Targeted proteomic analysis identifies ACVRL1 as a marker of cerebral edema in aneurysmal subarachnoid hemorrhage.

Cerebral edema (CE) is a major component of early brain injury from aneurysmal subarachnoid hemorrhage (SAH). Despite the utility of blood-based protein markers, biomarkers targeting cerebral edema have yet to be developed. We performed a targeted proteomic search analyzing 141 proteins in plasma samples taken from 80 adult patients within 48 hours after aneurysmal rupture to identify plasma biomarkers of cerebral edema.

Mild Hypothermia After Endovascular Treatment for Acute Ischemic Stroke: A Pilot Randomized Controlled Trial.

Background: Therapeutic hypothermia is a potent neuroprotective therapy that mitigates ischemic brain injury. This study aimed to investigate the safety and feasibility of mild therapeutic hypothermia after successful endovascular recanalization in patients with acute ischemic stroke due to major vessel occlusion.

Methods: We conducted a prospective, multicenter, open-label pilot randomized clinical trial at 5 stroke centers in South Korea between December 2016 and November 2019.

Temporal changes in symptomatic intracranial arterial disease: a longitudinal high-resolution vessel wall imaging study.

Introduction: The temporal dynamics of the vessel wall in intracranial arterial disease (ICAD) may differ depending on the etiology. We investigated temporal changes in narrowed intracranial arteries after ischemic stroke using serial high-resolution vessel wall imaging (HR-VWI).

Methods: We retrospectively recruited patients with ICAD-related ischemic stroke who underwent two or more HR-VWI scans.

Personalized Visual Perceptual Learning Digital Therapy for Visual Field Defects Following Stroke: A Randomized Clinical Trial.

Importance: Effective treatments for restoring visual field defects (VFDs) in patients with stroke necessitate validation through randomized clinical trials.

Objective: To evaluate the efficacy and safety of a personalized digital therapeutic based on visual perceptual learning for treating poststroke VFDs.

Design, Setting, And Participants: A multicenter randomized clinical trial was conducted from October 19, 2022, to November 8, 2023, at 12 hospitals in South Korea.

Temporal patterns of occult cancer incidence following acute ischemic stroke: A comparative study by stroke etiology.

Backgrounds And Aims: This study investigates the temporal patterns of occult cancer incidence among survivors of acute ischemic stroke (AIS), with a focus on variations by underlying stroke etiology.

Patients And Methods: We analyzed data from a prospective, multicenter stroke registry and a national claims database, identifying AIS patients hospitalized between 2011 and 2013. Patients were categorized by stroke etiology into two groups: unidentified stroke etiology (USE) and identified stroke etiology (ISE).

Association of Age, Sex and Education With Access to the Intravenous Thrombolysis for Acute Ischemic Stroke.

Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients.

Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea.

Deep learning-assisted detection of intracranial hemorrhage: validation and impact on reader performance.

Purpose: Intracranial hemorrhage (ICH) requires urgent treatment, and accurate and timely diagnosis is essential for improving outcomes. This pivotal clinical trial aimed to validate a deep learning algorithm for ICH detection and assess its clinical utility through a reader performance test.

Methods: Retrospective CT scans from patients with and without ICH were collected from a tertiary hospital.

Persistent Beta-Blocker Therapy Reduces Long-Term Mortality in Patients With Acute Ischemic Stroke With Elevated Heart Rates.

Background: Elevated heart rate in patients with acute ischemic stroke is associated with increased risk of mortality. Beta-blocker therapy is well known to reduce heart rate.

Methods And Results: This study was a post hoc analysis of patients with acute ischemic stroke with maximum heart rates ≥100 bpm.

Temporal Trends in Stroke Management and Outcomes Between 2011 and 2020 in South Korea: Results From a Nationwide Multicenter Registry.

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.

Long-Term Incidence of Gastrointestinal Bleeding Following Ischemic Stroke.

Background And Purpose: Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes.

Optimal Cerebral Blood Flow Thresholds for Ischemic Core Estimation Using Computed Tomography Perfusion and Diffusion-Weighted Imaging.

Objective: Computed tomography perfusion (CTP) imaging is crucial in quantifying cerebral blood flow (CBF) and thereby making an endovascular treatment (EVT) after large vessel occlusion. However, CTP is prone to overestimating the ischemic core. We sought to delineate the optimal regional CBF (rCBF) thresholds of pre-EVT CTP.

Trajectory clustering of immune cells and its association with clinical outcomes after aneurysmal subarachnoid hemorrhage.

Background And Purpose: The immune response following aneurysmal subarachnoid hemorrhage (aSAH) can exacerbate secondary brain injury and impact clinical outcomes. As the immune response after aSAH is a dynamic process, we aim to track and characterize immune cell trajectories over time to identify patterns associated with various clinical outcomes.

Methods: In this retrospective single-center study of patients with aSAH, we analyzed immune cell count trajectories, including neutrophil, monocyte, and lymphocyte counts, collected from day 1 to day 14.

Digital therapeutics using virtual reality-based visual perceptual learning for visual field defects in stroke: A double-blind randomized trial.

Introduction: Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs.

Effect of Statin Therapy on Cardiovascular Outcome in Stroke Patients with Low Baseline Low-Density Lipoprotein Cholesterol.

Objectives: To investigate whether post-stroke statin therapy reduces subsequent major vascular events in statin-naïve patients with pretreatment low-density lipoprotein cholesterol (LDL-C) below the recommended target (≤70 mg/dL for atherosclerotic stroke and ≤100 mg/dL for non-atherosclerotic stroke) at stroke onset.

Methods: Patients from an ongoing stroke registry who had an ischemic stroke between 2011 and 2020 were screened. Statin naïve patients with baseline LDL-C below the target were assessed.

Efficacy of Endovascular Thrombectomy in Acute Basilar Artery Occlusion with Low PC-ASPECTS: A Nationwide Prospective Registry-Based Study.

Objective: We evaluated the efficacy of endovascular thrombectomy (EVT) on the functional outcome of patients with acute basilar artery occlusion and low posterior circulation acute stroke prognosis early computed tomography score (PC-ASPECTS).

Methods: We identified patients with acute ischemic stroke due to basilar artery occlusion and PC-ASPECTS of 6 or less, presenting within 24 h between August 2008 and April 2022. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-3 at 90 days.

Strengthening deep-learning models for intracranial hemorrhage detection: strongly annotated computed tomography images and model ensembles.

Background And Purpose: Multiple attempts at intracranial hemorrhage (ICH) detection using deep-learning techniques have been plagued by clinical failures. We aimed to compare the performance of a deep-learning algorithm for ICH detection trained on strongly and weakly annotated datasets, and to assess whether a weighted ensemble model that integrates separate models trained using datasets with different ICH improves performance.

Methods: We used brain CT scans from the Radiological Society of North America (27,861 CT scans, 3,528 ICHs) and AI-Hub (53,045 CT scans, 7,013 ICHs) for training.

Improvement in Delivery of Ischemic Stroke Treatments but Stagnation of Clinical Outcomes in Young Adults in South Korea.

Background: There is limited information on the delivery of acute stroke therapies and secondary preventive measures and clinical outcomes over time in young adults with acute ischemic stroke. This study investigated whether advances in these treatments improved outcomes in this population.

Methods: Using a prospective multicenter stroke registry in Korea, young adults (aged 18-50 years) with acute ischemic stroke hospitalized between 2008 and 2019 were identified.

Association between blood pressure and endovascular treatment outcomes differs by baseline perfusion and reperfusion status.

We hypothesized that the association between BP and endovascular treatment (EVT) outcomes would differ by baseline perfusion and recanalization status. We identified 388 ICA or M1 occlusion patients who underwent EVT ≤ 24 h from onset with successful recanalization (TICI ≥ 2b). BP was measured at 5-min intervals from arrival and during the procedure.

Tricuspid regurgitation: a hidden risk factor for atrial fibrillation related stroke?

Background And Purpose: Tricuspid regurgitation (TR) is a common but overlooked valvular disease, and its association with the etiologic subtypes of ischemic stroke is unclear. We explored the relationship between TR and atrial fibrillation (AF) in patients with acute ischemic stroke.

Methods: This retrospective analysis of ongoing stroke registry assessed 6,886 consecutive acute ischemic stroke patients who underwent transthoracic echocardiography during their in-hospital care.