke patients.

High serum CTRP9 exerted protection against first-ever onset of ischemic stroke in non-hyperlipidemic subjects, and also protected general stroke patients against all-cause and cardiovascular mortality at least 1 year post stroke onset. Our findings in this study may pinpoint both the predictive and prognostic values of CTRP9 as a promising biomarker.

This study aims to evaluate and compare the clinical differences in intravenous thrombolytic therapy among patients with cerebral infarction transported to the hospital by private cars versus ambulances in Jiaxing, a non-supersized city in China. It also sought to examine the impact of different transportation methods on emergency department arrival times, delays in initiating thrombolytic therapy and final clinical prognosis. The findings aim to provide a basis for optimising emergency treatment protocols and improving outcomes for patients with cerebral infarction.

Data on age, gender, height, weight, body mass index, season, time of day (day vs night), modified Rankin Scale scores, door-to-needle time (DNT) and onset-to-needle time (ONT) were retrospectively collected from 808 patients admitted to the emergency department of the Affiliated Hospital of Jiaxing University for intravenous thrombolysis between January 2019 and September 2022. The data were analysed and compared.

A retrospective cohort study conducted in Jiaxing, China.

The primary outcomes were DNT and ONT.

Among the 808 eligible patients, 279 (34.53%) were transported by ambulance, and 529 (65.47%) arrived by private car. Patients in the private car group were younger on average than those in the ambulance group (aged 64.70 vs 68.41 years). Although ambulance transport resulted in shorter prehospital transportation times (113.89 vs 127.38 min), patients arriving by private car had shorter thrombolytic therapy initiation times (39.90 vs 36.30 min). At admission, the National Institutes of Health Stroke Scale scores were higher in the ambulance group (4 vs 2), indicating more severe conditions and a greater proportion of patients requiring bridging thrombectomy after thrombolysis (7.53% vs 3.02%).

In non-supersized cities, private car transportation for acute patients with cerebral infarction may lead to shorter DNT and ONT compared with those in ambulance transport. However, patients transported by ambulance tended to have more severe conditions, highlighting the importance of tailored emergency response strategies.

Atherosclerotic plaques in the internal carotid artery are responsible for more than 15% of ischemic strokes. Carotid 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) detects plaque inflammation. Plasma ICAM-1 and LRP1 concentrations have been associated with inflammation in ipsilateral carotid plaque. The aim of the present study was to test the association between the soluble (s) form of these biomarkers and contralateral carotid plaques.

Prospective study conducted in 53 patients with a recent ischemic stroke and at least one atherosclerotic plaque in both carotid arteries. All of the patients underwent an early carotid 18F-FDG PET, and a blood sample was obtained at 7±1 days. Several plasma inflammatory markers were evaluated by Multiplex and sLRP1 levels were measured by commercial ELISA. Bivariate and multivariable linear regression was used to assess the association between inflammatory markers and the clinical variables, including contralateral maximum standardized uptake value (SUVmax) and mean SUVmax (mean of contralateral and ipsilateral SUVmax) of 18F-FDG uptake. Hazard ratio (HR) was estimated with Cox models adjusted for potential confounding factors to evaluate recurrence.

Multivariable linear regression analysis showed an independent association between sICAM-1 and sVCAM-1 and mean SUVmax (CI=-0.064-0.325, p=0.004; CI=0.079-0.554, p=0.010). In addition, in bivariate regression analysis, sICAM-1 was associated with contralateral SUVmax (CI=0.049-0.382, p=0.012). Cox regression showed that mean SUVmax was associated with stroke recurrence (HR=5.604, p=0.044).

sICAM-1 was independently associated with mean carotid plaque inflammation and with inflammation in contralateral plaque. sICAM-1 could be an indicator of plaque inflammation even in asymptomatic plaques.

Sleep-disordered breathing is highly prevalent in stroke patients. It is associated with recurrence of stroke and poor neurologic outcomes. Polysomnography (PSG), the gold standard for diagnosing sleep apnea, may not be feasible for routine evaluation in stroke patients. There is a need for reliable screening tools to assess the likelihood of sleep apnea in these patients. This study evaluated the efficacy of sleep questionnaires to predict the likelihood of sleep apnea against PSG-determined sleep apnea.

A hospital-based study on ischemic stroke patients used the content-validated Kannada version of Berlin Questionnaire, STOP-BANG questionnaire, and Epworth Sleepiness Scale (ESS). All patients underwent overnight PSG, scored by blinded investigators, to assess the diagnostic properties of the questionnaires for various apnea-hypopnea index cutoffs.

The study included 70 Kannada-speaking patients with a mean age of 50.9 years. The study revealed a high prevalence of sleep apnea (80%), with obstructive sleep apnea being the most common type (77.5%). The Berlin Questionnaire showed modest sensitivity (0.51) and specificity (0.60), while the STOP-BANG questionnaire demonstrated moderate sensitivity (0.64) and specificity (0.70). The mean ESS scores were 6.6 (standard deviation [SD] 5.9) for patients with sleep apnea and 4.3 (SD 3.1) for those without sleep apnea.

Sleep questionnaires lacked the necessary diagnostic properties to serve as standalone screening tools for sleep apnea in ischemic stroke patients. Future research should aim to develop or improve screening instruments specifically designed for stroke patients.

Left ventricular thrombosis (LVT) is one of the most feared complications of both ischemic and non-ischemic cardiopathy, and despite its incidence having decreased over the years (mostly due to novel reperfusion therapies in acute coronary syndromes), it is still not negligible. If transthoracic echocardiography, possibly with the adjunction of echo contrast, represents the cornerstone in LVT diagnosis, sometimes it is found to be nonconclusive and advanced cardiovascular imaging, namely cardiac magnetic resonance, needs to be performed to fully exclude intraventricular masses or to better characterize them. Vitamin K antagonists always represented the anticoagulant of choice for the treatment of LVT; however, the recent spread of direct oral anticoagulants (DOACs) pushed clinicians to adopt them also in this setting despite the absence of robust evidence in their favor. If the optimal duration of anticoagulation for the treatment of LVT in non-ischemic cardiopathy is still a matter of debate, an initial treatment of 3-6 months seems to be reasonable in the setting of ischemic cardiopathy, with possible extension according to the follow-up findings. High-quality randomized studies are strongly needed to evaluate the potential role of prophylactic anticoagulation in high-risk patients and provide conclusive evidence for the use of DOACs in LVT treatment.

The secondary prevention strategy for cardiovascular disease (CVD) does not include anti-inflammatory treatment, which may lead to long-term inflammation in some patients. The aim of this study was to assess the association between inflammatory risk based on the Glasgow Prognostic Score (GPS) and long-term mortality risk in patients with CVD. This study included 3833 patients (≥ 20 years old) with CVD in the National Health and Nutrition Survey from 1999 to 2010 in the United States. The mortality rate was determined by correlation with the National Death Index on December 31, 2019. The GPS consists of the serum C-reactive protein and the serum albumin. The primary outcome was all-cause death, which included cardiac death and non-cardiac death. Cox proportional hazards adjusted for demographic factors and traditional cardiovascular risk factors were used to test the impact of the GPS on mortality. The sensitivity analysis was conducted on subsets within the cohort of patients with CVD, including congestive heart failure, coronary artery disease, angina, heart attack, and stroke. Among 3833 CVD patients with a median follow-up of 9.6 years, 2431 (63.4%) all-cause deaths, 822 (21.4%) cardiac deaths, and 1609 (41.9%) non-cardiac deaths were recorded. After full model adjustment, compared with those of the GPS (0) group, the hazard ratios (HRs) of all-cause death for GPS (1) and GPS (2) were 1.66 (95% confidence interval (CI), 1.48-1.86) and 2.75 (95% CI 2.01-3.75), respectively (P for trend < 0.001). Compared with those of the GPS (0) group, the HRs of cardiac death for the GPS (1) and GPS (2) groups were 1.69 (95% CI 1.39-2.05) and 2.18 (95% CI 1.22-3.91), respectively (P for trend < 0.001). Compared with those of the GPS (0) group, the HRs of non-cardiac death for the GPS (1) and GPS (2) groups were 1.65 (95% CI 1.44-1.89) and 3.05 (95% CI 2.11-4.40), respectively (P for trend < 0.001). The results of the sensitivity analysis were similar to those of the overall cohort. In our analysis of the United States National Database, we discovered that the GPS, a measure of inflammatory risk, was significantly associated with an increased risk of mortality among patients with CVD. Specifically, we observed that patients with a higher GPS had significantly higher risks of all-cause, cardiac, and non-cardiac mortality compared to those with a lower score. These findings suggest that the GPS, comprising easily obtainable biomarkers, could serve as a valuable tool for risk stratification in CVD patients and may contribute to the improvement of patient outcomes.

This study aimed to characterize the imaging features and the outcomes of endovascular treatment (EVT) in patients with moderate hemodynamic stroke due to large vessel stenosis.

Data from patients with moderate hemodynamic stroke due to large vessel stenosis who underwent EVT at a single center between January 2021 and June 2024 were retrospectively analyzed. Hemodynamic stroke was defined as infarction in the watershed area on diffusion-weighted imaging and hypoperfusion on perfusion-weighted imaging. Demographics, National Institutes of Health Stroke Scale (NIHSS), imaging findings, cerebral circulation time (CCT; the interval from arterial origin visualization to completion of the intracranial arterial phase), and EVT details were collected. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0-2 at 90-day post-stroke.

Among 313 patients treated with EVT, 14 (4.4%) were diagnosed with moderate hemodynamic stroke secondary to large vessel stenosis. The mean age was 64.6±11.8 years, and the median NIHSS score was 9 (range, 6-12). Stenosis was predominantly located at the origin of the vertebral artery in 12 cases and at the origin of the internal carotid artery in 2 cases. All patients underwent stent angioplasty, leading to a significant reduction in median CCT from 3.0 s preoperatively to 1.43 s postoperatively (P=0.00001). At 90-day post-stroke, 78.6% of patients (11/14) achieved a functional independence.

Moderate hemodynamic stroke caused by large vessel stenosis was relatively rare but could be safely and effectively treated with EVT.

Heightened interest in left ventricular thrombus (LVT) stems from the consistent association of subsequent stroke and systemic embolism after LVT, and many aspects of its management still exist in a grey area of evidence. The current delay in intervention is likely related to a limited understanding of the disease pathophysiology, along with an underestimation of LVT by standard imaging modalities. With the rapid development of antithrombotic regimens consisting of direct oral anticoagulants (OACs), which have shown early safety and efficacy, there is a growing need to understand and accurately diagnose the LVT process in order to determine appropriate management solutions. This educational review will oversee LVT pathophysiology, current status of the guidelines-recommended echocardiographic approach and the role of multimodality imaging, as well as prevention and treatment modalities in the modern era. Meanwhile, the review proposes an algorithm for the prevention and treatment of LVT based on current guidelines and expert consensus, and highlights the need for more investigations to identify risk stratification methods for individual patients, and lastly, discusses the potential of direct OACs in the management of LVT.

Cerebrovascular hemodynamics are believed to play an important role in the development of ischemic stroke (IS). However, the relationships between hemodynamics and prognosis are not fully understood. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables comprehensive characteristics of cerebrovascular hemodynamics. This study aims to investigate the associations of the different hemodynamics derived from 4D flow CMR with IS functional outcomes.

Ninety-one patients (median age 64 years, 62 males) with unilateral IS in middle cerebral artery (MCA) territory were included. All subjects underwent a CMR scan, including 4D flow, three-dimensional (3D) time-of-flight magnetic resonance angiography, and 3D whole brain black-blood high-resolution vessel wall imaging of the MCA. Six hemodynamic parameters, including flow rate, velocity, pulsatility index, time-averaged wall shear stress (TAWSS), oscillatory shear index, and relative residence time (RRT), were calculated for the lesion site, pre-bifurcation M1 (pM1) segment, and the distal M1 and/or first branches of M2 (dM1/M2) segments. Vessel characteristics, such as lumen area, vessel area, wall area, maximum wall thickness, and the degree of stenosis, were calculated at the most stenotic lesion site. The modified Rankin Scale (mRS) scores were assessed at 90 days and 1 year, and an mRS >2 was considered as a poor functional outcome.

Lower segment-level TAWSS (odds ratio [OR]: 0.24, P = 0.006 and OR: 0.29, P = 0.014), higher RRT (OR: 2.74, P = 0.007 and OR: 2.40, P = 0.011) of dM1/M2 segments, and lower segment- and lesion-level velocity (OR: 0.40, P = 0.019 and OR: 0.41, P = 0.025; OR: 0.41, P = 0.030 and OR: 0.42, P = 0.040) of pM1 segment were observed to be associated with poor functional outcome at both 90 days and 1 year. Using the cut-off value of 3.58 Pa and 0.29, respectively, TAWSS and RRT of dM1/M2 segments showed moderate performance in distinguishing poor functional outcome from favorable outcome (area under the curve ranging from 0.642-0.687) both at 90 days and 1 year.

Distal segmental TAWSS and RRT of dM1/M2 segments were associated with poor functional outcomes. Such alterations in hemodynamics might help in the identification of patients with potentially unfavorable prognosis.