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Increased arterial stiffness, a biomarker of vascular aging, is a recognized subclinical organ damage, and may thus serve as predictor of cardiovascular disease. The predictive value of arterial stiffness is higher in patients with higher baseline cardiovascular risk, such as in patients with hypertension. According to European Society of Hypertension, increased arterial stiffness should be recommended as a negative prognostic factor in the management of patients with hypertension. Arterial stiffness, an important determinant of transition of pulse wave energy from the heart into the periphery, could improve our understanding of the consequences of the hemodynamic-related vascular stress, especially in low-impedance organs, including the brain. Epidemiological studies have demonstrated arterial stiffness as a risk factor for silent cerebral lesions, stroke, and cognitive impairment. Arterial stiffness was found to be independently associated with all components of cerebral small vessel disease including silent lacunar infarcts, white matter hyperintensities, and microbleeds, although there are some methodological differences between the various surrogate markers. Arterial stiffness may be important also in recovery after ischemic stroke. Aortic stiffness was found to be an independent predictor of both short-term clinical improvement and long-term functional outcome after ischemic stroke. Furthermore, increased aortic stiffness has been shown to be linked to acute hypertensive response after ischemic stroke. However, the vascular, physiological, and metabolic roles of arterial stiffness in cerebrovascular diseases remain unclear. Better understanding of the hemodynamic consequences of arterial stiffness on brain damage is necessary, not only to select the most appropriate therapeutic management but also to optimize prevention, which should be started early in individuals at high risk of developing cerebral vascular lesions.

Objective: Cerebral lesion growth in acute ischemic stroke leads to secondary neurological deterioration and poor outcome. Whether cSBP and arterial stiffness are related to the early brain infarct growth in patients after ischemic stroke is unknown. Design and Methods: We enrolled 65 patients (43 males, age 62.9 ± 12.2 years, mean ± SD) with acute ischemic stroke (NIHSS at admission 6.0 ± 4.6 points). Carotid-femoral pulse wave velocity (CF-PWV), central systolic blood pressure (cSBP) and central augmentation index (cAIx) were measured (Sphygmocor®) within few (5 ± 2) days after stroke onset. Serial brain MRI were analysed. Cerebral lesion growth was assessed on diffusion-weighted imaging (DWI) by comparing baseline and follow-up scans. Marked cerebral lesion growth was determined as the highest tertile in a standardized measure of DWI lesion volume increase, and compared with the lowest tertile used as the reference group. Data were analysed with multivariate logistic regression. Results: CF-PWV was higher in patients with marked cerebral lesion growth than that in patients of the reference group (10.9 ± 3.1 vs. 9.1 ± 1.9 m/s, P = 0.035). By contrast, cAIx, as well as none of central and peripheral BP-derived parameters were significantly associated with cerebral lesion growth in univariate analysis. In multivariable regression logistic model, CF-PWV predicted cerebral lesion growth with an odds ratio of 1.43 [1.00–2.04], independently of age, and peripheral pulse pressure. Conclusions: Increased aortic stiffness is independently associated with cerebral lesion growth in patients with acute ischemic stroke. Its deleterious effect is more important than that of BP.

Patients with non-large vessel occlusion acute ischemic stroke (NL-AIS) on oral anticoagulants (OAC) constitute the biggest portion among those who cannot receive any potential-reperfusion treatment even if they appear early in the hospital. We present the first case of therapy for NL-AIS in a patient with active anti-Xa anticoagulation, combining andexanet alfa and rtPA, who was recruited for STRoke On AntiCoagulants for Thrombolysis (acronym: STROACT), an ongoing therapeutic trial for non-LVO ischemic stroke on a DOAC. This is also the first report of the use of andexanet alfa-rtPA for AIS in a patient on rivaroxaban, which is the most frequently used non-vitamin K antagonist oral anticoagulant. The patient received the intravenous bolus of 800 mg of andexanet (contralateral arm), followed by a bolus of rtPA (10% of the calculated dose; ipsilateral arm), then a continuous infusion of andexanet at 8 mg/min for 120 min (contralateral arm), and rtPA (90% of the calculated dose; ipsilateral arm)—both stopped after completion of 38.9 and 74% of infusion dose, respectively, due to the severe adverse event related to the administration of rtPA. In this schema, both infusions are ongoing concurrently for approximately 60 min, and then andexanet is administered alone until the completion of the dose (altogether lasting approximately 3 h). The therapy was spectacularly effective, with early and complete improvement in NIHSS from 8 to 0 points in 70 min from the initiation of the therapy; mRS = 0. Obviously, a single case cannot drive any standard therapeutic decisions, but the experience we share in this article may help manage selected special clinical problems, especially when a patient's expected outcome is poor and there is no other way to help than experimentally. Additionally, it seems a valuable addition to recent meta-data on thrombolysis in anticoagulated patients.Trial registrationhttps://www.clinicaltrialsregister.eu. Identifier: 2020-004898-41. Date of registration: March 31, 2021.

Purpose Wake-up stroke constitutes up to 1/4 of all ischaemic strokes; however, its pathomechanisms remain largely unknown. Although low nocturnal blood flow may be the underlying cause, little is known about blood pressure (BP) characteristic of wake-up stroke patients. The aim of our study was to look for differences in BP variables between wake-up stroke and known-onset stroke patients and to seek BP indices which could distinguish wake-up stroke patients from other stroke patients. Materials and Methods In the study, we included ischaemic stroke patients in whom office BP measurement and Ambulatory BP monitoring (ABPM) were recorded at day 7, after acute hypertensive response. The daytime period was defined as the interval from 6 a.m. to 10 p.m. From ABPM, we obtained parameters of BP variability. Additionally, we calculated the BP percentage differences defined as (supine office BP–average daytime BP)/average daytime BP for systolic, diastolic, and mean blood pressure. We calculated analogous indices for night-time. The univariate and multivariate relationships between BP variables and wake-up stroke were analysed. Results Among the recruited 120 patients (aged 61.6 ± 12.3; 88 [73%] males; the baseline National Institutes of Health stroke scale score 4 [3–8]), 36 (30%) had wake-up stroke. In a univariate analysis, the systolic and mean daytime and night-time BP differences were significantly lower in patients with wake-up stroke [(−1.92 (−11.55 to 3.95) vs 4.12 (−2.48 to 11.31), p = 0.006 and −6.20 (−12.32 to 7.42) vs 2.00 (−6.86 to 11.65), p = 0.029 for daytime, respectively; 0.00 (−9.79 to 11.82) vs 9.84 (0.00 to 18.25), p = 0.003 and 0.51 (−8.49 to 12.08) vs 7.82 (−2.47 to 20.39), p = 0.026, for night-time, respectively]. After adjustment for possible confounders, the systolic BP difference remained significantly associated with wake-up stroke (odds ratio = 0.96, 95% confidence interval = 0.92–1.00, p = 0.039). Conclusion The subacute office-ambulatory BP difference including the dynamic (systolic BP), but not static BP component was independently associated with wake-up stroke.

Purpose: Outcome after ischaemic stroke (AIS) depends on multiple factors, including values of blood pressure (BP) and arterial stiffness (AS) in the early phase. It is also known that stroke outcome is affected by BP variability; however, the influence of AS oscillations in the early phase of stroke on its prognosis is unknown. The aim of our study was to assess the relationship between changes of AS markers and stroke outcome. Materials and methods: Baseline clinical data, BP parameters, and markers of AS (pulse wave velocity [PWV], augmentation index [AIx]) were assessed 1, 6, and >90 days after AIS. The outcomes were defined using modified Rankin scale (mRS) score: early favourable (EFO) and early poor (EPO), as mRS ≤1 and >2 points at discharge, respectively; late favourable (LFO) and late poor (LPO), as mRS ≤1 and >2 points on day >90, respectively. Results: In the recruited 50 patients (62.2 ± 12.1 years, 68% males), BP and PWV decreased while AIx did not change within 90 days after AIS. Twenty-eight patients (56%) had EFO, 10 (20%) – EPO, 29 (58%) – LFO, and 9 (18%) – LPO. In univariate analysis, rise in AIx in days 1–6 was associated with EFO (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.02–1.17, p = 0.01) and LFO (OR = 1.08; 95%CI = 1.01–1.14, p = 0.02), whereas decrease in AIx in days 1–6 was associated with EPO (OR = 1.07, 95%CI = 1.00–1.15, p = 0.05). For EFO and LFO, the relationships remained significant after including confounders (p = 0.03 and p = 0.03, respectively). Conclusions: Rise in AIx within one week after ischaemic stroke may be of additional importance in determining better early and late favourable functional outcome.

Heart rate variability (hrv) is a physiological phenomenon of the variation in the length of the time interval between consecutive heartbeats. In many cases it could be an indicator of the development of pathological states. The classical approach to the analysis of hrv includes time domain methods and frequency domain methods. However, attempts are still being made to define new and more effective hrv assessment tools. Persistent homology is a novel data analysis tool developed in the recent decades that is rooted at algebraic topology. The Topological Data Analysis (TDA) approach focuses on examining the shape of the data in terms of connectedness and holes, and has recently proved to be very effective in various fields of research. In this paper we propose the use of persistent homology to the hrv analysis. We recall selected topological descriptors used in the literature and we introduce some new topological descriptors that reflect the specificity of hrv, and we discuss their relation to the standard hrv measures. In particular, we show that this novel approach provides a collection of indices that might be at least as useful as the classical parameters in differentiating between series of beat-to-beat intervals (RR-intervals) in healthy subjects and patients suffering from a stroke episode.

We organized 10Kin1day, a pop-up scientific event with the goal to bring together neuroimaging groups from around the world to jointly analyze 10,000+ existing MRI connectivity datasets during a 3-day workshop. In this report, we describe the motivation and principles of 10Kin1day, together with a public release of 8,000+ MRI connectome maps of the human brain.

Aging disrupts white matter integrity, and so does continuous elevated blood pressure that accompanies hypertension (HTN). Yet, our understanding of the interrelationship between these factors is still limited. The study aimed at evaluating patterns of changes in diffusion parameters (as assessed by quantitative diffusion fiber tracking – qDTI) following both aging, and hypertension, as well as the nature of their linkage. 146 participants took part in the study: the control group (N = 61) and the patients with hypertension (N = 85), and were divided into three age subgroups (25–47, 48–56, 57–71 years). qDTI was used to calculate the values of fractional anisotropy, mean, radial and axial diffusivity in 20 main tracts of the brain. The effects of factors (aging and hypertension) on diffusion parameters of tracts were tested with a two-way ANOVA. In the right hemisphere there was no clear effect of the HTN, nor an interaction between the factors, though some age-related effects were observed. Contrary, in the left hemisphere both aging and hypertension contributed to the white matter decline, following a functional pattern. In the projection pathways and the fornix, HTN and aging played part independent of each other, whereas in association fibers and the corpus callosum if the hypertension effect was significant, an interaction was observed. HTN patients manifested faster decline of diffusion parameters but also reached a plateau earlier, with highest between-group differences noted in the middle-aged subgroup. Healthy and hypertensive participants have different brain aging patterns. The HTN is associated with acceleration of white matter integrity decline, observed mainly in association fibers of the left hemisphere.