Exploring the efficacy and safety of dual antiplatelet therapy in patients with embolic stroke of undetermined source according to stroke risk stratification: Propensity-score matched analysis.

Introduction: Dual antiplatelet therapy (DAPT) is widely used for embolic stroke of undetermined source (ESUS) despite limited evidence regarding its efficacy and safety. This study compared DAPT and single antiplatelet therapy (SAPT) in patients with ESUS during hospitalization (first 7 days) and up to 30 days post-stroke, identifying subgroups that benefit most from DAPT.

Methods: We retrospectively analyzed data from 4,505 patients with ESUS enrolled in a multicenter registry from 2014 to 2019.

Predicting cognitive decline in cognitively impaired patients with ischemic stroke with high risk of cerebral hemorrhage: a machine learning approach.

Background And Objective: Cognitive decline progresses rapidly in stroke patients, increasing risks of stroke recurrence. Predicting deterioration within a year in patients with poststroke cognitive impairment (PSCI) could guide targeted interventions for dementia prevention and better prognosis. In this PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage for reducing cognitive decline substudy, machine learning on clinical and imaging data was used to predict cognitive decline over 9 months in PSCI patients.

Proximal and distal middle cerebral artery diameter ratio and lenticulostriate artery infarction.

Background: Lipohyalinotic degeneration (LD) and branch atheromatous disease (BAD) can contribute to subcortical infarctions in the lenticulostriate artery (LSA) territory. This study aimed to identify the association between the proximal and distal middle cerebral artery (MCA) diameter ratio and the two different pathomechanisms of LSA infarction.

Methods: Patients with acute LSA infarctions categorized as small vessel occlusive disease were included.

Blood pressure threshold and outcomes after successful endovascular thrombectomy.

Background: Several randomized clinical trials have indicated that intensive blood pressure (BP) lowering is associated with worse outcomes, leaving the optimal BP targets following endovascular thrombectomy (EVT) uncertain.

Aims: This study aimed to investigate the relationship between specific systolic BP (SBP) thresholds, time spent outside these thresholds, and clinical outcomes.

Methods: This post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP) trial, included patients with successful EVT randomized to intensive (<140 mmHg) or conventional (140-180 mmHg) BP management.

Deep learning to identify stroke within 4.5 h using DWI and FLAIR in a prospective multicenter study.

To enhance thrombolysis eligibility in acute ischemic stroke, we developed a deep learning model to estimate stroke onset within 4.5 h using diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images. Given the variability in human interpretation, our multimodal Res-U-Net (mRUNet) model integrates a modified U-Net and ResNet-34 to classify stroke onset as < 4.

Association Between Intravenous Antihypertensives and Functional Outcome After Successful Endovascular Thrombectomy.

Background: Intravenous antihypertensives are frequently used to control blood pressure after successful endovascular thrombectomy (EVT), yet studies investigating the relationship between intravenous antihypertensive use and functional outcomes after successful EVT remain limited.

Methods: We conducted an exploratory secondary analysis of the OPTIMAL-BP trial (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control), which compared intensive (systolic blood pressure <140 mm Hg) versus conventional blood pressure management (systolic blood pressure, 140-180 mm Hg) within the first 24 hours after successful recanalization across 19 stroke centers in South Korea between June 2020 and November 2022. Patients were classified according to the administration of intravenous antihypertensives within the initial 24 hours after enrollment.

Serial changes and optimal imaging windows in vessel wall MRI for unruptured intracranial artery dissection.

We investigated serial changes in intracranial artery dissection (ICAD) from the baseline to 12 months on vessel wall MRI. This prospective study enrolled 17 participants with clear onset of 20 unruptured ICADs between April 2016 and May 2018, and underwent vessel wall MRI within 1 week, and at 1-, 3-, 6-, and 12-months following symptom onset. Detection rates of imaging features, imaging time showing stable morphology and measurements were assessed, and compared between 1- and 3-month using exact McNemar's and Wilcoxon signed-rank test.

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.

Genetic and imaging features of CADASIL patients with acute ischemic stroke.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), which is caused by mutations in the NOTCH3 gene, is associated with early-onset strokes. However, the specific genetic and imaging characteristics associated with acute ischemic stroke (AIS) in patients with CADASIL remain unclear. We reviewed CADASIL patients with NOTCH3 mutations, dividing them into two groups based on the presence of clinically relevant AIS lesions on diffusion-weighted imaging, observed at any time, regardless of the timing of CADASIL diagnosis.

Blood pressure management based on infarct volume after successful endovascular thrombectomy.

Introduction: While the efficacy of endovascular thrombectomy (EVT) in large core infarcts has been established, the influence of blood pressure (BP) management on functional outcomes based on infarct volume remains unclear.

Patients And Methods: We conducted a secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP) trial, which compared intensive (systolic BP < 140 mmHg) versus conventional (systolic BP 140-180 mmHg) BP management within the first 24 h following successful recanalization. Patients were grouped based on an infarct volume cut-off of 50 ml, assessed 24 h post-EVT.

Impact of Polymorphism in Isolated Intracranial Arterial Steno-Occlusive Disease.

Background And Purpose: To determine whether the p.R4810K mutation modifies the number of moyamoya disease manifestations and recurrent strokes in isolated intracranial arterial steno-occlusive disease (ICAD).

Methods: This retrospective case-control study analyzed patients who visited the Asan Medical Center with steno-occlusive lesions in the M1 segment of the middle cerebral artery and terminal internal carotid artery, and underwent genetic testing for screening moyamoya disease between January 2010 and November 2022.

Occipital cerebral microbleeds as a predictor of intracranial hemorrhage in posterior reversible encephalopathy syndrome.

Background And Objectives: Intracranial hemorrhage (ICH), which often occurs in cases of posterior reversible encephalopathy syndrome (PRES), is regarded as a significant predictor of poor disease outcomes. While ICH and cerebral microbleeds (CMBs) can occur due to uncontrolled hypertension, the relationship between these conditions remains unclear.

Methods: This retrospective case-control study categorized PRES patients according to the presence of ICH on the day of symptom onset.

Mediation of Time-Related Blood Pressure Variability on Intensive Blood Pressure Lowering and Functional Outcomes Post Endovascular Therapy: A Post Hoc Analysis of the OPTIMAL-BP Trial.

Background: We investigated whether the association between blood pressure (BP) management in patients with successful reperfusion following endovascular therapy (EVT) and functional outcomes is mediated by BP variability parameters.

Methods And Results: This is a post hoc analysis of the OPTIMAL-BP (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control) trial, conducted at 19 centers in South Korea. The primary outcome was the 90-day functional outcome, assessed using the modified Rankin Scale.

Cardiovascular Outcomes of Early LDL-C Goal Achievement in Patients with Very-High-Risk ASCVD.

Introduction: Clinical trial evidence supports early low-density lipoprotein cholesterol (LDL-C) goal achievement in patients with atherosclerotic cardiovascular disease (ASCVD), but real-world evidence in Asia is lacking. We investigated the effects of early LDL-C goal achievement on recurrent major cardiovascular events (MACEs) among patients with very-high-risk ASCVD in South Korea.

Methods: We included adult patients hospitalized with ASCVD (acute coronary syndrome [ACS], stable angina, ischemic stroke, transient ischemic attack, peripheral arterial disease, or asymptomatic coronary artery disease) at a major Korean tertiary hospital from 2000 to 2020.

Factors Associated With Silent Brain Infarcts After Middle Cerebral Artery Stenting or Balloon Angioplasty.

Background And Purpose: Silent brain infarcts (SBIs), which manifest as dot-like lesions on diffusion-weighted imaging (DWI) after endovascular procedures, are associated with an increased risk of stroke, dementia, and cognitive decline. We aimed to identify the factors associated with SBIs following middle cerebral artery (MCA) stenting or balloon angioplasty.

Methods: We retrospectively reviewed patients who underwent MCA stenting or balloon angioplasty, including those with symptomatic, atherosclerotic MCA stenosis of ≥50%.

Nelonemdaz and Patients With Acute Ischemic Stroke and Mechanical Reperfusion: The RODIN Randomized Clinical Trial.

Importance: Nelonemdaz selectively antagonizes the 2B subunit of the N-methyl-d-aspartate glutamate receptor and scavenges free radical species.

Objective: To evaluate whether nelonemdaz enhances the clinical outcomes of patients with acute ischemic stroke undergoing emergent reperfusion therapy.

Design, Setting, And Participants: This multicenter double-blind placebo-controlled randomized phase 3 trial (December 25, 2021, to June 30, 2023, in South Korea) recruited patients with acute ischemic stroke who met the following criteria: National Institutes of Health Stroke Scale score greater than or equal to 8, Alberta Stroke Program Early Computed Tomography score greater than or equal to 4, and endovascular thrombectomy within 12 hours after stroke onset.

Effects of blood pressure lowering in patients treated with intravenous thrombolysis before endovascular thrombectomy.

Background: The effects of blood pressure (BP) lowering in patients treated with intravenous tissue plasminogen activator (IV tPA) before endovascular thrombectomy (EVT) are unclear.

Aims: This study aims to investigate whether intensive and conventional BP management affects outcomes differently, depending on IV tPA administration before EVT.

Methods: In this subgroup analysis of the Outcome in Patients Treated with Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP; ClinicalTrials.

Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source.

Background: Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up.

Methods: Patients with acute ischemic stroke classified as ESUS were included.

Intracranial Atherosclerotic Stenosis.

Background: Ischemic stroke is a significant global health problem associated with mortality and disability. Intracranial atherosclerotic stenosis (ICAS) is a leading cause of stroke and contributes to recurrent stroke, especially in the Asian population. ICAS should be distinguished from extracranial atherosclerotic stenosis (ECAS) due to differences in pathophysiology.

Intensive blood pressure lowering in acute stroke with intracranial stenosis post-thrombectomy: A secondary analysis of the OPTIMAL-BP trial.

Background: Intensive blood pressure (BP) management within 24 h after successful reperfusion following endovascular thrombectomy (EVT) is associated with worse functional outcomes than conventional BP management in Asian randomized controlled trials. Given the high prevalence of intracranial atherosclerotic stenosis (ICAS) in Asia, ICAS may influence these outcomes.

Aims: We aimed to assess whether ICAS affects the outcomes of intensive BP management after successful EVT.

Association Between the Timing of Atrial Fibrillation Detection and Functional Outcome Following Mechanical Thrombectomy.

Background: Atrial fibrillation detected after stroke (AFDAS) refers to the identification of newly diagnosed atrial fibrillation (AF) following an ischemic stroke in patients without known AF (KAF). The objective of this study was to compare the functional outcomes of patients diagnosed with AFDAS and those with KAF who underwent mechanical thrombectomy.

Methods And Results: We conducted a retrospective analysis of patients who underwent mechanical thrombectomy and with either new AF diagnosed during hospitalization or KAF.