Characterizing Stroke Clots Using Single-Cell Sequencing.

Background: Ischemic stroke results in significant morbidity and mortality. By examining gene expression of cells comprising stroke clots, we aim to gain valuable insights into the underlying mechanisms of this disease and identify potential biomarkers of stroke cause.

Methods: We employed single-cell RNA sequencing to analyze 10 clot samples from patients diagnosed with large vessel occlusion stroke.

National Versus State-Level Racial Disparities in Acute Stroke Interventions Using Get With The Guidelines-Stroke Data.

Background: Racial disparities have been reported in stroke care, but understanding if there is regional variability is critical to focusing policies and resources. Here, we sought to study racial and ethnic inequity in the administration of thrombolysis and thrombectomy at the national and state levels.

Methods: We conducted a retrospective cohort study using Get With The Guidelines-Stroke Program registry data from 2003 to 2022 to evaluate racial disparities in the administration of acute stroke treatments in US patients.

Polygenic Resistance to Blood Pressure Treatment and Stroke Risk: Insights from the All of Us Research Program.

Objective: Our goal was to investigate the impact of polygenic susceptibility to hypertension on systolic blood pressure (BP), uncontrolled hypertension, and stroke among hypertensive patients with BP treatment prescription.

Methods: This genetic association study used data from the All of Us Research Program (2017-2023) and replicated findings using the United Kingdom Biobank (2006-2010). Participants prescribed BP medication ≥4 years, with diagnosed hypertension or ≥2 systolic BP measurements >130mmHg, and without a previous stroke were categorized as having low, intermediate, or high polygenic susceptibility to hypertension using percentiles (<20, 20-80, >80) of a polygenic risk score for systolic BP.

Association of Polygenic Susceptibility to Hyperlipidemia With Cholesterol Control and Recurrent Stroke in Ischemic Stroke Survivors.

Background And Objectives: Common genetic variation significantly influences the risk of stroke, and previous research has indicated that polygenic susceptibility to hypertension and diabetes negatively affects the clinical trajectory of ischemic stroke survivors. We hypothesize that polygenic susceptibility to hyperlipidemia (PSH) negatively affects cholesterol control in this same population.

Methods: We conducted a genetic association study using data from the Vitamin Intervention Stroke Prevention (VISP) study, a clinical trial that enrolled survivors of ischemic stroke.

Global gender representation in neurointerventional surgery: a natural language processing analysis of journal publications.

Background: Despite increased awareness of diversity and inclusion in neurointerventional surgery, the representation of women in neurointerventional academic publishing has not been systematically quantified. We aimed to evaluate global and temporal gender trends among authors publishing in leading neurointerventional journals using natural language processing (NLP) tools.

Methods: We used the National Center for Biotechnology Information (NCBI) Entrez and Medline APIs (application programming interfaces) to extract metadata from all articles published between 2014 and 2024 in the and , the only two journals dedicated exclusively to the field of neurointerventional surgery.

Hypertension Is Associated With Earlier Onset of Nontraumatic Subarachnoid Hemorrhage in Women: A Mendelian Randomization Study.

Background: Nontraumatic subarachnoid hemorrhage (SAH) is linked to hypertension, a condition highly influenced by common genetic variants. For complex diseases affected by genetic and environmental factors, genetic predisposition plays a key role in early onset. We hypothesize that elevated polygenic susceptibility to hypertension is associated with a younger age of onset in SAH.

Automatic Detection and Classification of Cerebral Microbleeds Using 3D CNN.

Cerebral Microbleeds (CMBs) are referred to tiny foci of hemorrhage in brain parenchyma which are smaller than 5 (to 10) mm in size. The presence of CMBs is implicated in pathophysiology of cognitive impairment, dementia, radiation-induced vascular injury, traumatic brain injury, hypertensive microangiopathy, and aging. On brain Magnetic Resonance Imaging (MRI) scans, CMBs appear as hypointense foci, most notable on T2*-weighted or Susceptibility-Weighted Imaging (SWI).

Early CSF inflammatory markers after aneurysmal subarachnoid hemorrhage and their relationship to disease severity and shunt placement.

Background: The inflammatory response within the central nervous system is a key driver of secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Less is known about the impact that inflammation has on complications like persistent post-hemorrhagic hydrocephalus. To explore the association between inflammation, disease severity, and permanent shunt placement, we characterized the early cytokine profiles of the blood and cerebrospinal fluid (CSF) of patients with aSAH.

Shared genetic architecture of posttraumatic stress disorder with cardiovascular imaging, risk, and diagnoses.

Patients with post-traumatic stress disorder face increased cardiovascular risk. This study examines shared genetic regions between post-traumatic stress disorder and 246 cardiovascular conditions across electronic health records, 82 cardiac imaging, and health behaviors defined by Life's Essential 8. Post-traumatic stress disorder is genetically correlated with cardiovascular diagnoses in 33 regions, imaging traits in 4 regions, and health behaviors in 44 regions.

The Ethnic/Racial Variations of Intracerebral Hemorrhage Genetics (ERICH-GENE) Study Protocol.

Background: Spontaneous, non-traumatic intracranial hemorrhage (ICH) is highly heritable disease. However, the identification of the genetic risk factors driving this high genetic predisposition has been limited by small sample sizes and underrepresentation of non-European populations. The ERICH-GENE study will gather and harmonize clinical, neuroimaging and genomic data on the largest and more diverse collection of ICH cases assembled to date.

APOE ε4 and Risk of Intracranial Hemorrhage in Patients With Atrial Fibrillation Taking Apixaban.

Importance: The APOE ε4 variant is causally linked to cerebral amyloid angiopathy and is a risk factor for intracranial hemorrhage (ICH) among warfarin-treated patients with atrial fibrillation. Nevertheless, its impact on those treated with apixaban remains unknown.

Objective: To test the hypothesis that APOE ε4 allele carriership is associated with an increased risk of ICH in patients with atrial fibrillation taking apixaban.

Acute Ischemic Stroke Risk Following Cardiac Interventions in the United States From 2016 to 2021.

Background And Objectives: Ischemic stroke following cardiac intervention is a serious complication. However, there are limited data comparing stroke risk and severity among patients undergoing different types of cardiac interventions. We examined the incidence of ischemic stroke among patients undergoing cardiac interventions and identified variables associated with risk and severity of ischemic stroke.

The Brain Care Score and its associations with cardiovascular disease and cancer.

Background: The Brain Care Score (BCS) was developed in partnership with patients and practitioners to convey actionable knowledge to individuals everywhere that can motivate change in health-related behaviors and thereby reduce the risk of dementia, stroke, and late-life depression (LLD). Because diseases outside the brain share modifiable risk factors with dementia, stroke, and LLD, we investigated the associations of the BCS with other common age-related diseases, including cardiovascular disease (CVD) and cancer.

Methods: Among all UK Biobank (UKB) participants with complete BCS data, we performed Cox proportional hazard regression analyses between the BCS at baseline and incident CVD (ischemic heart disease, stroke, and heart failure) and the three most common cancer types (lung, colorectal, and breast cancer), adjusted for sex and stratified by age.

Different Responses to Blood Pressure Reduction in Lobar and Deep Intracerebral Hemorrhage.

Background: Intensive blood pressure (BP) reduction may benefit patients with acute intracerebral hemorrhage (ICH), but it is unknown if those benefits apply equally to patients with lobar and deep ICH. Our objective was to assess the impact of intensive BP reduction on hematoma expansion (HE), 90-day functional outcomes, and renal adverse events (RAEs) in patients with deep ICH compared with those with lobar ICH.

Methods: This was an exploratory, post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) randomized clinical trial, which investigated the efficacy of intensive BP reduction (110-139 mm Hg systolic BP) versus standard (140-179 mm Hg systolic BP) reduction 4.

Impact of Social Determinants of Health on Outcomes of Nontraumatic Subarachnoid Hemorrhage.

Background: Nontraumatic subarachnoid hemorrhage (SAH) presents a significant health burden, yet the influence of social determinants of health on outcomes remains unclear. This study examines the impact of social determinants of health on outcomes of patients with SAH.

Methods And Results: We conducted a retrospective analysis of prospectively collected data from the GWTG (Get With The Guidelines)-Stroke registry, including patients with SAH across the United States from 2012 to 2021.

Modifiable risk factors for stroke, dementia and late-life depression: a systematic review and DALY-weighted risk factors for a composite outcome.

Background: At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.

Methods: A systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023.

Outcomes Following Minimally Invasive Surgery for Intracerebral Hemorrhage in the AHA Get With The Guidelines-Stroke Registry.

Background: The efficacy of minimally invasive surgery (MIS) in improving outcomes after nontraumatic intracerebral hemorrhage (ICH) remains uncertain, with inconsistent findings from randomized clinical trials. Our objective was to evaluate the real-world impact of MIS on ICH outcomes using a nationally representative cohort.

Methods: We performed a retrospective cohort study of patients with a nontraumatic ICH enrolled in the American Heart Association Get With The Guidelines-Stroke Registry between January 1, 2011, and December 31, 2021.

Genetically-Determined Low-density Lipoprotein in Ischemic Stroke Survivors.

Background And Objectives: Polygenic susceptibility to hypertension and diabetes negatively impacts the clinical trajectory of ischemic stroke survivors. We hypothesize that polygenic susceptibility to hyperlipidemia (PSH) negatively impacts cholesterol control in this same population.

Methods: We conducted a genetic association study using data from the Vitamin Intervention Stroke Prevention (VISP) study, a clinical trial that enrolled survivors of ischemic stroke.

Voxel-Wise Map of Intracerebral Hemorrhage Locations Associated With Worse Outcomes.

Background: Prior studies on the clinical impact of intracerebral hemorrhage (ICH) location have used visual localization of hematomas to neuroanatomical structures. However, hematomas often cross neuroanatomical structure boundaries with inter-reviewer variability in visual localization. To address these limitations, we applied voxel-wise analysis to identify brain regions where ICH presence is independently predictive of worse outcomes.

Optimizing Automated Hematoma Expansion Classification from Baseline and Follow-Up Head Computed Tomography.

Hematoma expansion (HE) is an independent predictor of poor outcomes and a modifiable treatment target in intracerebral hemorrhage (ICH). Evaluating HE in large datasets requires segmentation of hematomas on admission and follow-up CT scans, a process that is time-consuming and labor-intensive in large-scale studies. Automated segmentation of hematomas can expedite this process; however, cumulative errors from segmentation on admission and follow-up scans can hamper accurate HE classification.

Polygenic score integrating neurodegenerative and vascular risk informs dementia risk stratification.

Introduction: An integrative polygenic risk score (iPRS) capturing the neurodegenerative and vascular contribution to dementia could identify high-risk individuals and improve risk prediction.

Methods: We developed an iPRS for dementia (iPRS-DEM) in Europeans (aged 65+), comprising genetic risk for Alzheimer's disease (AD) and 23 vascular or neurodegenerative traits (excluding apolipoprotein E [APOE]). iPRS-DEM was evaluated across cohorts comprising older community-dwelling people (N = 3702), a multi-ancestry biobank (N = 130,797 Europeans; 105,404 non-Europeans), and dementia-free memory clinic participants (N = 2032).

Spatial Correlates of Dementia and Disability After Intracerebral Hemorrhage.

Background: Dementia and disability are highly prevalent after spontaneous intracerebral hemorrhage (ICH). Previous studies categorizing ICH by large anatomic boundaries have demonstrated that lobar ICH is associated with dementia, while ICH in the basal ganglia is associated with disability. This study aims to refine our understanding of the association between ICH location and post-ICH dementia and disability at a voxel level, which could improve the prognostic accuracy of these outcomes and provide mechanistic insights into post-ICH functional outcomes.

Optimal Magnitude of Blood Pressure Reduction and Hematoma Growth and Functional Outcomes in Intracerebral Hemorrhage.

Background And Objectives: Early intensive systolic blood pressure (SBP) reduction is a promising strategy for intracerebral hemorrhage (ICH), but the optimal magnitude of reduction in the first 2 hours remains uncertain. This study aimed to determine the optimal SBP reduction magnitude to maximize benefit in patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial.

Methods: We performed a post hoc analysis of the ATACH-2 trial.

Bidirectional relationship between epigenetic age and stroke, dementia, and late-life depression.

Chronological age is an imperfect estimate of molecular aging. Epigenetic age, derived from DNA methylation data, provides a more nuanced representation of aging-related biological processes. We examine the bidirectional relationship between epigenetic age and brain health events (stroke, dementia, late-life depression) using data from 4,018 participants.

Polygenic Susceptibility to Diabetes and Poor Glycemic Control in Stroke Survivors.

Background And Objectives: Type 2 diabetes mellitus (T2DM) is highly genetically determined, and polygenic susceptibility to T2DM (PSD) increases the risk of worse glycemic control and adverse vascular outcomes. Its role in stroke patients remains unknown. We aim to determine whether higher PSD is associated with worse glycemic control in stroke survivors.