Vascular Risk Research Articles (Page 3)

Intravenous immunoglobulin (IVIg) is effective in many neuroinflammatory disorders but carries a risk of thromboembolic events (TEEs). Subcutaneous immunoglobulin (SCIg) is effective, but its thromboembolic risk profile is less well-described, particularly in patients with prominent vascular risk factors. We investigated the thromboembolic risk profile of IVIg and SCIg using a large single-centre retrospective dataset of patients with neuroinflammatory disorders. 243 patients treated with immunoglobulin over a 15-year monitoring period were analysed. Demographic information was used to calculate QRISK3 vascular risk scores. Patients were grouped based on having received IVIg-only, SCIg-only or both IVIg and SCIg (with subgroup analysis of IVIg and SCIg treatment periods). TEE incidence rates were compared. The relationship between QRISK3 and TEE likelihood was analysed. A total of 1401 patient-years immunoglobulin treatment data were obtained. The SCIg-only cohort was older with higher QRISK3 scores. More patients on IVIg (n=14) than SCIg (n=2) experienced TEEs on treatment (1.38 vs 0.52 events per 100 patient-years), but this difference was not statistically significant. IVIg-treated patients with TEEs were younger (p=0.039) than SCIg-treated TEE patients. QRISK3 scores broadly correlated with thromboembolic risk across the cohort (p=0.027), but some younger IVIg patients with low QRISK3 scores experienced TEEs indicating that IVIg but not SCIg independently increases thromboembolic risk. QRISK3 scores >10% identified 71% and 100% of TEEs in IVIg-treated and SCIg-treated patients, respectively, but are insensitive (7%) as TEEs are rare events. SCIg is at least equivalent in thromboembolic risk to IVIg and may be safer for patients with existing vascular risk factors.

Persistent pulmonary hypertension of the newborn (PPHN) and retinopathy of prematurity (ROP) are traditionally regarded as distinct morbidities in preterm infants, yet both share common antecedents such as oxygen instability, hyperoxia, and inflammation. Inhaled nitric oxide (iNO) is established as first-line therapy for PPHN, but its broader impact on extra-pulmonary vascular development has remained uncertain. In a nationwide U.S. study, Cho et al. reported that PPHN was independently associated with an increased risk of ROP, and that iNO administration in infants with PPHN was linked to a reduced incidence of severe ROP. Our Japanese cohort studies complement these findings by showing that PPHN independently predicted long-term visual impairment, even after adjusting for severe ROP, and that coexistence with bronchopulmonary dysplasia further amplified ocular risk. In contrast, post-acute iNO use beyond the first week of life, typically in infants with established severe lung disease, was not associated with improved neurodevelopmental or visual outcomes. Together, these observations suggest that PPHN represents a systemic vascular phenotype and that the impact of iNO depends critically on timing and pathology. Integrating pulmonary and ocular outcomes in both clinical management and research may reframe PPHN therapy as multi-organ protection for extremely preterm infants. IMPACT: This Commentary highlights the emerging recognition of persistent pulmonary hypertension of the newborn (PPHN) as a systemic vascular risk phenotype that links pulmonary and ocular outcomes in preterm infants. By integrating evidence from U.S. population data and Japanese cohort studies, it emphasizes the phase-specific effects of inhaled nitric oxide (iNO) on both pulmonary and retinal health. The article reframes PPHN management as a strategy for multi-organ protection and underscores the importance of future prospective trials that include visual outcomes alongside traditional respiratory and survival endpoints.

Objective: To determine the specific quantitative relationship between the hypersensitive C-reactive protein-albumin ratio and short-term clinical outcome measures within 30 days of endovascular therapy in patients diagnosed with acute ischaemic stroke. Method: The retrospective study was conducted at the Jinyang Hospital, China, and comprised data from January 2019 to July 2023 of patients with acute large-vessel occlusive stroke who underwent endovascular therapy. The patients were stratified into two prognostic groups according to their 30-day postoperative modified Rankin Scale scores. Group A had patients with score 0-2 indicating good prognosis, and group B had patients with score 3-6 indicating poor prognosis. Baseline characteristics, vascular risk factors, laboratory test parameters, consultation duration, stroke subtype, responsible vessel and other relevant clinical data was noted and compared between the groups. Data was analysed using SPSS 25. Results: Of the 195 patients, 125(64%) were males and 70(36%) were females. The overall median age was 65 years (interquartile range: 54-74 years). There were 102(52.3%) patients in group A and 93(47.7%) were in group B. Advanced age, hypertension, cerebral oedema, haemorrhagic transformation, baseline National Institutes of Health Stroke score, white blood cell count, infarct volume and hypersensitive C-reactive protein-albumin ratio were significantly different between the groups (p<0.05). Receiver operating characteristic curve analysis revealed that C-reactive protein-albumin ratio predicted the highest value with area under the curve being 0.778. Conclusion: Elevated hypersensitive C-reactive protein-albumin ratio levels independently correlated with adverse clinical outcomes in acute ischaemic stroke patients undergoing endovascular therapy. Key Words: Hypersensitive C-reactive protein-albumin ratio, Endovascular treatment of acute, Acute ischaemic stroke, Prognostic.

White matter hyperintensities (WMH), traditionally linked to cerebral small vessel disease, are frequent in Progressive Supranuclear Palsy (PSP). This study assessed their prognostic value in disease progression. Sixty PSP patients underwent 3 Tesla Magnetic Resonance Imaging (MRI) at baseline and then were followed for of 48.62 ± 25.11 (mean ± standard deviation) months with extensive neurological evaluations. WMH were rated with the age-related white matter changes (ARWMC) scale (total and lobar),classifying patients into two groups: ARWMC = 0 (without WMH) and ARWMC >0 (with WMH). Outcomes included time to disease milestones (unintelligible speech, wheelchair dependency, PEG placement, death). Kaplan-Meier, Cox regression, and linear mixed models were applied, adjusting for age, sex, and vascular risk factors. Baseline WMH were present in 65% (mean ARWMC score 4.7 ± 3.3), predominantly in frontal and parietal lobes. The presence of WMH did not significantly influence time to milestones or death. In subregional analyses, higher temporal lobe WMH scores predicted reaching any milestones (HR 3.336, 95% CI 1.698-6.555, p<0.001) and death (HR 2.533, 95% CI 1.297-4.945, p=0.006), even after adjusting for age, sex and ARWMC score of all lobes. No effect of WMH burden on PSP-rs progression was observed. Overall WMH burden at baseline was not associated with clinical progression in PSP, although temporal lobe WMH may represent a specific prognostic marker. These findings suggest a limited role of WMH in PSP progression and call for advanced imaging studies to clarify their contribution.

The incidence and prevalence of both cardiac and renal disease in Germany are steadily rising. Heart disease is the most common cause of death, especially among people with chronic kidney disease. Impaired kidney function increases the risk of cardiovascular events, and vice versa. This narrative review is based on pertinent publications retrieved by a literature search up to the year 2025, with particular attention to the guidelines of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) and the European Society of Cardiology (ESC). Supplementary searches were conducted on individual aspects of the epidemiology, diagnosis, and treatment of heart and kidney disease. The heart and the kidneys are closely pathophysiologically linked. Both can be damaged by shared vascular risk factors, including diabetes mellitus, arterial hypertension, and chronic inflammation. These shared mechanisms give rise to a continuum of diseases. Multiple RCTs have shown in recent years that the morbidity and mortality of patients with heart and kidney diseases can be significantly lowered by treatment not only with ACE inhibitors, but also with sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 receptor agonists (GLP1-RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRA). Absolute risk reductions in the range of 1.8% to 6.7% have been found to be achievable for most of the combined endpoints studied, depending on the particular active substance used. Heart and kidney diseases often arise together and can be treated with new pharmacotherapeutic strategies. Open questions remain concerning the potential synergistic effects of the drugs mentioned above, the suitable management of polypharmacy, and the enabling of cost-effective care.

Apolipoprotein ε4 (APOE ε4) is a potent genetic risk factor for Alzheimer's disease (AD). However, its role in cerebral small vessel disease (CSVD) remains unclear. Given the clinical and pathological similarities between CSVD and AD, this study aimed to investigate the associations of APOE ε4 gene dosage with cognitive function and dyslipidemia in CSVD patients, and to explore whether lipid disturbances mediate the effect of APOE ε4 on white matter hyperintensity (WMH) burden and cognitive impairment. The study was a retrospective study. A total of 717 inpatients with CSVD admitted to the Department of Neurology, Wuhan No.1 Hospital, from January 2023 to January 2025 were enrolled. Associations among APOE ε4 gene dosage, cognitive function, lipid metabolism, and WMH were analyzed. The number of APOE ε4 alleles showed a significant negative correlation with MMSE and MoCA scores (p < 0.001), and a dose-dependent positive correlation with the risk of cognitive impairment and WMH severity, independent of traditional vascular risk factors. Lipid analysis indicated that APOE ε4 was an independent risk factor for elevated low-density lipoprotein cholesterol (LDL-C), but had no significant associations with high-density lipoprotein cholesterol (HDL-C) or triglycerides (TG). Mediation analysis suggested that LDL-C may mediate the indirect detrimental effect of APOE ε4 on cognitive function. APOE ε4 gene dosage is an independent risk factor for cognitive decline and WMH in CSVD patients, independent of traditional vascular risk factors. APOE ε4 may indirectly impair cognitive function by elevating LDL-C levels to exacerbate atherosclerosis and cerebrovascular injury.

BackgroundBoth patients with migraine with aura (MA) and patients with ischemic stroke have an increased risk of white matter hyperintensities (WMH) indicating structural microvascular brain damage. It is unclear whether other signs of microvascular damage are also more abundant in these patients, and whether patients with both conditions are more severely affected.MethodsWe included middle-aged women with a history of MA, ischemic stroke, or both, as well as age-matched female control participants without any neurological disease, from two cross-sectional MRI studies (CREW and WHISPER). We assessed WMH, enlarged perivascular spaces, cerebral microbleeds, lacunes, cortical superficial siderosis, parenchymal volume, and cortical atrophy, according to STRIVE criteria. A total small vessel disease (SVD) burden score was determined. We performed regression analyses to assess the association between a history of MA, stroke, or both, and the different MRI markers, adjusted for vascular risk factors.ResultsWe included 207 women (mean age 51 years): 39 with MA, 67 with stroke, 62 with both MA and stroke, and 39 controls. MA was not associated with increased microvascular damage compared with controls. Stroke patients had more cerebellar WMH (OR 7.9, 95%CI 0.9-73.6), more cortical atrophy (β 0.2, 95%CI 0.0-0.4), and a lower parenchymal volume (β -16.1, 95%CI -30.7--1.4) compared with controls. There was no difference in the frequency of any of the SVD markers on 3T-MRI in patients with stroke with or without migraine.ConclusionsIn our study, markers of microvascular cerebral damage were infrequent in middle-aged women with MA and healthy controls, while stroke was associated with more cerebellar WMH, decreased parenchymal volume, and cortical atrophy. We found no (supra-)additive effect of a history of migraine on the extent of microvascular brain damage in women with stroke.

Cerebrovascular events remain a major health issue, and despite significant improvements in diagnosis and treatment in recent years, their high morbidity and mortality mean that increasing attention is now being given to prevention and early prediction. One option for achieving this is to examine various biomarkers. This mini review covers copeptin, a 39-amino-acid glycopeptide, derived from the precursor protein pre-provasopressin. Copeptin shows great potential in the diagnosis and prognosis of diverse diseases, including cerebrovascular events. Compared to arginine vasopressin or cortisol alone, it shows better potential for use in emergency care due to its rapid determination. Understanding the role of copeptin and its clinical applications is essential for advancing patient care and treatment strategies. This mini review presents selected studies on the use of copeptin as a potential biomarker for cerebrovascular events. Its level correlates with the severity of both clinical and radiological impairment after a stroke. A correlation has been demonstrated between copeptin levels and the ability to predict a cerebrovascular event recurrence within 90 days after a transient ischemic attack. This mini review also includes the limits to copeptin, which are influenced by selected vascular risk factors for cerebrovascular events.

To evaluate the long-term incidence of hypercoagulable complications in young patients with retinal vein occlusions (RVO) and negative workups compared to matched controls. A retrospective cohort study was conducted using the TriNetX Analytics Network. Patients aged 18-50 with newly diagnosed RVO and no history of hypertension, glaucoma, thrombophilia, or recent oral contraceptive use were compared to age-matched controls. Propensity score matching (PSM) was performed to balance baseline demographics and comorbidities. Primary outcomes included the cumulative incidence and risk ratio (RR) of deep vein thrombosis (DVT), pulmonary embolism (PE), cerebral infarction, anticoagulant use, composite embolic events, myocardial infarctions (MI) and composite cardiovascular events over 1, 3, and 5 years. A secondary validation cohort was performed using controls diagnosed with astigmatism. After PSM, 2,731 patients were included in each cohort. Patients with RVO had significantly higher rates of venous thromboembolism, cerebral infarction, anticoagulation use, and composite embolic outcomes at 1, 3, and 5 years (all p < 0.0001). No significant differences were observed in MI or composite cardiovascular event outcomes. Young patients with RVO and no identifiable vascular or hypercoagulable risk factors are at significantly increased risk for venous thrombosis and stroke, but not myocardial infarction.

Diabetic peripheral neuropathy (DPN) is one of the most frequent complications of diabetes mellitus (DM). The aim of this brief narrative review was to discuss the relationship between DPN and balance impairment. DPN may alter movement perception as a result of diminished proprioceptive and cutaneous input from skin, muscles and joints, leading to balance impairment. In everyday practice, diagnosis of impaired balance relies on a combination of clinical history, physical examination and functional tests, such as the Timed Up and Go test or the Berg Balance Scale, as well as instrumental assessments where available. Therapeutic principles include optimised glycaemic control and management of vascular risk factors for prevention and management of DPN. While these measures do not directly improve balance, they may contribute to better postural stability by preserving peripheral nerve function, reducing the progression of neuropathic deficits, and maintaining muscle strength. In addition, general exercises for balance improvement, physiotherapy, and focused and specialised strengthening, stretching and functional training programs may improve static and dynamic balance. Finally, electric stimulation has demonstrated positive results in improving postural stability in DPN.

The discordance between glycated haemoglobin (HbA1c) and the glucose management indicator (GMI) has been proposed as a marker of vascular risk in diabetes. This study evaluated whether the GMI/ HbA1c ratio independently predicts diabetic retinopathy (DR) in adults with type 1 diabetes (T1D) using continuous glucose monitoring. We conducted a multicenter cross-sectional study involving 1,070 adults using flash glucose monitoring. Participants were stratified as high glycators (ratio < 0.9) or non-high glycators based on the GMI/HbA1c ratio. DR status was assessed by ophthalmologic evaluation. Multivariable logistic regression and 1:1 propensity score matching were used to assess independent associations with DR, adjusting for age, sex, diabetes duration, smoking, hypertension, LDL cholesterol, BMI and insulin dose. While high glycators had a higher crude DR prevalence (31.3% vs. 23.1%, p = 0.020), the GMI/HbA1c ratio was not independently associated with DR in adjusted models (OR 1.19; 95% CI: 0.34–4.15; p = 0.785) or in the matched cohort (OR 1.23; 95% CI: 0.76–1.99; p = 0.391). Absolute HbA1c remained the strongest glycemic predictor. These findings suggest that the GMI/HbA1c ratio may aid in interpreting discordant glycemic profiles, serving as a contextual tool in clinical practice, but it lacks independent prognostic value for DR.

The 2024 ESC atrial fibrillation guidelines introduced the CHA₂DS₂-VA score by removing female sex as an independent risk criterion. Although intended to simplify risk stratification and avoid sex-based overtreatment, the real-world implications for women who present with AF-related ischemic stroke/TIA remain unclear. In this prospective observational study, we examined the clinical implications of CHA₂DS₂-VA recalibration in a post-stroke setting, focusing on sex-specific differences in stroke severity and early functional outcome, and on the proportion of women who newly fall below the anticoagulation threshold (score ≤ 1). In a prospective cohort of 714 consecutive stroke patients, 161 (22.5%) had documented AF. Risk stratification was performed using both CHA₂DS₂-VASc and the revised CHA₂DS₂-VA score. Stroke severity (NIHSS) and functional outcome (mRS) were analyzed by sex. Propensity score matching and multivariable logistic regression were used to examine the independent association between sex and stroke severity. Female patients with AF were older and had a higher vascular risk burden than men. They presented with significantly more severe strokes (median NIHSS 12 vs. 8; P < 0.01) and tended toward worse outcomes. After score recalibration, 11 of 81 women (13.6%) had a CHA₂DS₂-VA score ≤ 1, falling below the ESC anticoagulation threshold-despite having experienced an ischemic stroke. Most of these patients had cardioembolic strokes and moderate-to-severe neurological deficits. In matched analyses, female sex remained independently associated with severe stroke (aOR 1.54, 95% CI 1.03-2.29). In this prospective cohort of AF-related ischemic stroke, women had greater comorbidity burden and higher stroke severity than men. A subgroup with CHA₂DS₂-VA ≤ 1 nonetheless sustained ischemic stroke, and exploratory 5-year follow-up suggested excess recurrence without anticoagulation. These findings require validation in larger cohorts.

ABSTRACTIntroductionPartial splenic embolization is a valuable option to manage hypersplenism and reduce portal pressure while preserving splenic function. It may improve surgical safety in patients with portal hypertension.Case PresentationA 67‐year‐old Japanese male with renal cell carcinoma and hepatitis B‐related liver cirrhosis presented with thrombocytopenia, collateral vessels, and a splenorenal shunt. Due to concerns regarding surgical risk, partial splenic embolization was performed preoperatively. Following the procedure, the platelet count increased, and collateral circulation decreased. These improvements enabled a safe left radical nephrectomy.ConclusionPartial splenic embolization can be an effective preoperative strategy in patients with renal tumors and coexisting portal hypertension. By improving hematologic parameters and reducing vascular risk, it may facilitate curative surgery in high‐risk patients and expand treatment options.

Hypertension contributes to arterial stiffness and may promote early atherosclerosis. Assessing aortic elasticity non-invasively could help identify early vascular changes before clinical atherosclerotic disease manifests. This study aimed to compare aortic elasticity parameters between hypertensive and healthy individuals using echocardiography to evaluate their association with hypertension and potential value in early vascular risk assessment. In this case-control study, 140 participants aged 30–60 were divided into two equal groups: newly diagnosed hypertensive patients and had no significant difference (P value > 0.05) in age- and sex with healthy controls. Transthoracic echocardiography was used to assess aortic elasticity indices, including aortic strain (relative change in diameter), distensibility (diameter change per pressure change), stiffness index (pressure-diameter relationship), and Peterson’s elastic modulus (a measure of arterial wall resistance to deformation). Logistic regression and ROC analysis were performed to assess diagnostic value. Hypertensive patients showed significantly lower strain and distensibility and higher stiffness index and elastic modulus compared to controls (p < 0.001). These parameters demonstrated high diagnostic performance, with area under the curve (AUC) values of 0.97–0.99 for identifying hypertensive individuals, suggesting their potential utility in detecting early vascular stiffening. Echocardiographic measures of aortic elasticity differ significantly between hypertensive and healthy individuals. These indices may serve as useful, non-invasive markers for early vascular changes associated with hypertension. However, as this was an observational study, further longitudinal research is warranted to confirm their predictive value for atherosclerosis. The correlation between increased stiffness and inflammatory markers such as CRP suggests that further research is warranted to explore additional inflammatory indices.

Disruption of cerebral hemodynamics may impair perivascular and glymphatic clearance, contributing to aging-related brain pathology. This study aimed to explore the interaction between large-vessel hemodynamics and glymphatic neuroimaging markers in cerebral small vessel disease (CSVD), a common age-related condition. Using 4D flow MRI, we quantified flow/area pulsatility index (PIflow/PIarea) and wall shear stress (WSS) in carotid arteries and superior sagittal sinus (SSS) among 66 CSVD patients and 34 healthy controls (HCs). Free water (FW) fraction and diffusivity along the perivascular space (ALPS) were measured as glymphatic markers via diffusion-weighted imaging. Multivariate regressions and mediation analyses were conducted to assess the relationships between vascular metrics and glymphatic markers, as well as disease burden, adjusting for age, sex, white matter hyperintensity (WMH) volume, and vascular risk factors. CSVD patients exhibited increased arterial and venous PIs and WSS alongside elevated FW in multiple brain regions. PIarea of common carotid artery (CCA) and higher WSS of internal carotid artery (ICA)-C1 correlated with increased FW of basal ganglia (FW-BG); PIflow of SSS linked to FW in the hippocampus; and PIarea of ICA-C4 correlated with ALPS (β = 0.188-0.267, p < 0.05). Contrastingly, HCs exhibited inverse associations between PIs/WSS and glymphatic markers (β=-0.517 to -0.317, p < 0.05). Interestingly, FW-BG mediated 42.1% of the effect between PIarea-CCA and CSVD burden (BootCI:0.015-0.956, p < 0.05). Elevated WSS of SSS predicted worse global cognition (β=-0.32, p = 0.005). Altered large-vessel hemodynamics correlated to glymphatic dysfunction and cognitive function in CSVD, highlighting the critical role of vascular health in preserving brain clearance and cognitive aging.

Background: Deep vein thrombosis (DVT) is a serious thromboinflammatory complication of acute ischemic stroke (AIS). The true incidence, mechanistic risk factors, and optimal prophylactic strategies remain uncertain, particularly in the era of reperfusion therapy. Methods: This systematic review and meta-analysis (IRIS-DVT) searched PubMed, Embase, Cochrane, Scopus, and Web of Science for studies reporting DVT incidence, risk factors, or prophylaxis in AIS (2004–2025). Random-effects models were used to generate pooled prevalence and effect estimates, and the certainty of evidence was graded using the GRADE framework. Results: Forty-two studies (n = 6,051,729 patients) were included. The pooled prevalence of DVT was 7% (95% CI, 6–9%), approximately seventy-fold higher than in the general population, with wide heterogeneity influenced by screening timing and diagnostic modality. Pathophysiological risk factors included higher stroke severity (NIHSS; SMD 0.41; 95% CI, 0.38–0.43), older age (SMD 0.32; 95% CI, 0.18–0.46), elevated D-dimer (SMD 0.55; 95% CI, 0.38–0.72), female sex (OR 1.33; 95% CI, 1.19–1.50), and malignancy (OR 2.69; 95% CI, 1.56–5.22), supported by moderate-certainty evidence. Respiratory infection and admission hyperglycemia showed weaker, low-certainty associations. Traditional vascular risk factors (hypertension, diabetes, atrial fibrillation, dyslipidemia) were not significantly related to DVT risk. Evidence for prophylaxis with low-molecular-weight heparin, direct oral anticoagulants, or intermittent pneumatic compression was limited and graded very low certainty. Conclusions: DVT complicates approximately one in fourteen AIS cases, reflecting a distinct thromboinflammatory process driven more by acute neurological severity, systemic hypercoagulability, and malignancy than by conventional vascular risk factors. Early systematic screening (≤72 h) and consistent use of mechanical prophylaxis are warranted. Dedicated AIS-specific mechanistic and interventional trials are urgently needed to refine prevention strategies and improve post-stroke outcomes.

Abstract Artificial intelligence (AI) is a science where computer programs perform tasks that typically require human intelligence. AI technologies and machine learning applications have resulted in exponential technical advancement in the field of medicine. Analyzing databases for improving clinical and hospital workflow, to intraoperative applications, such as video analysis, are some of the applications of AI in the healthcare scenario. In recent times, the application of AI in vascular surgery has focused on improving patient care. AI analyzes large amounts of data, detects patterns and, makes predictions using sophisticated algorithms, and applies it to vascular diagnosis, risk stratification, and outcome prediction. This review aims to provide an outline of the basic principles of AI and highlights its clinical applications in vascular surgery. We also discuss the limitations that challenge its benefits.

Vascular inflammation is involved in the pathophysiology of post-stroke cognitive impairment. We aimed to assess whether blood-based biomarkers of inflammation and endothelial dysfunction, such as interleukin 6 (IL-6), vascular cell adhesion molecule (VCAM-1), and tumor necrosis factor-alpha (TNF-α), are associated with cognitive function over time in a prospective cohort of first-ever ischemic stroke patients. Data were obtained from the Prospective Cohort with Incident Stroke Berlin (NCT01363856). Cognitive function was assessed with the Telephone Interview for Cognitive Status-modified (TICS-m) at 1 to 3 years of follow-up. Associations of baseline levels of IL-6, VCAM-1, and TNF-α with cognitive function over time were estimated using a linear mixed model adjusted for demographics, education, vascular risk factors, stroke severity, ischemic stroke subtype, and severity of white matter hyperintensity. We included 570 patients with mild-to-moderate ischemic stroke and baseline data on biomarker levels. The mean age was 67 (± 12 SD), 38.6% were female, and the median National Institutes of Health Stroke Scale (NIHSS) was 2 (IQR 1-4). Frequency of cognitive impairment defined as TICS-m score ≤ 31 was 21.9% at year one, 15.4% at year two, and 11.6% at year three. Higher log-transformed levels of IL-6 and VCAM-1 were associated with lower TICS-m scores over time in the adjusted linear mixed model including white matter hyperintensity burden (IL-6: β = -2.0, 95% CI -3.3 to -0.7, p = 0.003; VCAM-1: β = -4.1, 95% CI -7.3 to -1.0, p = 0.01). In patients with mild-to-moderate first-ever ischemic stroke, higher baseline levels of IL-6 and VCAM-1 were associated with lower Telephone Interview for Cognitive Status-modified during 3 years of follow-up.ClinicalTrials.gov Identifier: NCT01363856.

BackgroundVascular mild cognitive impairment (VMCI) is a significant global health concern, particularly in Asia. The visual cognitive assessment test (VCAT) has shown promise as a language-neutral screening tool for cognitive impairment.ObjectiveThis study aims to assess the effectiveness of the VCAT in detecting VMCI and compare its diagnostic performance with the widely used and validated Montreal Cognitive Assessment (MoCA).MethodsCross-sectional data from 524 community-dwelling participants were analyzed from the BIOCIS (Biomarkers and Cognition Study, Singapore) and classified into cognitively unimpaired, non-VMCI, and VMCI groups. The participants underwent neuropsychological assessments and 3-T magnetic resonance imaging. The random forest technique and multivariable logistic regression were applied to assess the discriminative properties of the tests.ResultsParticipants with VMCI exhibited significantly lower performance across various neuropsychological tests (P<.001) and higher rates of vascular risk factors (P<.001). At a cutoff of 27, the VCAT achieved near-perfect accuracy in discriminating the VMCI group from the cognitively unimpaired group (area under the receiver operating characteristic curve=1; sensitivity=1; specificity=0.991). For differentiating the VMCI group from the non-VMCI group, both the VCAT and the MoCA showed optimal performance at a cutoff of 25 (area under the receiver operating characteristic curve=1.00; sensitivity=1.00; specificity=1.00).ConclusionsThe VCAT could be a valuable tool for detecting VMCI, particularly in diverse, multilingual populations. Its comparable or even superior performance to the MoCA, combined with its language-neutral design, positions the VCAT as a strong addition to cognitive assessment toolkits for VMCI. However, the complex nature of cognitive processing in VMCI suggests that a multifaceted approach that integrates both visual and verbal assessments may ultimately offer the most comprehensive evaluation.International Registered Report Identifier (IRRID)RR2-10.14283/jpad.2024.89

Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown. A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching. Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses. Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.