JAMA Neurology, volume 79, issue 1, pages 61

Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes

Kazunori Toyoda 1
, 
Sohei Yoshimura 1
, 
Michikazu Nakai 2
, 
Masatoshi KOGA 1
, 
Yusuke Sasahara 2
, 
Kazutaka Sonoda 3
, 
Kenji Kamiyama 4
, 
Yukako Yazawa 5
, 
Sanami Kawada 6
, 
Masahiro SASAKI 7
, 
Tadashi TERASAKI 8
, 
Kaori Miwa 1
, 
Junpei Koge 1
, 
Akiko Ishigami 1
, 
Shinichi Wada 2
, 
Yoshitaka Iwanaga 2
, 
Yoshihiro MIYAMOTO 2
, 
Kazuo Minematsu 9
, 
Shotai KOBAYASHI 10
, 
Koji Iihara 11
, 
Ryo Itabashi 11
, 
Takanari Kitazono 11
, 
Kuniaki Ogasawara 11
, 
Shigeru NOGAWA 11
, 
Masaaki Uno 11
, 
FUSAO IKAWA 11
, 
Shuhei Yamaguchi 11
, 
Ai Ito 11
Show full list: 28 authors
1
 
2
 
3
 
Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan | 
4
 
Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan | 
5
 
Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan | 
6
 
Stroke Center, Okayama Kyokuto Hospital, Okayama, Japan | 
7
 
Department of Stroke Science, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan | 
8
 
Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan | 
9
 
Medical Corporation Iseikai, Osaka, Japan | 
10
 
11
 
for the Japan Stroke Data Bank Investigators
Publication type: Journal Article
Publication date: 2022-01-01
Journal: JAMA Neurology
scimago Q1
SJR: 6.194
CiteScore: 41.9
Impact factor: 20.4
ISSN: 21686149, 21686157
Neurology (clinical)
Abstract
Whether recent changes in demographic characteristics and therapeutic technologies have altered stroke outcomes remains unknown.To determine secular changes in initial neurological severity and short-term functional outcomes of patients with acute stroke by sex using a large population.This nationwide, hospital-based, multicenter, prospective registry cohort study used the Japan Stroke Data Bank and included patients who developed acute stroke from January 2000 through December 2019. Patients with stroke, including ischemic and hemorrhagic strokes, who registered within 7 days after symptom onset were studied. Modified Rankin Scale scores were assessed at hospital discharge for all patients.Time.Initial severity was assessed by the National Institutes of Health Stroke Scale for ischemic stroke and intracerebral hemorrhage and by the World Federation of Neurological Surgeons grading for subarachnoid hemorrhage. Outcomes were judged as favorable if the modified Rankin Scale score was 0 to 2 and unfavorable if 5 to 6.Of 183 080 patients, 135 266 (53 800 women [39.8%]; median [IQR] age, 74 [66-82] years) developed ischemic stroke, 36 014 (15 365 women [42.7%]; median [IQR] age, 70 [59-79] years) developed intracerebral hemorrhage, and 11 800 (7924 women [67.2%]; median [IQR] age, 64 [53-75] years) developed subarachnoid hemorrhage. In all 3 stroke types, median ages at onset increased, and the National Institutes of Health Stroke Scale and World Federation of Neurological Surgeons scores decreased throughout the 20-year period on multivariable analysis. In ischemic stroke, the proportion of favorable outcomes showed an increase over time after age adjustment (odds ratio [OR], 1.020; 95% CI, 1.015-1.024 for women vs OR, 1.015; 95% CI, 1.011-1.018 for men) but then stagnated, or even decreased in men, on multivariate adjustment including reperfusion therapy (OR, 0.997; 95% CI, 0.991-1.003 for women vs OR, 0.990; 95% CI, 0.985-0.994 for men). Unfavorable outcomes and in-hospital deaths decreased in both sexes. In intracerebral hemorrhage, favorable outcomes decreased in both sexes, and unfavorable outcomes and deaths decreased only in women. In subarachnoid hemorrhage, the proportion of favorable outcomes was unchanged, and that of unfavorable outcomes and deaths decreased in both sexes.In this study, functional outcomes improved in patients with ischemic stroke during the past 20 years in both sexes presumably partly owing to the development of acute reperfusion therapy. The outcomes of patients with hemorrhagic stroke did not clearly improve in the same period.
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BMJ
Visualisation of the non-linear correlation between age and poor outcome in patients with aneurysmal subarachnoid haemorrhage
Ikawa F., Ichihara N., Uno M., Shiokawa Y., Toyoda K., Minematsu K., Kobayashi S., Yamaguchi S., Kurisu K.
Journal of Neurology, Neurosurgery and Psychiatry scimago Q1 wos Q1 , 
2021-06-15,  citations by CoLab: 17 ,  Abstract  
ObjectiveTo visualise the non-linear correlation between age and poor outcome at discharge in patients with aneurysmal subarachnoid haemorrhage (SAH) while adjusting for covariates, and to address the heterogeneity of this correlation depending on disease severity by a registry-based design.MethodsWe extracted data from the Japanese Stroke Databank registry for patients with SAH treated via surgical clipping or endovascular coiling within 3 days of SAH onset between 2000 and 2017. Poor outcome was defined as a modified Rankin Scale Score ≥3 at discharge. Variable importance was calculated using machine learning (random forest) model. Correlations between age and poor outcome while adjusting for covariates were determined using generalised additive models in which spline-transformed age was fit to each neurological grade of World Federation of Neurological Societies (WFNS) and treatment.ResultsIn total, 4149 patients were included in the analysis. WFNS grade and age had the largest and second largest variable importance in predicting the outcome. The non-linear correlation between age and poor outcome was visualised after adjusting for other covariates. For grades I–III, the risk slope for unit age was relatively smaller at younger ages and larger at older ages; for grade IV, the slope was steep even in younger ages; while for grade V, it was relatively smooth, but with high risk even at younger ages.ConclusionsThe clear visualisation of the non-linear correlation between age and poor outcome in this study can aid clinical decision making and help inform patients with aneurysmal SAH and their families better.
Ovid Technologies (Wolters Kluwer Health)
The Story of Intracerebral Hemorrhage
Broderick J.P., Grotta J.C., Naidech A.M., Steiner T., Sprigg N., Toyoda K., Dowlatshahi D., Demchuk A.M., Selim M., Mocco J., Mayer S.
Stroke scimago Q1 wos Q1 , 
2021-04-08,  citations by CoLab: 51 ,  Abstract  
This invited special report is based on an award presentation at the World Stroke Organization/European Stroke Organization Conference in November of 2020 outlining progress in the acute management of intracerebral hemorrhage (ICH) over the past 35 years. ICH is the second most common and the deadliest type of stroke for which there is no scientifically proven medical or surgical treatment. Prospective studies from the 1990s onward have demonstrated that most growth of spontaneous ICH occurs within the first 2 to 3 hours and that growth of ICH and resulting volumes of ICH and intraventricular hemorrhage are modifiable factors that can improve outcome. Trials focusing on early treatment of elevated blood pressure have suggested a target systolic blood pressure of 140 mm Hg, but none of the trials were positive by their primary end point. Hemostatic agents to decrease bleeding in spontaneous ICH have included desmopressin, tranexamic acid, and rFVIIa (recombinant factor VIIa) without clear benefit, and platelet infusions which were associated with harm. Hemostatic agents delivered within the first several hours have the greatest impact on growth of ICH and potentially on outcome. No large Phase III surgical ICH trial has been positive by primary end point, but pooled analyses suggest that earlier ICH removal is more likely to be beneficial. Recent trials emphasize maximization of clot removal and minimizing brain injury from the surgical approach. The future of ICH therapy must focus on delivery of medical and surgical therapies as soon as possible if we are to improve outcomes.
Ovid Technologies (Wolters Kluwer Health)
Nationwide Trends in Incidence and Mortality of Stroke Among Younger and Older Adults in Denmark
Skajaa N., Adelborg K., Horváth-Puhó E., Rothman K.J., Henderson V.W., Casper Thygesen L., Toft Sørensen H.
Neurology scimago Q1 wos Q1 Open Access , 
2021-02-10,  citations by CoLab: 41 ,  Abstract  
ObjectiveTo investigate the extent to which the incidence and mortality of a first-time stroke among younger and older adults changed from 2005 to 2018 in Denmark using nationwide registries.MethodsWe used the Danish Stroke Registry and the Danish National Patient Registry to identify patients 18 to 49 years of age (younger adults) and those ≥50 years of age (older adults) with a first-time ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. We computed age-standardized incidence rates and 30-day and 1-year mortality risks separately for younger and older adults and according to smaller age groups, stroke subtype, sex, and severity (Scandinavian Stroke Scale score). Average annual percentage changes (AAPCs) were computed to assess temporal trends.ResultsWe identified 8,680 younger adults and 105,240 older adults with an ischemic stroke or intracerebral hemorrhage. The incidence rate per 100,000 person-years of ischemic stroke (20.8 in 2005 and 21.9 in 2018, AAPC −0.6 [95% confidence interval (CI) −1.5 to 0.3]) and intracerebral hemorrhage (2.2 in 2005 and 2.5 in 2018, AAPC 0.6 [95% CI −1.0 to 2.3]) remained steady in younger adults. In older adults, rates of ischemic stroke and intracerebral hemorrhage declined, particularly in those ≥70 years of age. Rates of subarachnoid hemorrhage declined, but more so in younger than older adults. Stroke mortality declined over time in both age groups, attributable largely to declines in the mortality after severe strokes. Most trends were similar for men and women.ConclusionThe incidence of ischemic stroke and intracerebral hemorrhage was steady in younger adults from 2005 to 2018, while it dropped in adults >70 years of age. Stroke mortality declined during this time.
Ovid Technologies (Wolters Kluwer Health)
Female Stroke
Bonkhoff A.K., Karch A., Weber R., Wellmann J., Berger K.
Stroke scimago Q1 wos Q1 , 
2021-01-25,  citations by CoLab: 62 ,  Abstract  
Background and Purpose: Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry. Methods: Analyses were based on the Stroke Registry of Northwestern Germany from 2000 to 2018. We focused on admission-stroke severity and disability, acute recanalization treatment, and early stroke outcomes. Potential sex divergences were investigated via odds ratio (OR) using logistic regression models. Covariates were introduced in 3 steps: (1) base models (age and admission year), (2) partially adjusted models (additionally corrected for acute stroke severity and recanalization treatment), (3) fully adjusted models (additionally adjusted for onset-to-admission time interval, prestroke functional status, comorbidities, and stroke cause). Models were separately fitted for the periods 2000 to 2009 and 2010 to 2018. Results: Data from 761 106 patients with AIS were included. In fully adjusted models, there were no sex differences with respect to treatment with intravenous thrombolysis (2000–2009: OR, 0.99 [95% CI, 0.94–1.03]; 2010–2018: OR, 1.0 [0.98–1.02]), but women were more likely to receive intraarterial therapy (2010–2018: OR, 1.12 [1.08–1.15]). Despite higher disability on admission (2000–2009: OR, 1.10 [1.07–1.13]; 2010–2018: OR, 1.09 [1.07–1.10]), female patients were more likely to be discharged with a favorable functional outcome (2003–2009: OR, 1.05 [1.02–1.09]; 2010–2018: OR, 1.05 [1.04–1.07]) and experienced lower in-hospital mortality (2000–2009: OR, 0.92 [0.86–0.97]; 2010–2018: OR, 0.91 [0.88–0.93]). Conclusions: Female patients with AIS have a higher chance of receiving intraarterial treatment that cannot be explained by clinical characteristics, such as age, premorbid disability, stroke severity, or cause. Women have a more favorable in-hospital recovery than men because their higher disability upon admission was followed by a lower in-hospital mortality and a higher likelihood of favorable functional outcome at discharge after adjustment for covariates.
Ovid Technologies (Wolters Kluwer Health)
Sex difference in prevalence of depression after stroke
Dong L., Sánchez B.N., Skolarus L.E., Stulberg E., Morgenstern L.B., Lisabeth L.D.
Neurology scimago Q1 wos Q1 Open Access , 
2020-04-20,  citations by CoLab: 27 ,  Abstract  
ObjectiveThis study investigated the sex difference in prevalence of depression at 90 days after first-ever stroke.MethodsPatients with first-ever stroke (n = 786) were identified from the population-based Brain Attack Surveillance in Corpus Christi project (2011–2016). Poststroke depressive symptoms were assessed by the 8-item Patient Health Questionnaire, and prestroke depression status (history and medication use) was self-reported. Logistic regression was used to examine the association between sex and depression after stroke, and effect modification by prestroke depression status, accounting for missing data.ResultsWomen were more likely to have a history of and be on medication for depression at the time of stroke than men (p< 0.001). Prevalence of depression at 90 days was 28.2% for men (95% confidence interval [CI], 23.7%–32.8%) and 32.7% for women (95% CI, 27.8%–37.5%). The age-adjusted odds ratio (OR) of depression after stroke comparing women and men was 1.34 (95% CI, 0.97–1.85), and fully attenuated after adjustment for sociodemographic, stroke, and prestroke characteristics. Effect modification by prestroke depression status was present (p= 0.038). Among participants on medication for depression at the time of stroke, women were significantly less likely to have depression at 90 days compared with men (OR, 0.39; 95% CI, 0.16–0.96), whereas significant sex differences were not noted among those with and without a depression history.ConclusionThe sex difference in prevalence of depression at 90 days after first-ever stroke was not significant overall, but varied by prestroke depression status. Interventions to address and prevent poststroke depression are needed, particularly among those with prestroke depression but not undergoing treatment for depression at stroke onset.
Ovid Technologies (Wolters Kluwer Health)
Three-month modified Rankin Scale as a determinant of 5-year cumulative costs after ischemic stroke
Kim S., Lee H., Kim J.Y., Lee K., Kang J., Kim B.J., Han M., Choi K., Kim J., Shin D., Yeo M., Cha J., Kim D., Nah H., Kim D., et. al.
Neurology scimago Q1 wos Q1 Open Access , 
2020-02-06,  citations by CoLab: 24 ,  Abstract  
ObjectiveStroke is a devastating and costly disease; however, there is a paucity of information on long-term costs and on how they differ according to 3-month modified Rankin scale (mRS) score, which is a primary outcome variable in acute stroke intervention trials.MethodsWe analyzed a prospective multicenter stroke registry (Clinical Research Collaboration for Stroke in Korea) database through linkage with claims data from the National Health Insurance Service with follow-up to December 2016. Healthcare expenditures were converted into daily cost individually, and annual and cumulative costs up to 5 years were estimated and compared according to the 3-month mRS score.ResultsBetween January 2011 and November 2013, 11,136 patients were enrolled in the study. The mean age was 68 years, and 58% were men. The median follow-up period was 3.9 years (range 0–5 years). Mean cumulative cost over 5 years was $117,576 (US dollars [USD]); the cost in the first year after stroke was the highest ($38,152 USD), which increased markedly from the cost a year before stroke ($8,718 USD). The mean 5-year cumulative costs differed significantly according to the 3-month mRS score (p < 0.001); the costs for a 3-month mRS score of 0 or 5 were $53,578 and $257,486 USD, respectively. Three-month mRS score was an independent determinant of long-term costs after stroke.ConclusionsWe show that 3-month mRS score plays an important role in the prediction of long-term costs after stroke. Such estimates relating to 3-month mRS categories may be valuable when undertaking health economic evaluations related to stroke care.
American Medical Association (AMA)
Trends in Stroke Incidence Rates in Older US Adults
Koton S., Sang Y., Schneider A.L., Rosamond W.D., Gottesman R.F., Coresh J.
JAMA Neurology scimago Q1 wos Q1 , 
2020-01-01,  citations by CoLab: 61 ,  Abstract  
Importance Determining whether the previously reported decreased stroke incidence rates from 1987 to 2011 among US adults 65 years and older in the Atherosclerosis Risk in Communities (ARIC) study continued to decrease subsequently can help guide policy and planning efforts. Objective To evaluate whether stroke incidence declines among older adults in the ARIC study continued after 2011. Design, Setting, and Participants ARIC is a community-based prospective cohort study including 15 792 individuals aged 45 to 64 years at baseline (1987-1989), selected by probability sampling from residents of Forsyth County, North Carolina; Jackson, Mississippi (black individuals only); the northwestern suburbs of Minneapolis, Minneapolis; and Washington County, Maryland (ie, center). The present study included ARIC participants free of stroke at baseline, followed up through December 31, 2017. Data were collected through personal interviews and physical examinations during study visits, annual/semiannual telephone interviews, and active surveillance of discharges from local hospitals. Stroke events were adjudicated by study-physicians reviewers. Analysis began September 2018. Main Outcomes and Measures The main outcome was stroke incidence rates, which were computed with 95% CIs stratifying the analysis by age and calendar time. Trends in adjusted incidence rates were assessed using Poisson regression incidence rate ratios. Models included calendar time, age, sex, race/center, and time-varying risk factors (hypertension, diabetes, coronary heart disease, cholesterol-lowering medication use, and smoking). Results Of 14 357 ARIC participants with 326 654 person-years of follow-up, the mean (SD) age at baseline was 54.1 (5.8) years and 7955 (55.4%) were women. From 1987 to 2017, a total of 1340 incident strokes occurred among ARIC participants, and among them, 1028 (76.7%) occurred in participants 65 years and older. Crude incidence rates of stroke for participants 65 years and older decreased progressively from 1987 to 2017. Incidence rates, adjusted for age, sex, race/center, and time-varying risk factors, decreased by 32% (95% CI, 23%-40%) per 10 years in participants 65 years and older. Findings were consistent across decades, sex, and race. Conclusions and Relevance Validated total stroke incidence rates in adults 65 years and older decreased over the last 30 years in the ARIC cohort. The decrease in rates previously reported for 1987 to 2011 extends for the subsequent 6 years in men and women as well as in white and black individuals.
American Medical Association (AMA)
Outcomes Associated With Clopidogrel-Aspirin Use in Minor Stroke or Transient Ischemic Attack
Pan Y., Elm J.J., Li H., Easton J.D., Wang Y., Farrant M., Meng X., Kim A.S., Zhao X., Meurer W.J., Liu L., Dietrich D., Wang Y., Johnston S.C.
JAMA Neurology scimago Q1 wos Q1 , 
2019-12-01,  citations by CoLab: 170 ,  Abstract  
Importance Dual antiplatelet therapy with clopidogrel and aspirin is effective for secondary prevention after minor ischemic stroke or transient ischemic attack (TIA). Uncertainties remained about the optimal duration of dual antiplatelet therapy for minor stroke or TIA. Objective To obtain precise estimates of efficacy and risk of dual antiplatelet therapy after minor ischemic stroke or TIA. Design, Setting, and Participants This analysis pooled individual patient–level data from 2 large-scale randomized clinical trials that evaluated clopidogrel-aspirin as a treatment to prevent stroke after a minor stroke or high-risk TIA. The Clopidogrel in High-Risk Patients With Acute Non-Disabling Cerebrovascular Events (CHANCE) trial enrolled patients at 114 sites in China from October 1, 2009, to July 30, 2012. The Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial enrolled patients at 269 international sites from May 28, 2010, to December 19, 2017. Both were followed up for 90 days. Data analysis occurred from November 2018 to May 2019. Interventions In the 2 trials, patients with minor stroke or high-risk TIA were randomized to clopidogrel-aspirin or aspirin alone within 12 hours (POINT) or 24 hours (CHANCE) of symptom onset. Main Outcomes and Measures The primary efficacy outcome was a major ischemic event (ischemic stroke, myocardial infarction, or death from ischemic vascular causes). The primary safety outcome was major hemorrhage. Results The study enrolled 5170 patients (CHANCE) and 4881 patients (POINT). Analysis included individual data from 10 051 patients (5016 in the clopidogrel-aspirin treatment group and 5035 in the control group) with a median age of 63.2 (interquartile range, 55.0-72.9) years; 6106 patients (60.8%) were male. Clopidogrel-aspirin treatment reduced the risk of major ischemic events at 90 days compared with aspirin alone (328 of 5016 [6.5%] vs 458 of 5035 [9.1%]; hazard ratio [HR], 0.70 [95% CI, 0.61-0.81];P  Conclusions and Relevance In this analysis of the POINT and CHANCE trials, the benefit of dual antiplatelet therapy appeared to be confined to the first 21 days after minor ischemic stroke or high-risk TIA.
Wiley
Small but Steady Steps in Stroke Medicine in Japan
Toyoda K., Inoue M., Koga M.
Journal of the American Heart Association scimago Q1 wos Q1 Open Access , 
2019-08-08,  citations by CoLab: 27 ,  Abstract  
December 14, 1702, was an unforgettable day for many Japanese, when 47 samurais from Ako Domain launched a raid on their foe's residence in the snowy night of Edo (the former name of Tokyo) and avenged their deceased master, who was illogically forced to commit suicide by self‐disembowelment on a sword, after waiting and planning for a year and a half persevering through all sorts of hardships. They have been repeatedly praised by Bunraku (puppet play) and Kabuki plays, novels, and movies. On the same day 316 years later (December 14, 2018), a Stroke and Cardiovascular Disease Control Act was proclaimed by the Japanese government to vanquish these national maladies.1 Eight basic policies on stroke and cardiovascular diseases are listed in the new law: (1) promotion of education to the general population and prevention by national and local governments; (2) development of a system for transportation using an ambulance and others and acceptance of emergent patients; (3) development of medical institutes where specialized medical care for stroke and cardiovascular diseases can be offered; (4) maintenance and improvement of participation in social activities and other quality of life for patients with subsequent complications; (5) development of a system for collaboration among agencies involved in health, medical care, and welfare, such as hospital ambulance services, social welfare services, and others; (6) human resource development for health, medical support, and welfare; (7) development of a system for collection and provision of information; and (8) promotion of research. The Japan Stroke Association, a stroke support organization, and other organizations prepared the draft for the basic law on stroke in 2009 and appealed to the government for its enactment but without success. The bill was then expanded to include cardiovascular disease in general and was then finally approved. The Japan Stroke Society, an academic organization, has joined with the Japanese Circulation Society for the 5‐year strategy for stroke and cardiovascular diseases (Stop CVD Project) since 2016 in anticipation of the basic law. Although stroke has long been called the Japanese national disease, the government was relatively slow to act to take measures for stroke care compared with cancer care. The new Act is a steady step forward for tomorrow's stroke medicine in Japan.
Ovid Technologies (Wolters Kluwer Health)
Effect of Edaravone on Neurological Symptoms in Real-World Patients With Acute Ischemic Stroke
Kobayashi S., Fukuma S., Ikenoue T., Fukuhara S., Kobayashi S.
Stroke scimago Q1 wos Q1 , 
2019-06-05,  citations by CoLab: 63 ,  Abstract  
Background and Purpose— In Japan, nearly half of ischemic stroke patients receive edaravone for acute treatment. The purpose of this study was to assess the effect of edaravone on neurological symptoms in patients with ischemic stroke stratified by stroke subtype. Methods— Study subjects were 61 048 patients aged 18 years or older who were hospitalized ≤14 days after onset of an acute ischemic stroke and were registered in the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database, between June 2001 and July 2013. Patients were stratified according to ischemic stroke subtype (large-artery atherosclerosis, cardioembolism, small-vessel occlusion, and cryptogenic/undetermined) and then divided into 2 groups (edaravone-treated and no edaravone). Neurological symptoms were evaluated using the National Institutes of Health Stroke Scale (NIHSS). The primary outcome was changed in neurological symptoms during the hospital stay (ΔNIHSS=NIHSS score at discharge−NIHSS score at admission). Data were analyzed using multivariate linear regression with inverse probability of treatment weighting after adjusting for the following confounding factors: age, gender, and systolic and diastolic blood pressure at the start of treatment, NIHSS score at admission, time from stroke onset to hospital admission, infarct size, comorbidities, concomitant medication, clinical department, history of smoking, alcohol consumption, and history of stroke. Results— After adjusting for potential confounders, the improvement in NIHSS score from admission to discharge was greater in the edaravone-treated group than in the no edaravone group for all ischemic stroke subtypes (mean [95% CI] difference in ΔNIHSS: −0.46 [−0.75 to −0.16] for large-artery atherosclerosis, −0.64 [−1.09 to −0.2] for cardioembolism, and −0.25 [−0.4 to −0.09] for small-vessel occlusion). Conclusions— For any ischemic stroke subtype, edaravone use (compared with no use) was associated with a greater improvement in neurological symptoms, although the difference was small (<1 point NIHSS) and of limited clinical significance.
Wiley
Annals of Neurology scimago Q1 wos Q1 , 
2019-05-14,  citations by CoLab: 4 , 
Elsevier
Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Johnson C.O., Nguyen M., Roth G.A., Nichols E., Alam T., Abate D., Abd-Allah F., Abdelalim A., Abraha H.N., Abu-Rmeileh N.M., Adebayo O.M., Adeoye A.M., Agarwal G., Agrawal S., Aichour A.N., et. al.
The Lancet Neurology scimago Q1 wos Q1 , 
2019-05-01,  citations by CoLab: 2060 ,  Abstract  
Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016.We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles.In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (-39·3 to -33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (-37·2 to -31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (-10·7 to -5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men.Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor.Bill & Melinda Gates Foundation.
Wiley
Sex Differences in Severity of Stroke in the INSTRUCT Study: a Meta‐Analysis of Individual Participant Data
Phan H.T., Reeves M.J., Blizzard C.L., Thrift A.G., Cadilhac D.A., Sturm J., Otahal P., Rothwell P., Bejot Y., Cabral N.L., Appelros P., Kõrv J., Vibo R., Minelli C., Gall S.L.
Journal of the American Heart Association scimago Q1 wos Q1 Open Access , 
2018-12-28,  citations by CoLab: 61 ,  Abstract  
Background Women have worse outcomes after stroke than men, and this may be partly explained by stroke severity. We examined factors contributing to sex differences in severity of acute stroke assessed by the National Institutes of Health Stroke Scale. Methods and Results We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population‐based stroke incidence studies (1996–2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke‐related clinical factors, comorbidities, and pre‐stroke function were obtained. Within each study, relative risk regression using log‐binominal modeling was used to estimate the female:male relative risk ( RR ) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study‐specific unadjusted and adjusted RR s, controlling for confounding variables, were pooled using random‐effects meta‐analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24–1.46). The sex difference in severity was attenuated after adjustment for age, pre‐stroke dependency, and atrial fibrillation but remained statistically significant (pooled RR adjusted 1.20, 95% CI 1.10–1.30). There was no sex difference in severity for intracerebral hemorrhage ( RR crude 1.08, 95% CI 0.97–1.21; RR adjusted 1.08, 95% CI 0.96–1.20). Conclusions Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre‐stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre‐stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.
Ovid Technologies (Wolters Kluwer Health)
Declining Rate and Severity of Hospitalized Stroke From 2004 to 2013
Koton S., Geva D., Streifler J.Y., Harnof S., Pougach Y., Azrilin O., Hadar S., Bornstein N.M., Tanne D.
Stroke scimago Q1 wos Q1 , 
2018-05-02,  citations by CoLab: 16 ,  Abstract  
Background and Purpose— Stroke is a leading cause of morbidity and disability. We assessed trends in rates of hospitalized stroke and stroke severity on admission in a prospective national registry of stroke from 2004 to 2013. Methods— All 6693 acute ischemic strokes and intracerebral hemorrhage in the National Acute Stroke Israeli participants ≥20 years old were included. Data were prospectively collected in 2004 (February–March), 2007 (March–April), 2010 (April–May), and 2013 (March–April). Rates of hospitalized stroke from 2004 to 2013 were studied using generalized linear models assuming a quasi-Poisson error distribution with a log link. Stroke severity on admission was determined using the National Institutes of Health Stroke Scale score and trends were studied. Analysis was performed for stroke overall and by sex and age-group as well as by stroke type. Results— Estimated average annual rates of hospitalized stroke decreased from 24.9/10 000 in 2004 to 19.5/10 000 in 2013. The age and sex-adjusted rates ratio (95% confidence interval) for hospitalized stroke overall was 0.82 (0.76–0.89) for 2007, 0.71 (0.65–0.77) for 2010, and 0.72 (0.66–0.78) for 2013 compared with 2004. Severity on admission decreased over time: rates (95% confidence interval) of severe stroke (National Institutes of Health Stroke Scale score of ≥11) decreased from 27% (25%–29%) in 2004 to 19% (17%–21%) in 2013, whereas rates (95% confidence interval) of minor stroke (National Institutes of Health Stroke Scale score of ≤5) increased from 46% (44%–49%) in 2004 to 60% (57%–62%) in 2013 ( P <0.0001). Findings were consistent by sex, age-group, and stroke type. Conclusions— Based on our national data, rates of hospitalized stroke and severity of stroke on admission have decreased from 2004 to 2013 overall and by stroke type, in men and women. Despite the observed declines in rates and severity, stroke continues to place a considerable burden to the Israeli health system.
Ovid Technologies (Wolters Kluwer Health)
Factors contributing to sex differences in functional outcomes and participation after stroke
Phan H.T., Blizzard C.L., Reeves M.J., Thrift A.G., Cadilhac D.A., Sturm J., Heeley E., Otahal P., Vemmos K., Anderson C., Parmar P., Krishnamurthi R., Barker-Collo S., Feigin V., Bejot Y., et. al.
Neurology scimago Q1 wos Q1 Open Access , 
2018-04-27,  citations by CoLab: 50 ,  Abstract  
ObjectiveTo examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.MethodsIndividual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993–2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0–100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis.ResultsIn unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RRunadjusted 1.32, 95% confidence interval [CI] 1.18–1.48; 5 years: RRunadjusted 1.31, 95% CI 1.16–1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RRadjusted 1.08, 95% CI 0.97–1.20; 5 years: RRadjusted 1.05, 95% CI 0.94–1.18). Women also had greater participation restriction than men (pooled MDunadjusted −5.55, 95% CI −8.47 to −2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted −2.48, 95% CI −4.99 to 0.03).ConclusionsWorse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.
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Baishideng Publishing Group
Role of triggering receptor expressed on myeloid cells 1/2 in secondary injury after cerebral hemorrhage
Yi F., Wu H., Zhao H.
World Journal of Clinical Cases wos Q3 , 
2025-03-26,  citations by CoLab: 0 ,  Abstract  
Intracerebral hemorrhage (ICH) is a common severe emergency in neurosurgery, causing tremendous economic pressure on families and society and devastating effects on patients both physically and psychologically, especially among patients with poor functional outcomes. ICH is often accompanied by decreased consciousness and limb dysfunction. This seriously affects patients’ ability to live independently. Although rapid advances in neurosurgery have greatly improved patient survival, there remains insufficient evidence that surgical treatment significantly improves long-term outcomes. With in-depth pathophysiological studies after ICH, increasing evidence has shown that secondary injury after ICH is related to long-term prognosis and that the key to secondary injury is various immune-mediated neuroinflammatory reactions after ICH. In basic and clinical studies of various systemic inflammatory diseases, triggering receptor expressed on myeloid cells 1/2 (TREM-1/2), and the TREM receptor family is closely related to the inflammatory response. Various inflammatory diseases can be upregulated and downregulated through receptor intervention. How the TREM receptor functions after ICH, the types of results from intervention, and whether the outcomes can improve secondary brain injury and the long-term prognosis of patients are unknown. An analysis of relevant research results from basic and clinical trials revealed that the inhibition of TREM-1 and the activation of TREM-2 can alleviate the neuroinflammatory immune response, significantly improve the long-term prognosis of neurological function in patients with cerebral hemorrhage, and thus improve the ability of patients to live independently.
Ovid Technologies (Wolters Kluwer Health)
Low Hemoglobin Causes Hematoma Expansion and Poor Intracerebral Hemorrhage Outcomes
Cottarelli A., Mamoon R., Ji R., Mao E., Boehme A., Kumar A., Song S., Allegra V., Sharma S.V., Konofagou E., Spektor V., Guo J., Connolly E.S., Sekar P., Woo D., et. al.
Stroke scimago Q1 wos Q1 , 
2025-03-20,  citations by CoLab: 0 ,  Abstract  
BACKGROUND: Although lower hemoglobin levels associate with worse intracerebral hemorrhage (ICH) outcomes, causal drivers for this relationship remain unclear. We investigated the hypothesis that lower hemoglobin relates to increased hematoma expansion risk and poor outcomes using human observational data and assessed causal relationships using a translational murine model of anemia and ICH. METHODS: A multicenter, prospective observational cohort study of 2997 patients with ICH enrolled between 2010 and 2016 was assessed. Patients with baseline hemoglobin measurements and serial computed tomography neuroimaging were included for analyses. Patients with systemic evidence of coagulopathy were excluded. Separate regression models assessed relationships of baseline hemoglobin with hematoma expansion (≥33% and/or ≥6 mL growth) and poor long-term neurological outcomes (modified Rankin Scale score of 4–6) after adjusting for relevant covariates. Using a murine collagenase ICH model with serial neuroimaging in anemic versus nonanemic C57/BL6 mice, intergroup differences in ICH lesion volume, lesion volume changes, and early mortality were assessed. RESULTS: Among 1190 ICH patients analyzed, the mean age was 61 years old, and 62% of the cohort were males. Lower baseline hemoglobin levels are associated with increased odds of hematoma expansion (adjusted odds ratio per −1 g/dL hemoglobin decrement, 1.10 [95% CI, 1.02–1.19]) and poor 3-month clinical outcomes (adjusted odds ratio per −1 g/dL hemoglobin decrement, 1.11 [95% CI, 1.03–1.21]). Similar relationships were seen with poor 6- and 12-month outcomes. In our animal model, anemic mice had significantly greater ICH lesion expansion, 24-hour lesion volumes, and greater mortality, as compared with nonanemic mice. CONCLUSIONS: These results, in a human cohort and a mouse model, provide novel evidence suggesting that anemia has causal roles in hematoma expansion and poor ICH outcomes. Additional studies are required to clarify whether correcting anemia can improve these outcomes.
MDPI
Increased Plasma Levels of Thrombin-Cleaved Osteopontin in Patients with Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage
Aoki K., Kawakita F., Hakozaki K., Kanamaru H., Asada R., Suzuki H.
International Journal of Molecular Sciences scimago Q1 wos Q2 Open Access , 
2025-03-19,  citations by CoLab: 0 ,  PDF,  Abstract  
Osteopontin (OPN), a matricellular protein, is produced as a full-length OPN (FL-OPN) and cleaved by thrombin, thus generating the N-terminal half of OPN (OPN N-half) with new functions. Although plasma FL-OPN levels have been associated with neurovascular events after aneurysmal subarachnoid hemorrhage (SAH), plasma OPN N-half levels have never been investigated. In this study, prospective clinical data and plasma samples were collected from 108 consecutive SAH patients with ruptured aneurysms undergoing acute treatment via surgery, and FL-OPN and OPN N-half levels were measured in plasma with a particular focus on delayed cerebral infarction (DCIn), which has the greatest impact on outcomes. Plasma FL-OPN and OPN N-half levels were intercorrelated and significantly higher in patients with DCIn at days 10–12 post-SAH; a greater area under the receiver-operating characteristic curve was observed for OPN N-half levels, with a cut-off value of 70.42 pmol/L. Multivariate analyses revealed that plasma OPN N-half levels of ≥70.42 pmol/L at days 10–12 were independently associated with DCIn development (adjusted odds ratio, 5.65; 95% confidence interval, 1.68–18.97; p = 0.005). Based on the findings of this study and previous reports, an increase in the OPN N-half level may be indicative of a protective mechanism against DCIn development, and, thus, it holds promise as a new therapeutic target against DCIn after aneurysmal SAH.
Ovid Technologies (Wolters Kluwer Health)
Clinical course, causes of worsening, and outcomes of severe ischemic stroke: A prospective multicenter cohort study
Wu S., Wang Y., Yuan R., Liu M., Hua X., Huang L., Guo F., Yang D., Li Z., Wu B., Wang C., Duan J., Ling T., Zhang H., Zhang S., et. al.
Chinese Medical Journal scimago Q1 wos Q1 Open Access , 
2025-03-17,  citations by CoLab: 0 ,  Abstract  
Abstract Background: Severe stroke has high rates of mortality and morbidity. This study aimed to investigate the clinical course, causes of worsening, and outcomes of severe ischemic stroke. Methods: This prospective, multicenter cohort study enrolled adult patients admitted ≤30 days after ischemic stroke from nine hospitals in China between September 2017 and December 2019. Severe stroke was defined as a score of ≥15 on the National Institutes of Health Stroke Scale (NIHSS). Clinical worsening was defined as an increase of 4 in the NIHSS score from baseline. Unfavorable functional outcome was defined as a modified Rankin scale score ≥3 at 3 months and 1 year. We per­formed logistic regression to explore baseline features and reperfusion therapies associated with clinical worsening and functional outcomes. Results: Among 4201 patients enrolled, 854 patients (20.33%) had severe stroke on admission. Of 3347 patients without severe stroke on admission, 142 (4.24%) patients developed severe stroke in hospital. Of 854 patients with severe stroke on admission, 33.95% (290/854) experienced clinical worsening (time from stroke onset median: 43 h, interquartile range [IQR]: 20–88 h), with brain edema (54.83% [159/290]) as the leading cause; 24.59% (210/854) of these patients died by 30 days, and 81.47% (677/831) and 78.44% (633/807) had unfavorable functional outcomes at 3 months and 1 year, respectively. Reperfusion reduced the risk of worsening (adjusted odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.12–0.49, P <0.01), 30-day death (adjusted OR: 0.22, 95% CI: 0.11–0.41, P <0.01), and unfavorable functional outcomes at 3 months (adjusted OR: 0.24, 95% CI: 0.08–0.68, P <0.01) and 1 year (adjusted OR: 0.17, 95% CI: 0.06–0.50, P <0.01). Conclusions: Approximately one-fifth of patients with ischemic stroke had severe neurological deficits on admission. Clinical worsening mainly occurred in the first 3 days after stroke onset, with brain edema as the leading cause of worsening. Reperfusion reduced the risk of clinical worsening and improved functional outcomes. Registration: ClinicalTrials.gov, NCT03222024.
Springer Nature
Neural repair mechanisms after ischemic stroke
Irisa K., Shichita T.
Inflammation and Regeneration scimago Q1 wos Q1 Open Access , 
2025-03-17,  citations by CoLab: 0 ,  PDF,  Abstract  
Abstract Ischemic stroke triggers inflammation that promotes neuronal injury, leading to disruption of neural circuits and exacerbated neurological deficits in patients. Immune cells contribute to not only the acute inflammatory responses but also the chronic neural repair. During the post-stroke recovery, reparative immune cells support the neural circuit reorganization that occurs around the infarct region to connect broad brain areas. This review highlights the time-dependent changes of neuro-immune interactions and reorganization of neural circuits after ischemic brain injury. Understanding the molecular mechanisms involving immune cells in acute inflammation, subsequent neural repair, and neuronal circuit reorganization that compensate for the lost brain function is indispensable to establish treatment strategies for stroke patients.
Springer Nature
Bioinformatics identification and validation of pyroptosis-related gene for ischemic stroke
Shang X., Wei R., Yang D., Yu B., Zhang W.
BMC Medical Genomics scimago Q2 wos Q3 Open Access , 
2025-03-16,  citations by CoLab: 0 ,  PDF, 
SAGE
Prediction of dementia using CT imaging in stroke (PRODUCTS)
Hafdi M., Taylor-Rowan M., Drozdowska B., Elliott E., McGuire L., Richard E., Quinn T.J.
European Stroke Journal scimago Q1 wos Q1 , 
2025-03-13,  citations by CoLab: 0 ,  Abstract  
Introduction: A better understanding of who will develop dementia can inform patient care. Although MRI offers prognostic insights, access is limited globally, whereas CT-imaging is readily available in acute stroke. We explored the prognostic utility of acute CT-imaging for predicting dementia. Patients and methods: We included stroke or transient ischaemic attack (TIA) survivors from participating stroke centres in Scotland. Acute CT-scans were rated using ordinal scales for neurodegenerative and cerebrovascular changes (old infarcts, white matter lesions (WMLs), medial temporal lobe atrophy (MTA), and global atrophy (GA)) and combined together to a ‘brain-frailty’ score. Dementia status was established at 18-months following stroke or TIA. Results: Among 195 participants, 33% had dementia after 3 years of follow-up. High brain-frailty score (⩾2/4) correlated with higher risk of dementia (HR (95% CI) 6.02 (1.89–19.21)). As individual predictor, severe MTA was most strongly associated with dementia (adjusted HR (95% CI) 2.09 (1.07–4.08)). Other predictors associated with dementia included older age, higher prestroke morbidity (mRS), WMLs, and GA. Integrated in a prediction model with clinical parameters, prestroke mRS, cardiovascular disease, GA, MTA and Abbreviated-Mental-Test were the strongest predictors of dementia (c-statistic: 0.77). Discussion and conclusion: Increased brain-frailty, and its individual components (WMLs, MTA, and GA) are associated with a higher risk of dementia in participants with stroke. Combining clinical and brain-frailty parameters created a moderate dementia prediction model but added little value over clinical parameters in combination with cognitive testing. CT-based brain-frailty may provide better prognostic insights when cognitive testing isn’t feasible and for identifying highest-risk individuals for dementia prevention trials to increase trial efficiency.
Springer Nature
Beyond Routine Monitoring: A Comprehensive Review of Direct Oral Anticoagulants and the Role of Coagulation Profiles in Their Management
Jayakumar J., Khan F., Ayyazuddin M., Turku D., Ginjupalli M., Kalaivani Babu A., Rajarajan S., Gaddam M., Kumar V., Ullah A.
Cureus wos Q3 , 
2025-03-12,  citations by CoLab: 0 , 
Elsevier
Trends in stroke incidence, death, and disability outcomes in a multi-ethnic population: Auckland regional community stroke studies (1981–2022)
Feigin V.L., Krishnamurthi R., Nair B., Rautalin I., Parag V., Anderson C.S., Arroll B., Barber P.A., Barker-Collo S., Bennett D., Brown P., Cadilhac D.A., Douwes J., Exeter D., Ranta A., et. al.
The Lancet Regional Health - Western Pacific scimago Q1 wos Q1 Open Access , 
2025-03-10,  citations by CoLab: 0 , 
Elsevier
Atherosclerotic Cardiovascular Disease Risk Prediction Models in China, Japan, and Korea
Nguyen P.K., Zhao D., Okamura T., Chang Kim H., Wong N.D., Yang E.
JACC Asia scimago Q1 Open Access , 
2025-03-04,  citations by CoLab: 0 , 
Ovid Technologies (Wolters Kluwer Health)
Temporal Trends in Stroke Management and Outcomes Between 2011 and 2020 in South Korea: Results From a Nationwide Multicenter Registry
Park T.H., Hong K., Cho Y., Ryu W., Kim D., Park M., Choi K., Kim J., Kang J., Kim B., Han M., Lee J., Cha J., Kim D., Kim J.G., et. al.
Journal of the American Heart Association scimago Q1 wos Q1 Open Access , 
2025-03-04,  citations by CoLab: 0 ,  Abstract  
Background This study aims to evaluate temporal trends of advanced treatments and related clinical outcomes of ischemic stroke through a decade‐long trend analysis, using data from a comprehensive, national, multicenter registry. We also seek to identify areas in need of improvement. Methods and Results This analysis involved patients with ischemic stroke or transient ischemic attack registered prospectively in the CRCS‐K‐NIH (Clinical Research Center for Stroke in Korea–National Institute of Health) registry between 2011 and 2020. We examined temporal trends in risk factors, pathogenetic subtypes, acute management strategies, and outcomes for up to 1 year following a stroke. Generalized linear mixed models were used to account for center clustering. The average age of 77 662 patients increased 2.2 years in men and 2.4 years in women over the 10‐year follow‐up. Notably, in‐hospital neurological deterioration, 3‐month and 1‐year mortality rate, and cumulative incidence of recurrent stroke within 1‐year decreased over time after adjustments for age, sex, and initial stroke severity ( P <0.01). However, functional outcomes at 3 months and 1 year remained unchanged. Endovascular thrombectomy increased from 5.4% in 2011 to 10.6% in 2020. Use of anticoagulants for atrial fibrillation, dual antiplatelet therapy, statins, and stroke unit care also increased. Contrarily, the rate of intravenous thrombolysis showed a slight decline. Conclusions This study points to a reduction in death and risk of recurrent stroke over the past decade, paralleling enhancement in acute and preventive stroke management. Nevertheless, the decline in the use of intravenous thrombolysis and the lack of improvement in functional outcomes following stroke are concerning trends that warrant thorough investigation.
Japan Atherosclerosis Society
Severity, Outcomes, and their Secular Changes in 33,870 Ischemic Stroke Patients with Atrial Fibrillation in a Hospital-Based Registry: Japan Stroke Data Bank
Toyoda K., Yoshimura S., Nakai M., Wada S., Miwa K., Koge J., Yoshida T., Kamiyama K., Mizoue T., Hatano T., Yoshida Y., Sasahara Y., Ishigami A., Iwanaga Y., Miyamoto Y., et. al.
Journal of Atherosclerosis and Thrombosis scimago Q1 wos Q2 , 
2025-03-01,  citations by CoLab: 1 , 
Elsevier
Management of eight cases of subarachnoid hemorrhage using transpulmonary thermodilution during clazosentan therapy
Iyota H., Kawano Y., Fukumoto H., Tajiri T., Iwaasa M., Morimoto S., Izutani Y., Yamasaki S., Yamauchi K., Hatomoto H., Abe H., Nakamura Y.
Interdisciplinary Neurosurgery: Advanced Techniques and Case Management scimago Q3 wos Q4 Open Access , 
2025-03-01,  citations by CoLab: 0 , 
Wiley
Unravelling the nexus of stroke and dementia: Deciphering the role of secondary neurodegeneration in orchestrating cognitive decline
Stuckey S.M., Hood R.J., Ong L.K., Bilecki I.M., Collins‐Praino L.E., Turner R.J.
Neuroprotection , 
2025-02-25,  citations by CoLab: 0 ,  Abstract  
AbstractStroke is the leading cause of acquired disability. The development of acute ischemic stroke treatments, such as mechanical thrombectomy and tissue plasminogen activator, has resulted in more patients surviving the initial insult. However, long‐term complications, such as post‐stroke cognitive impairment (PSCI) and dementia (PSD), are at an all‐time high. Notably, 80% of stroke survivors suffer from cognitive impairment, and a history of stroke doubles a patient's lifetime risk of developing dementia. A combination of greater life expectancy, an increase in the number of strokes in young individuals, and improved survival have inherently increased the number of years patients are living post‐stroke, highlighting the critical need to understand the long‐term effects of stroke, including how pathological changes in the brain might give rise to functional and behavioral changes in stroke survivors. Even with this increased risk of PSCI and PSD in stroke survivors, understanding of how the stroke itself develops into these conditions remains incomplete. Recently, secondary neurodegeneration (SND) following stroke has been linked with PSCI and PSD. SND is the degeneration of brain regions outside the original stroke site. Degeneration in these sites is thought to arise due to functional diaschisis with the infarct core; however, observation of SND pathology in multiple regions without direct connectivity to the stroke infarct suggests that the degeneration in these regions is likely more complex. Moreover, pathological hallmarks of dementia, such as a deposition of neurodegenerative proteins and iron, cell death, inflammation and blood–brain barrier alterations, have all been found in regions such as the thalamus, hippocampus, basal ganglia, amygdala and prefrontal cortex following stroke. Hence, in this review, we present the current understanding of PSCI and PSD in the context of SND and outline how remote anatomical and molecular changes may drive the development of these conditions.
Springer Nature
Disproportionality analysis from World Health Organization data on migraine-specific medications and cerebrovascular diseases
Cho J., Jo H., Park J., Lee K., Lee H., Kim S., Son Y., Oh J., Jeong J., Lee S., Oh J., Cho H., Yang J.M., Woo H.G., Yon D.K., et. al.
European Journal of Clinical Pharmacology scimago Q2 wos Q3 , 
2025-02-24,  citations by CoLab: 1 , 

Top-30

Journals

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Journal of Stroke and Cerebrovascular Diseases
Journal of Stroke and Cerebrovascular Diseases, 7, 4.46%
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Stroke, 6, 3.82%
Journal of the American Heart Association
Journal of the American Heart Association, 6, 3.82%
Journal of Atherosclerosis and Thrombosis
Journal of Atherosclerosis and Thrombosis, 6, 3.82%
Journal of the Neurological Sciences
Journal of the Neurological Sciences, 5, 3.18%
European Stroke Journal
European Stroke Journal, 4, 2.55%
Hypertension Research
Hypertension Research, 4, 2.55%
International Journal of Stroke
International Journal of Stroke, 4, 2.55%
Frontiers in Neurology
Frontiers in Neurology, 3, 1.91%
Cureus
Cureus, 3, 1.91%
Geriatrics and Gerontology International
Geriatrics and Gerontology International, 2, 1.27%
PLoS ONE
PLoS ONE, 2, 1.27%
BMC Neurology
BMC Neurology, 2, 1.27%
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Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery, 2, 1.27%
Heliyon
Heliyon, 2, 1.27%
Stroke Vascular and Interventional Neurology
Stroke Vascular and Interventional Neurology, 2, 1.27%
Neurology
Neurology, 2, 1.27%
BMJ Open
BMJ Open, 2, 1.27%
Europace
Europace, 1, 0.64%
Journal of Cerebral Blood Flow and Metabolism
Journal of Cerebral Blood Flow and Metabolism, 1, 0.64%
Brain Sciences
Brain Sciences, 1, 0.64%
Cell Transplantation
Cell Transplantation, 1, 0.64%
Neurotherapeutics
Neurotherapeutics, 1, 0.64%
Circulation Research
Circulation Research, 1, 0.64%
Annals of Statistics
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Frontiers in Aging Neuroscience
Frontiers in Aging Neuroscience, 1, 0.64%
Life
Life, 1, 0.64%
Medicina
Medicina, 1, 0.64%
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Publishers

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Elsevier
Elsevier, 32, 20.38%
Springer Nature
Springer Nature, 29, 18.47%
Ovid Technologies (Wolters Kluwer Health)
Ovid Technologies (Wolters Kluwer Health), 18, 11.46%
SAGE
SAGE, 13, 8.28%
Wiley
Wiley, 12, 7.64%
MDPI
MDPI, 8, 5.1%
Frontiers Media S.A.
Frontiers Media S.A., 6, 3.82%
Japan Atherosclerosis Society
Japan Atherosclerosis Society, 6, 3.82%
Cold Spring Harbor Laboratory
Cold Spring Harbor Laboratory, 4, 2.55%
Oxford University Press
Oxford University Press, 3, 1.91%
Research Square Platform LLC, 3, 1.91%
BMJ
BMJ, 3, 1.91%
Public Library of Science (PLoS)
Public Library of Science (PLoS), 2, 1.27%
Taylor & Francis
Taylor & Francis, 2, 1.27%
The Japanese Association of Rehabilitation Medicine, 2, 1.27%
Institute of Mathematical Statistics
Institute of Mathematical Statistics, 1, 0.64%
Nippon-Shinzobyo-Gakkai/Japanese College of Cardiology, 1, 0.64%
SMW Supporting Association
SMW Supporting Association, 1, 0.64%
The Society of Physical Therapy Science, 1, 0.64%
American Medical Association (AMA)
American Medical Association (AMA), 1, 0.64%
Harran Universitesi Tip Fakultesi Dergisi
Harran Universitesi Tip Fakultesi Dergisi, 1, 0.64%
IntechOpen, 1, 0.64%
Japan Stroke Society, 1, 0.64%
Media Sphere Publishing House
Media Sphere Publishing House, 1, 0.64%
The Japanese Circulation Society
The Japanese Circulation Society, 1, 0.64%
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