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Purpose: Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. The aim of the present study was to explore independent risk factors to predict cerebrovascular events following CAS to identify high-risk patients and improve the safety of CAS in this population. Materials and Methods: HISPANIAS is a national prospective multicenter study that included 14 hospitals that collected data from patients who underwent CAS. We analyzed morbidity and mortality within 30 days after CAS, looking for factors that might be associated with cerebrovascular events (stroke and transient ischemic attack [TIA]). Results: The HISPANIAS cohort included 757 patients: 80.32% were men, the mean age was 70.73 years, and 82.96% underwent symptomatic CAS. Cerebrovascular complications occurred in 42 patients (5.6%), including TIA in 24 patients (70.8% ipsilateral; mean 2.79 days after CAS) and stroke in 18 patients (72.2% ipsilateral; mean 6.72 days after CAS). The main independent clinical predictors of stroke/TIA identified by logistic regression were female sex (odds ratio [OR] 2.29, 95% CI 1.15–4.54) and diabetes (OR 3.29, 95% CI 1.71–6.40). Survival analysis showed that diabetic women, compared with the rest of the patients, had a higher number of events concentrated mainly in the first days after the intervention (p=0.003). Conclusion: Cerebrovascular ischemic complications after CAS continue to be a challenge for the management of these patients. Although there are other factors, female sex and the presence of diabetes are emerging as strong risk factors for the development of complications after symptomatic CAS. Clinical Impact: Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. Although CAS has been regarded as a reliable and safety approach, some studies reported that CAS was associated with a higher risk of procedure-related stroke. Cerebrovascular complications after CAS continue to be a main problem and a challenge for the management of these patients. Therefore, it is essential to identify the factors involved in the development of these complications. Our study shows that the combination of female sex and diabetes is associated with a clearly worse outcome, with a greater number of events concentrated mainly in the first days. This is different from other studies that have explored each factor separately. It would be interesting to perform separate interventions for this group given the increased risk of complications. [ABSTRACT FROM AUTHOR]

Abstract Background Individuals with diabetes exhibit a higher risk of cardiovascular disease and mortality compared to healthy individuals. Following a transient ischemic attack (TIA) the risk of stroke and death increase further. Physical activity engagement after a TIA is an effective way of secondary prevention. However, there's a lack of research on how individuals with diabetes modify physical activity levels and how these adjustments impact survival post-TIA. This study aimed to determine the extent to which individuals with diabetes alter their physical activity levels following a TIA and to assess the impact of these changes on mortality. Methods This was a nationwide longitudinal study, employing data from national registers in Sweden spanning from 01/01/2003 to 31/12/2019. Data were collected 2 years retro- and prospectively of TIA occurrence, in individuals with diabetes. Individuals were grouped based on decreasing, remaining, or increasing physical activity levels after the TIA. Cox proportional hazards models were fitted to evaluate the adjusted relationship between change in physical activity and all-cause, cardiovascular, and non-cardiovascular mortality. Results The final study sample consisted of 4.219 individuals (mean age 72.9 years, 59.4% males). Among them, 35.8% decreased, 37.5% kept steady, and 26.8% increased their physical activity after the TIA. A subsequent stroke occurred in 6.7%, 6.4%, and 6.1% of individuals, while death occurred in 6.3%, 7.3%, and 3.7% of individuals, respectively. In adjusted analyses, participants who increased their physical activity had a 45% lower risk for all-cause mortality and a 68% lower risk for cardiovascular mortality, compared to those who decreased their physical activity. Conclusions Positive change in physical activity following a ΤΙΑ was associated with a reduced risk of mortality. Increased engagement in physical activity should be promoted after TIA, thereby actively supporting individuals with diabetes in achieving improved health outcomes.

The Valve Academic Research Consortium (VARC)-3 definition for neurologic events after transcatheter aortic valve replacement (TAVR) lacks clinical validation. This study sought to determine the incidence, predictors, and clinical impact of neurologic events following TAVR as defined by VARC-3 criteria. This was a multicenter study including 2,924 patients with severe aortic stenosis undergoing TAVR. Based on Neurologic Academic Research Consortium (NeuroARC) classification, neurologic events were classified as NeuroARC type 1 (stroke), NeuroARC type 2 (covert central nervous system injury), and NeuroARC type 3 (transient ischemic attack and delirium). Baseline, procedural, and follow-up data were prospectively collected in a dedicated database. After a median follow-up of 13 (7-37) months, neurologic events occurred in 471 patients (16.1%), NeuroARC type 1, 2, and 3 in 37.4%, 4.7%, and 58.0% of cases, respectively, and the majority (58.6%) were periprocedural. Advanced age, chronic kidney disease, atrial fibrillation, major vascular complications, and in-hospital bleeding determined an increased risk of periprocedural events (P < 0.03 for all). Neurologic events occurring during the periprocedural time frame were independently associated with a substantial increase in mortality at 1 year after the intervention (HR: 1.91; 95% CI: 1.23-2.97; P = 0.004). However, although NeuroARC type 1 was associated with an increased mortality risk (IRR: 3.38; 95% CI: 2.30-5.56; P < 0.001 and IRR: 21.7; 95% CI: 9.63-49.1; P < 0.001 for ischemic and hemorrhagic stroke, respectively), the occurrence of NeuroARC type 3 events had no impact on mortality. Neurologic events after TAVR were associated with poorer short- and long-term survival. This correlation was related to the type of NeuroARC event defined by the VARC-3 criteria. Given the negative impact on clinical outcomes, every attempt should be made to reduce the risk of neurologic complications after TAVR. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Aims Design Methods Results Conclusions Relevance to Clinical Practice Impact (Addressing) What problem did the study address? What were the main findings? Where and on whom will the research have an impact? Reporting Method Patient or Public Contribution Fatigue, depression, anxiety and cognitive difficulties are reported by 1/3 of patients following transient ischemic attack (TIA).To explore the timeline and how the diagnosis impacts individuals experiencing lasting challenges after TIA. Furthermore, to identify what they believed facilitated return to everyday life.Qualitative exploratory study with a phenomenological‐hermeneutic approach.Individual semi‐structured interviews and thematic analysis.Fifteen patients were included. Four themes were identified; (1) ‘They say it is transient – no, not for me’ where all participants described lasting challenges emphasizing invalidating fatigue and impaired social participation, (2) ‘I am a changed person; how does this impact my future?’ which reflects altered identity and elevated alertness to symptoms, (3) ‘Time has been my ally and new perspectives have evolved’ where most participants described improvement over time and a few considered the diagnosis a wake‐up call to change lifestyle. Lastly (4) ‘What would have helped me recover?’ which unfolds that close, trustful relations influence positively. In addition, the system often failed to support. Participants described pressure to return to work and lack of trust and negative experiences when involving their general practitioner.During the 4 months since diagnosis, participants experienced limitations impacting physical, psychological and social domains. They felt uninformed that lasting challenges could affect them. Different coping strategies were activated, and participants with close, supportive relations managed better. A pressure to return to work and a lack of trust in the general practitioner affected their recovery negatively. Overall, return to everyday life after TIA was considered stressful and appropriate support lacking.To be able to support patients with challenges following TIA, we as healthcare professionals need to understand the identified impact and life changing circumstances. Currently the system seemingly is not able to provide timely, sufficient and competent support.We know from the literature that up to 1/3 of patients following transient ischemic attack experience lasting challenges measured on a variety of questionnaires. This is paradoxical to a diagnosis defined by focal neurological symptoms that resolve within 24 h. It is unknown how patients with lasting challenges experience the timeline from diagnosis and until 4 months after, how the diagnosis impacts the lives of these individuals, and what they believe as beneficial in returning to their everyday life.These participants with self‐reported lasting challenges experienced substantial impacts on physical, psychological and social domains. Further, they felt alone with their struggles and when in need of support from the healthcare system, it failed to provide this. A pressure to return to work and a lack of trust in the general practitioner affected return to everyday life negatively, whereas close and supportive relations facilitated positively.This study will have an impact on the healthcare professionals that provide support and the (limited) follow‐up services to patients after TIA. These healthcare professionals are often specialized nurses who need to know what these patients experience and need in order to act upon their struggles and provide timely support.The Standards of Reporting Qualitative Research (SRQR).Patients with TIA was involved in planning this study. They participated in a panel to plan a prospective observational cohort study and emphasized the importance of exploring the subjective perspectives of impact and prognosis for those patients struggling in a longer term (through qualitative interviews). [ABSTRACT FROM AUTHOR]

Background: Individuals with diabetes exhibit a higher risk of cardiovascular disease and mortality compared to healthy individuals. Following a transient ischemic attack (TIA) the risk of stroke and death increase further. Physical activity engagement after a TIA is an effective way of secondary prevention. However, there's a lack of research on how individuals with diabetes modify physical activity levels and how these adjustments impact survival post-TIA. This study aimed to determine the extent to which individuals with diabetes alter their physical activity levels following a TIA and to assess the impact of these changes on mortality. Methods: This was a nationwide longitudinal study, employing data from national registers in Sweden spanning from 01/01/2003 to 31/12/2019. Data were collected 2 years retro- and prospectively of TIA occurrence, in individuals with diabetes. Individuals were grouped based on decreasing, remaining, or increasing physical activity levels after the TIA. Cox proportional hazards models were fitted to evaluate the adjusted relationship between change in physical activity and all-cause, cardiovascular, and non-cardiovascular mortality. Results: The final study sample consisted of 4.219 individuals (mean age 72.9 years, 59.4% males). Among them, 35.8% decreased, 37.5% kept steady, and 26.8% increased their physical activity after the TIA. A subsequent stroke occurred in 6.7%, 6.4%, and 6.1% of individuals, while death occurred in 6.3%, 7.3%, and 3.7% of individuals, respectively. In adjusted analyses, participants who increased their physical activity had a 45% lower risk for all-cause mortality and a 68% lower risk for cardiovascular mortality, compared to those who decreased their physical activity. Conclusions: Positive change in physical activity following a ΤΙΑ was associated with a reduced risk of mortality. Increased engagement in physical activity should be promoted after TIA, thereby actively supporting individuals with diabetes in achieving improved health outcomes. [ABSTRACT FROM AUTHOR]

Background: Following transient ischemic attack (TIA) and minor stroke, the risk of recurrent stroke can be significantly reduced with short-duration dual antiplatelet therapy (DAPT). We wish to investigate whether 10 days of DAPT is as effective as 21 days' treatment. Study design: This is an open-label, randomized, parallel-group study comparing whether 10 days of DAPT treatment (ASA + clopidogrel) is non-inferior to 21 days of DAPT in patients with acute ischemic stroke (AIS) or high-risk TIA. In both groups, DAPT is started within 24 hours of symptom onset. This study is being conducted in approximately 15 study sites in the Kingdom of Saudi Arabia. The planned sample size is 1932. Outcomes: Non-inferiority of 10 days compared to 21 days of DAPT in the prevention of the composite endpoint of stroke and death at 90 days in AIS/TIA patients. The primary safety outcome is major intra-cranial and systemic hemorrhage. Study period: Enrolment started in the second quarter of 2023, and the completion of the study is expected in the fourth quarter of 2025. Discussion: The trial is expected to show that 10 days of DAPT is non-inferior for the prevention of early recurrence of vascular events in patients with high-risk TIAs and minor strokes. [ABSTRACT FROM AUTHOR]

Key clinical message: Isolated cardiac sarcoidosis may rarely present with TIA or stroke as an initial clinical manifestation. This case highlights the necessity of a broad differential and a high degree of suspicion for cardiac sarcoidosis in a patient with new neurologic symptoms and evidence of cardiac disease. Cardiac sarcoidosis is a rare disease with a variety of clinical manifestations including heart failure and sudden death. Stroke as the earliest sign of disease has been described in rare cases. We present a case of a 54‐year‐old female with recurrent transient ischemic attacks (TIAs) of unknown etiology, initially in the absence of left ventricular dysfunction. Cardiomyopathy was later identified on echocardiography after a second TIA. Cardiac MRI was remarkable for focal left ventricular wall thinning with akinesis and dyskinesis of multiple wall segments, a right ventricular aneurysm, and diffuse myocardial late gadolinium enhancement. PET/CT showed multifocal areas of myocardial FDG uptake. At follow‐up, echocardiography showed a left ventricular apical thrombus, in a previously identified thinned, akinetic region, suggesting cardioembolic origin for previous TIAs. She was started on anticoagulation therapy, prednisone, methotrexate, and adalimumab, with resolution of the thrombus and improvement in cardiac function. In conclusion, this case highlights the need to consider CS as a potential cause of cerebrovascular ischemic events in patients with few stroke risk factors but findings indicative of cardiac disease. It is essential to further explore the mechanisms behind these events and develop treatments that target their causes in this patient population. [ABSTRACT FROM AUTHOR]

This paper presents an inverter-based active feedback transimpedance amplifier (IAF-TIA), in which an active feedback is applied to a voltage-mode inverter-based TIA, and therefore, the controlled positive regeneration process enables the proposed IAF-TIA to achieve the limiting operations for input currents greater than 100 μApp. However, the active inverter feedback mechanism might be prone to instability, hence mandating a very careful optimization of the loop gain. For this purpose, a diode-connected NMOS transistor is employed as a switch in the feedback path with its gate connected to the input, which helps not only to mitigate the corresponding issue but also to accommodate large input currents up to 1.5 mApp. The proposed IAF-TIA implemented in a standard 180 nm CMOS process demonstrates a 70.5 dBΩ transimpedance gain, 1.21 GHz bandwidth, 4.3   pA / Hz noise current spectral density, 63.5 dB input dynamic range, and 23.6 mW power dissipation from a single 1.8 V supply. The chip core occupies an area of 180 × 50 μm2, including an on-chip P+/N-well/Deep N-well avalanche photodiode as an optical detector. [ABSTRACT FROM AUTHOR]

The performance of optical receivers is significantly influenced by the design of Complementary Metal Oxide Semiconductor (CMOS) operational amplifiers (op-amps), which benefit from advancements in CMOS technology that offer reduced noise and power consumption. This study outlines the design process for a low-noise CMOS op-amp aimed at achieving high-quality signal output, essential for applications such as professional audio equipment and precision instruments where noise interference must be minimized. Typically, efforts to reduce noise result in diminished speed and increased power consumption. Thus, achieving an optimal balance in performance parameters is critical, with noise level being the primary focus. An effective design methodology is proposed to enhance the overall performance of op-amps. Analytical methods are employed to gain insights into the design, prioritizing noise performance. Device sizes and biasing conditions are determined based on several factors including noise level, bandwidth, signal swing, slew rate, and power consumption. A two-stage op-amp has been developed to validate the proposed design approach. The device parameters derived from this method exhibit a close match to the simulated results generated using MATLAB, underscoring the accuracy and effectiveness of the design process. [ABSTRACT FROM AUTHOR]

Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0–4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384–1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869–1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data. [ABSTRACT FROM AUTHOR]

PurposeProspective studies on vascular vertigo and dizziness (VVD) due to vertebrobasilar transient ischemic attack (VBTIA) have been sparse. This study aimed to characterize clinical features, response to treatments, and prognostic factors of VVD due to VBTIA using a cohort established in 2021.MethodsWe recruited 103 patients (58 female individuals, 56.3%), with a mean age of 70.9 ± 9.3 years (range = 37–85), between January 2021 and January 2024. All patients met the diagnostic criteria of “Probable transient VVD” published by the Bárány Society. The mean interval from symptom onset to recruitment was 11.8 months (range = 0.5–72). Treatments followed the current American Heart Association–American Stroke Association's Guidelines for Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Patients with recurrent strokes among TIAs, and patients who were already taking an antithrombotic agent and should maintain the same regimen were excluded.ResultsImbalance (46.7%) and vertigo (39.8%) were the most frequent symptoms. The duration of attacks was 60 min in 19 patients (18.5%). Trigger factors were reported in 20 patients (19.4%), which included eccentric neck position in 12 patients (11.7%), physical exercise in four patients (3.9%), positional changes in three patients (2.9%), and eccentric neck position and physical exercise in the remaining patient (0.9%). The frequency of attacks before the medication was 1 or

Introduction. Strokes remain the second leading cause of death and the third leading cause of disability. Additional serum biomarker testing should be used to better diagnose transient ischemic attack (TIA), but most neurospecific biomarkers have low prognostic specificity and sensitivity. Timely identification of TIA and differential diagnosis of stroke in the first hour will ensure a shorter period of patient recovery and reduce the risk of mortality and disability. Serum biomarker studies should be included to overcome the difficulty of diagnosing TIA.Text. Neurospecific biomarkers such as S100B, GFAP, and NSE are used to diagnose acute ischemic damage to glial cells and neurons. S100B and GFAP are detected in astrocytes and NSE in neurons and cells of the neuroendocrine system. Elevated serum concentrations of these biomarkers are associated with various pathological conditions such as strokes and brain injuries and other central nervous system (CNS) lesions. Dynamic monitoring of biomarker concentrations makes it possible to evaluate the efficacy of the ongoing therapy and to identify predictors of patient deterioration for prompt correction of therapeutic procedures. To create a diagnostic panel it is necessary to study metabolic processes in ischemic tissue, taking into account concomitant diagnoses and results of neuroimaging, and to use breakthrough advances in machine learning and big data.Conclusion. The review showed that none of the assessed biomarkers can be recommended for the diagnosis of cerebral circulation disorders, but the combination of several neurospecific biomarkers can significantly improve diagnostic efficiency and find application in the differential diagnosis of stroke, intracranial hematoma, and other brain lesions for the purpose of early pharmacotherapy of CNS lesions and as surrogate endpoints during clinical trials.

Subclavian steal syndrome (SSS) is a rare vascular condition characterized by retrograde blood flow in the vertebral artery, often discovered incidentally in asymptomatic patients. We present a 65-year-old male with recurrent transient ischemic attacks (TIAs) attributed to 99% stenosis at the origin of the left subclavian artery, leading to SSS. Diagnostic modalities included duplex ultrasound, confirming inverted left vertebral artery flow, and multi-slice computed tomography angiography, confirming the diagnosis. Despite an unsuccessful attempt at balloon angioplasty, successful vascular surgery was performed, establishing a left carotid-vertebral artery bypass. The patient recovered well without complications. This case underscores the importance of considering SSS in TIA cases, utilizing non-invasive diagnostic tools, and highlighting the successful management of symptomatic SSS through surgical intervention. [ABSTRACT FROM AUTHOR]

The aim of the current study was to assess the relationship among thrombin receptor activator peptide 6 (TRAP test), adenosine-5′-diphosphate (ADP test), arachidonic acid (ASPI test), and stroke/transient ischemic attack (TIA), using the multiple electrode aggregometry (Multiplate) in patients undergoing carotid thromboendarterectomy (CEA). A retrospective study. Vascular surgery operating rooms of a university hospital. One hundred thirty-one out of 474 patients undergoing CEA between November 2020 and October 2022. None. A preoperative blood sample of all enrolled patients was analyzed using the Multiplate analyzer. Receiver operating characteristics curves, were generated to test the ability of TRAP, ADP, and ASPI in discriminating perioperative thromboembolic stroke/TIA. A logistic LASSO regression model was used to identify factors independently associated with stroke/TIA. Eight patients experienced a perioperative stroke/TIA. Although all the platelet functional assays showed excellent predictive performance, an ADP value exceeding 72 U showed the highest specificity (87%) and sensitivity (68%) in discriminating patients who had a perioperative thromboembolic stroke/TIA, with a negative predictive value of 99% and a positive predictive value of 15%. After LASSO regression, an ADP >72 U and the need for a shunt during CEA were the only 2 variables independently associated with perioperative stroke/TIA. Because the ADP test was independently associated with perioperative stroke/TIA, the assessment of platelet reactivity using Multiplate may offer potential utility in monitoring patients undergoing CEA. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Mental health and quality of life are commonly affected following a stroke or Transient Ischemic Attack (TIA) diagnosis, although many people are discharged without clear information about their psychological impact. Evidence suggests psychological interventions can be successfully delivered via remote methods (e.g. videoconferencing, telephone). However, it is unclear whether such interventions are effective for people post-stroke/TIA. This scoping review aimed to identify current evidence for remote group-based psychological interventions for people following TIA and stroke. Methods: Four electronic databases (MEDLINE, Embase, PsycINFO, Scopus) were searched for articles on online group psychological interventions post-TIA and stroke. Four reviewers independently screened titles, abstracts and full texts, then two authors extracted data for included studies. A bespoke data extraction form was used to describe interventions, informed by Template for Intervention Description and Replication (TIDieR) checklists. Results: The search yielded 1333 studies, from which six were included in the review. Four were feasibility studies (two randomised controlled trials, two single-group pre-/post-design). All interventions targeted stroke survivors; no studies targeted people with TIA. Delivery methods included teleconferencing, videoconferencing, an online platform (virtual multiuser world) and a hybrid approach using videoconferencing and face-to-face visits. Remote intervention components were delivered in the community or at participants' homes. All studies included a mood measure. Improvement in mood and/or quality of life was reported across the four studies. Conclusions: More research is needed to explore and confirm the potential benefits of remote delivery of group psychological interventions following stroke and TIA. Better reporting of implementation barriers/facilitators and more high-quality research are required to determine the effectiveness of remote interventions. Evidence suggests remotely delivered interventions can support psychological issues following stroke or transient ischemic attack (TIA). However, it is unclear whether this approach is effective and acceptable. This review aimed to identify current evidence for remote group-based psychological interventions post-TIA/stroke. Six studies involving stroke patients were reviewed. No studies included TIA patients. Improved mood and/or quality of life was reported in the four studies. More research is needed to explore the potential benefits of, and barriers to, remote group-based interventions in this population. [ABSTRACT FROM AUTHOR]

Key clinical message Isolated cardiac sarcoidosis may rarely present with TIA or stroke as an initial clinical manifestation. This case highlights the necessity of a broad differential and a high degree of suspicion for cardiac sarcoidosis in a patient with new neurologic symptoms and evidence of cardiac disease. Abstract Cardiac sarcoidosis is a rare disease with a variety of clinical manifestations including heart failure and sudden death. Stroke as the earliest sign of disease has been described in rare cases. We present a case of a 54‐year‐old female with recurrent transient ischemic attacks (TIAs) of unknown etiology, initially in the absence of left ventricular dysfunction. Cardiomyopathy was later identified on echocardiography after a second TIA. Cardiac MRI was remarkable for focal left ventricular wall thinning with akinesis and dyskinesis of multiple wall segments, a right ventricular aneurysm, and diffuse myocardial late gadolinium enhancement. PET/CT showed multifocal areas of myocardial FDG uptake. At follow‐up, echocardiography showed a left ventricular apical thrombus, in a previously identified thinned, akinetic region, suggesting cardioembolic origin for previous TIAs. She was started on anticoagulation therapy, prednisone, methotrexate, and adalimumab, with resolution of the thrombus and improvement in cardiac function. In conclusion, this case highlights the need to consider CS as a potential cause of cerebrovascular ischemic events in patients with few stroke risk factors but findings indicative of cardiac disease. It is essential to further explore the mechanisms behind these events and develop treatments that target their causes in this patient population.

【Objective】In order to meet the growing demand for ultra-gigabit, from gigabit to 10-gigabit, from The 5th Generation Fixed networks (F5G) to F5G-Advanced (F5.5G), 50 Gbit/s Passive Optical Network (PON) is considered to be an important part of F5.5G. This paper conducts a thorough study of 50 Gbit/s PON technology, reflecting the latest advancements in access networks.【Methods】This paper initially addresses the difficulties in achieving high sensitivity in 50 Gbit/s PON, and proposes a solution. 50 Gbit/s Non-Return-to-Zero (NRZ) signals pass through Avalanche Photodiode (APD) detectors to form macroscopic currents that can be detected under strong electric fields. These currents are then amplified by a Transresistance Amplifier (TIA) and converted into voltage outputs. After balancing, the Feed Forward Equalizer (FFE) and Decision Feedback Equalizer (DFE) of optical Digital Signal Processing (oDSP) chip are used to compensate the trailing phenomenon of pulse signal, and the influence of intersymbol interference is minimized by DFE. Then the paper analyses the key technologies such as APD, TIA and oDSP, comparing the reception performance between 25 Gbit/s and 50 Gbit/s APDs.【Results】Experimental test results show that the 25 Gbit/s APD maintains error-free signal reception at -8.48 dBm over 4 minutes, and reaches -26.61 dBm at a Bit Error Rate(BER) of 2.78e-2. The 50 Gbit/s APD exhibits no bit errors at -8.97 dBm and achieves -27.05 dBm at the same BER, with the second 50 Gbit/s APD set demonstrating similar results.【Conclusion】The 50 Gbit/s APD has superior receiving sensitivity and performance, making it highly suitable for 50 Gbit/s PON optical modules to help achieve high receiver sensitivity. The paper suggests a feasible approach for cost reduction in future implementations, focusing on the balance technology and APD.

Background and aim: Rapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics. Methods: Relevant services were identified by literature search and contacted. Three years of monthly data were requested - a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a timedependent outcome using a defined impact model. Results: Six centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI -1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI -7.8 to 1.9, p = 0.25), IVT (-14.3, 95% CI -36.7, 6.1, p < 0.01), and EVT (0, 95% CI -16.9 to 16.9, p = 0.98) counts. Proportion of ischemic strokes requiring IVT decreased from 13.2 to 11.4% (p < 0.05), but those requiring EVT did not change (16.0 to 16.7%, p = 0.33). Conclusion: This suggests that the pandemic has not had an enduring effect on TIA clinic or stroke service activity for these centers. Furthermore, the disproportionate decrease in IVT suggests that patients may be presenting outside the IVT window during the pandemic - delays in seeking treatment in this group could be the target for public health intervention. [ABSTRACT FROM AUTHOR]

To evaluate the relationship between different angiographic patterns of middle cerebral artery M1 segment stenosis and related territorial stroke in patients receiving aggressive medical treatment without stenting. We retrospectively reviewed our patient registry database to identify ICAS patients diagnosed by digital subtraction angiography between January 2017 and December 2020 and identified 3 different angiographic patterns (normal, shift, and dilation) in 124 patients with M1 stenosis. The association between these patterns and recurrent ischemic stroke in the M1 territory was analyzed. The rates of recurrent M1 territorial stroke and transient ischemic attack in the normal group, shift group, dilation group and shift-dilation group were 34.5%, 35.0%, 78.3%, and 44.4% respectively. In patients with the shift pattern, the rate of recurrent stroke is significantly higher at a deflection angle ≥9.32° than at a deflection angle <9.32°(P < 0.05). In patients with dilation pattern, the rate of recurrent stroke is significantly higher than patients with non-dilation pattern (72.3% vs. 36.8%, P < 0.05). Angiographic patterns of M1 stenosis may predict recurrent territorial strokes, thus providing a surrogate marker to identify high-risk patients for potential endovascular treatment. [ABSTRACT FROM AUTHOR]

Objective In order to cope with the growing demand for ultra-gigabit, from gigabit to 10-gigabit, from The 5th Generation Fixed networks(F5G) to F5G-Advanced(F5. 5G), 50 Gbit/s Passive Optical Network (PON) is considered to be an important part of F5. 5G. Therefore, according to the current access network development situation, 50 Gbit/s PON technology is deeply studied in this paper. Methods This paper first introduces the difficulties in achieving high sensitivity of 50 Gbit/s PON, and proposes a solution. 50 Gbit/s Non-Return-Zero (NRZ) signals pass through Avalanche Photodiode (APD) detectors to form macroscopic currents that can be detected under the action of strong electric fields. The current is amplified by a Transresistance Amplifier (TIA) and converted into a voltage output. After balancing, the Feed Forward Equalizer (FFE) and Decision Feedback Equalizer (DFE) of optical Digital Signal Processing (oDSP) chip are used to compensate the trailing phenomenon of pulse signal, and then the influence of intersymbol interference is minimized by DFE. Then the paper analyses the key technologies such as APD, TIA and oDSP, and the receiving performance is compared with that of 25 Gbit/s APD. Results According to the experimental test results of the two groups, the received optical power of the 25 Gbit/s APD in the first group is -8.48 dBm when the receiving signal has no error code during the test time of 4 min, and the received optical power reaches -26.61 dBm when the Bit Error Rate(BER) is 2.78e-2. In the case of 50 Gbit/s APD, the received optical power is - 8.97 dBm when the received signal has no bit error in 4 min, and the received optical power reaches -27.05 dBm when the BER is 2.78e-2. The second set of 50 Gbit/s APD-2 data also achieves the same experimental results. Conclusion In conclusion, 50 Gbit/s APD has higher receiving sensitivity, better performance, and is more suitable for use in 50 Gbit/s PON optical modules to achieve high receiver sensitivity. Finally, a feasible scheme is proposed on the balance technology and APD for future cost reduction. [ABSTRACT FROM AUTHOR]

Determination of total impervious area (TIA) or effective impervious area (EIA) is mandatory for hydrological modelling of water quantity and quality in urban areas. In this study, a multilayer deep learning model Convolutional Neural Network (CNN) is implemented for estimating TIA. A more realistic automated method is suggested to determine EIA by integrating the remote sensing data, the digital format of the drainage network, and a digital elevation model (DEM). A graphical user interface (GUI) called EIA estimator is developed for automatic creation of EIA maps. An effort is made to derive a relationship between TIA and EIA. Several power relationships are obtained for easily measurable TIA and hydraulically relevant EIA in urban catchments of India. These relationships would aid planners and decision-makers with quick initial estimates for surface water quantity and quality problems. [ABSTRACT FROM AUTHOR]

Introduction. Primary familial brain calcification (PFBC) is a neurodegenerative disease characterised by bilateral calcification in the brain, especially in the basal ganglia, leading to neurological and neuropsychiatric manifestations. White matter hyperintensities (WMH) have been described in patients with PFBC and pathogenic variants in the gene for platelet-derived growth factor beta polypeptide (PDGFB), suggesting a manifest cerebrovascular process. We present below the cases of two PFBC families with PDGFB variants and stroke or transient ischaemic attack (TIA) episodes. We examine the possible correlation between PFBC and vascular events as stroke/TIA, and evaluate whether signs for vascular disease in this condition are systemic or limited to the cerebral vessels. Material and methods. Two Swedish families with novel truncating PDGFB variants, p.Gln140* and p.Arg191*, are described clinically and radiologically. Subcutaneous capillary vessels in affected and unaffected family members were examined by light and electron microscopy. Results. All mutation carriers showed WMH and bilateral brain calcifications. The clinical presentations differed, with movement disorder symptoms dominating in family A, and psychiatric symptoms in family B. However, affected members of both families had stroke, TIA, and/or asymptomatic intracerebral ischaemic lesions. Only one of the patients had classical vascular risk factors. Skin microvasculature was normal. Conclusions. Patients with these PDGFB variants develop microvascular changes in the brain, but not the skin. PDGFB-related small vessel disease can manifest radiologically as cerebral haemorrhage or ischaemia, and may explain TIA or stroke in patients without other vascular risk factors. [ABSTRACT FROM AUTHOR]

Background: A 78-year-old female presented for chiropractic care following a week long stay in hospital for multiple Transient Ischemic Attacks (Mini-strokes). She had been advised that more mini-strokes would very likely occur as her medical doctors could not adequately diagnose the source of any bleeding, of which there were likely several. This caused further health-related anxiety and difficulty with sleep. Management: The patient undertook three five-day courses of concentrated Chiropractic care over the course of three months. During this time, a variety of Chiropractic adjustments were deployed alongside complementary therapies. Outcomes: Notably, the forecasted repeat strokes did not occur, and arterial regeneration was achieved concomitant with regenerative chiropractic care. [ABSTRACT FROM AUTHOR]

Objective: The scope of this paper is to review the subtypes of transient ischemic attack (TIA) and minor stroke (mS) in which a surgical treatment is needed, discussing the importance and the timing of a multidisciplinary approach, in order to achieve an optimized management and prevent major strokes or other critical complications. Materials and methods: The keywords "transient ischemic attack," "minor stroke," "surgical treatment," "vascular surgery," "heart surgery," "neurosurgery," and "multidisciplinary" were searched using MEDLINE, EMBASE, and Scopus. Relevant search results were discussed by the authors for references inclusion. Results: Notwithstanding that best medical therapy is usually the first choice for the most part of cases, there are specific but recurrent etiologies that must be properly recognized because of a potential surgical approach, even in urgency. In fact, symptomatic carotid stenosis, or particular cases of hemodynamic cerebrovascular events, should be promptly referred to vascular surgeon, since increasing evidences highlighted a benefit from an early artery revascularization. In addition, beyond arrhythmic causes, cardioembolic events due to bacterial endocarditis and atrial myxoma should be quickly diagnosed, possibly in emergency department, because they are a presumptive urgency for heart surgery. In addition to the above-mentioned conditions, in patients suffering from vertebrobasilar TIA or mS, clinicians should keep in mind the Bow Hunter disease, because surgical artery decompression can represent the only suitable treatment in selected cases. Conclusions: TIA and mS require a multidisciplinary in order to discuss therapeutic options, comparing risks and benefits and determining the best timing for an optimized management. [ABSTRACT FROM AUTHOR]

Background/aims: Data are limited on the frequency of 'consensus decisions' between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM 'adherence' to such advice. Methods: This prospective audit/quality improvement project collated prospectively-recorded data from a weekly Neurovascular/Stroke Centre MDM documenting the proportion of extracranial carotid/vertebral stenosis patients in whom 'consensus management decisions' were reached by neurologists, vascular surgeons, stroke physicians-geriatricians and neuroradiologists. Adherence to MDM advice was analysed in asymptomatic carotid stenosis (ACS), symptomatic carotid stenosis (SCS), 'indeterminate symptomatic status stenosis' (ISS) and vertebral artery stenosis (VAS) patients, including intervals between index event to MDM + / − intervention. Results: One hundred fifteen patients were discussed: 108 with carotid stenosis and 7 with VAS. Consensus regarding management was noted in 96.5% (111/115): 100% with ACS and VAS, 96.2% with SCS and 92.9% with ISS. Adherence to MDM management advice was 96.4% (107/111): 100% in ACS, ISS and VAS patients; 92% (46/50) in SCS patients. The median interval from index symptoms to revascularisation in 50–99% SCS patients was 12.5 days (IQR: 9–18.3 days; N = 26), with a median interval from MDM to revascularisation of 5.5 days (IQR: 1–7 days). Thirty patients underwent revascularisation. Two out of twenty-nine patients (6.9%) with either SCS or ISS had a peri-procedural ipsilateral ischaemic stroke, with no further strokes/deaths during 3-months follow-up. Conclusions: The high frequency of inter-specialty consensus regarding management and adherence to proposed treatment supports a collaborative/multidisciplinary model of care in patients with extracranial arterial stenoses. Service development should aim to shorten times between MDM discussion-intervention and optimise prevention of stroke/death. [ABSTRACT FROM AUTHOR]

This paper presents an inverter-based active feedback transimpedance amplifier (IAF-TIA), in which an active feedback is applied to a voltage-mode inverter-based TIA, and therefore, the controlled positive regeneration process enables the proposed IAF-TIA to achieve the limiting operations for input currents greater than 100 μApp. However, the active inverter feedback mechanism might be prone to instability, hence mandating a very careful optimization of the loop gain. For this purpose, a diode-connected NMOS transistor is employed as a switch in the feedback path with its gate connected to the input, which helps not only to mitigate the corresponding issue but also to accommodate large input currents up to 1.5 mApp. The proposed IAF-TIA implemented in a standard 180 nm CMOS process demonstrates a 70.5 dBΩ transimpedance gain, 1.21 GHz bandwidth, 4.3 pA/Hz noise current spectral density, 63.5 dB input dynamic range, and 23.6 mW power dissipation from a single 1.8 V supply. The chip core occupies an area of 180 × 50 μm2, including an on-chip P+/N-well/Deep N-well avalanche photodiode as an optical detector.

Background and aimRapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics.MethodsRelevant services were identified by literature search and contacted. Three years of monthly data were requested – a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a time-dependent outcome using a defined impact model.ResultsSix centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI –1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI –7.8 to 1.9, p = 0.25), IVT (−14.3, 95% CI −36.7, 6.1, p

Background and purpose: Guidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1–3 days from onset should be oered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database. Methods: The Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ∼16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed. Results: After excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately oered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients. Conclusion: This large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation. [ABSTRACT FROM AUTHOR]

• Urine ketone bodies may appear in different states in the acute stage of stroke. • Positive ketone bodies in urine was independently associated with recurrent stroke. • The urine ketone bodies should get screened whether patients have diabetes or not. Urine ketone bodies may appear in different states in the acute stage of stroke. We aimed to examine the association between urine ketone bodies and recurrent stroke in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) in this study. In Third China National Stroke Registry (CNSR-III), 14,015 patients with AIS or TIA were screened for urine ketone bodies. The outcomes were any stroke, ischemic stroke and combined vascular events within 1 year. The association of urine ketone bodies with recurrent stroke were analyzed by Cox proportional hazards. During 1 year of follow-up, 1,335 (9.53%) participants experienced recurrent stroke. After adjustment for conventional confounding factors, patients with urine ketone bodies test positive had a higher risk of recurrent stroke (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.13–1.82), compared to those were negative. The correlation between positive urine ketone bodies and recurrent stroke were consistent in patient with (HR, 1.45; 95% CI, 1.00–2.12) and without (HR, 1.40; 95% CI, 1.02–1.94) diabetes. No significant interaction between urine ketone bodies and diabetes were observed. Positive ketone bodies in urine was independently associated with recurrent stroke in patients with AIS or TIA. [ABSTRACT FROM AUTHOR]

Objective: Transient ischemic attack is a significant risk factor for acute cerebral infarction. Previous studies have demonstrated that hypoperfusion in patients with transient ischemic attack was associated with the recurrence of transient ischemic attack, stroke, and persistent worsening of neurological symptoms. Moreover, transient ischemic attack patients classified as high-risk group according to the ABCD² score have a higher incidence of stroke. Therefore, the objective of this study was to investigate the plaque characteristics of transient ischemic attack patients with concomitant cerebral hypoperfusion using multimodal MRI, as well as hemodynamic changes in the high-risk group with transient ischemic attack patients. Materials and methods: A total of 151 patients with transient ischemic attack were prospectively recruited for this study. All enrolled patients underwent multimodal MRI, including DWI, TOF-MRA, HR-VWI, and DSC-PWI. Finally, 56 patients met the inclusion criteria. Based on DSC-PWI images, patients were divided into two groups: hypoperfusion (n = 41) and non-hypoperfusion (n = 15). Clinical baseline characteristics and plaque characteristics were analyzed between the two groups. Furthermore, within the hypoperfusion group, patients were further classified into low-risk (n = 11) and high-risk (n = 30) subgroups based on the ABCD² score. Hemodynamic differences between these subgroups were also analyzed. Results: Compared with the non-hypoperfusion group, the hypoperfusion group had a significantly higher prevalence of hypertension (68.3% vs. 33.3%, p = 0.019) and hyperhomocysteinemia (65.9% vs. 33.3%, p = 0.029). Moreover, the hypoperfusion group exhibited more significant luminal stenosis degree [41.79 ± 31.36 vs. 17.62 ± 13.62, p = 0.006] and greater NWI (57.1%±20.47% vs. 40.21%± 21.56%, p = 0.009) compared to the non-hypoperfusion group. In addition, the high-risk group identified by the ABCD² score had a higher rMTT [117.6(109.31-128.14) vs. 108.36(100.67-119.92), p = 0.037]. Conclusion: Transient ischemic attack patients with hypoperfusion exhibited a higher prevalence of hypertension and hyperhomocysteinemia, as well as higher luminal stenosis degree, and greater NWI. Furthermore, Transient ischemic attack patients in the high-risk group demonstrated higher MTT. [ABSTRACT FROM AUTHOR]

Background & Objectives: The risk of recurrence after a transient ischemic attack (TIA) or minor stroke is high especially within three months after first event. The aim of study is assessing the efficacy of ticagrelor plus aspirin in reduction of mild non-cardioembolic ischemic stroke or high risk TIA recurrence during first 3 months. Methods: This is a randomized, controlled, active comparator arm, outcome assessor blind, parallel group, feasibility study design on 90 patients with diagnosis of non-cardioembolic minor ischemic stroke or high risk TIA admitted in Bou-Ali Sina Hospital, Sari, Iran. After meeting all inclusion and exclusion criteria, patients will be randomized to ticagrelor 90 mg BID plus aspirin (ASA) 80 mg daily or clopidogrel 75 mg daily plus ASA 80 mg daily (1:1 ratio) until 21 days and then ASA 80 mg daily. Participants will be visited at month one and three. Any adverse events, serious side effects and outcome events will be recorded. The primary outcome is defined as ischemic stroke recurrence. Conclusion: Ticagrelor plus ASA is expected to be effective for prevention of recurrence in mild non-cardioembolic stroke and high risk TIA. [ABSTRACT FROM AUTHOR]

Background and purposeGuidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1–3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database.MethodsThe Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ~16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed.ResultsAfter excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients.ConclusionThis large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation.

Background: The purpose of this study was to determine the quality of life of a patient with per- sistent complications of SARS-CoV-2 infection requiring urgens surgical intervention – endarterectomy with emergency angioplasty of an inflamed, bleeding Right Inter- nal Carotid Artery (RICA) by direct access via Right Common Carotid Artery (RCCA), known as Transcarotid Artery Revascularization (TCAR). Case study A patient in her 60s was infected with the SARS-CoV-2 virus and contracted COVID-19 in March 2022, as confirmed by RT PCR antigen test. The infection was followed by short- and long-term complications, many of which can be linked to COVID. These include significant weakness persisting for months after the illness, rapid weight loss of 25 kg, sleep disturbances, chronic fatigue, severe dizziness, onset of diabetes, decrease dimmunity with increased periodontal inflammation (including formation of a periapical abscess of a molar tooth) and secondary suppuration of the submandibular lymphnodes, one of which lying jacent to the right internal carotidartery (RICA). This accumulation of symptoms led the patient to seek medical and neuropsychological help. Test ingusing the Beck Depression Inventory (BDI) confirmed depression, with vegetative disorders being the most predominant. Eight months after undergoing COVID-19, the patient suffered a Transient Ischemic Attack (TIA). The accumulation of diseases (diabetes mellitus, stage III hypertension and TIA) had a dramatic impact on the patient's health, including life-threatening conditions.A vascular surgeon consulted the patient advised immediate surgical treatment: carotid endarterectomy. The urgency of the situation was exacerbated by bleeding during the operation from the operated, secondarily inflamed wall of the RICA (lying adjacent to the suppurated submandibular node).This prompted an emergency decision for an endovascular procedure: the implantation of a stent covered with water-proof material (peripheral stent graft). This was made by a direct access via puncture of the common carotid artery (RCCA) below the endarterectomy level (TCAR).The SF-36 questionnaire was chosen to measure health-related quality of life (HRQOL).The SF-36 results are presented in such a way that higher scores correspond to fewer complaints, indicating better health and higher quality of life. Before revascularization, the patient's HRQOL was found to be lower, which was related to the negative impact of long COVID, while after the procedure, the quality of life gradually improved in subsequent surveys. A significant difference was found in physical function, with a mean score of 66.0 (p<0.001) compared to a score of 94.9 (±9.4) for 100 age-matched health subjects. A similar result was found in the physical role (p < 0.001). The patient's overall quality of life score was 331.0 compared to a score of 578.0 (±111.9) for age-matched normal healthy people. Conclusions Better quality of life in patients with long COVID is an important therapeutic goal that can be achieved through comprehensive, multispecialty treatment for both physical and psychological conditions. [ABSTRACT FROM AUTHOR]

It has been suggested that peri-operative complications after carotid surgery may be higher in women than in men. This assumption may affect the treatment patterns, and it is thus possible that carotid endarterectomy (CEA) is provided to women less often. The aim of the current VASCUNET study was to determine sex related differences in operative risk in routine clinical practice among non-selected patients undergoing carotid revascularisation. Data on CEA and carotid artery stenting (CAS) from 14 vascular registries were collected and amalgamated. Comprehensive data were available for 223 626 carotid artery procedures; these were analysed overall and by country. The primary outcome was any stroke and or death within 30 days of carotid revascularisation. Secondary outcomes were stroke, death, or any major cardiac event or haemorrhage leading to re-operation. Of the procedures, 34.8% were done in women. The proportion of CEA for asymptomatic stenosis compared with symptomatic stenosis was significantly higher among women than men (38.4% vs. 36.9%, p <.001). The proportion of octogenarians was higher among women than men who underwent CEA in both asymptomatic (21.2% vs. 19.9%) and symptomatic patients (24.3% vs. 21.4%). In the unadjusted analysis of symptomatic and asymptomatic patients, there were no significant differences between men and women in the rate of post-operative combined stroke and or death, any major cardiac event, or combined death, stroke, and any major cardiac event after CEA. Also, after stenting for asymptomatic or symptomatic carotid stenosis, there were no significant differences between men and women in the rate of post-operative complications. In adjusted analyses, sex was not significantly associated with any of the end points. Higher age and CAS vs. CEA were independently associated with all four end points. This study confirmed that, in a large registry among non-selected patients, no significant sex related differences were found in peri-operative complication rates after interventions for carotid stenosis. [ABSTRACT FROM AUTHOR]

Objectives: Patients with TIA and minor stroke commonly undergo CT and CTA in the emergency department with subsequent MRI with MRA for further workup. The purpose of this study was to review outpatient MRIs for TIA/stroke patients to assess the additional benefit, if any, of the MRA sequence in the detection of intracranial atherosclerotic disease in patients for whom CTA had already been performed. Methods: The radiology reports of outpatient MRIs of the brain for TIA/minor stroke patients were retrospectively reviewed via the hospital PACS system. Following this, the imaging report from the patient's initial presentation to the emergency department was reviewed. This index imaging and subsequent MRI were compared to assess the incidence of new vascular findings detected on the MRA sequence in patients for whom CTA had already been performed. Where new lesions had been identified at follow-up, the imaging was retroactively reviewed to assess if they were present on the index imaging. Results: Two hundred seven consecutive patients were reviewed. Significant (> 50%) intracranial atherosclerotic disease was present on MRA in 18 patients (8.7%). This was a new finding in 11 patients. Five had initial CTA where the atherosclerosis was not detected. All 5 of these cases were located in the posterior cerebral arteries. Incidental aneurysms were seen in 14 (6.7%); 12 were a new finding at time of MRI. Conclusion: The MRA sequence provides additional value by increasing the detection of clinically important intracranial atherosclerotic disease which may inform management in patients with minor stroke and TIA. [ABSTRACT FROM AUTHOR]

The aims of this article are to review the evidence regarding the use of non-vitamin K oral anticoagulants (NOACs) for secondary stroke prevention as compared to vitamin K antagonists in patients with atrial fibrillation (AF) and in patients with embolic strokes of uncertain source (ESUS), and when to initiate or resume anticoagulation after an ischaemic stroke or intracranial haemorrhage. Four large trials compared NOACs with warfarin in patients with AF. In our meta-analyses, the rate of all stroke or systemic embolism (SE) was 4.94% with NOACs vs. 5.73% with warfarin. Among the patients with AF and previous transient ischaemic attack or ischaemic stroke, the rate of haemorrhagic stroke was halved with a NOAC vs. warfarin, and the rate of major bleeding was 5.7% with a NOAC vs. 6.4% with warfarin. There was no significant difference in mortality. In a trial comparing apixaban with aspirin in patients with AF, the rate of stroke or SE was 2.4% at 1 year with apixaban vs. 9.2% at 1 year with aspirin and the rates of major bleeding were 4.1% with apixaban vs. 2.9% with aspirin. Data from registries confirmed the results from the randomized trials. Initiation or resumption of anticoagulation after ischaemic stroke or cerebral haemorrhage depends on the size and severity of stroke and the risk of recurrent bleeding. Two large trials tested the hypothesis that NOACs are more effective than 100 mg aspirin in patients with ESUS. Neither trial showed a significant benefit of the NOAC over aspirin. In the meta-analysis, the rate all stroke or SE was 4.94% with NOACs vs. 5.73% with warfarin and the rate of haemorrhagic stroke was halved with a NOAC. The four NOACs had broadly similar efficacy for the major outcomes in secondary stroke prevention.

Introduction: Patients with severe, symptomatic carotid stenosis can have their subsequent stroke risk reduced by surgical intervention if performed soon after a transient ischemic attack (TIA) or stroke. Patients presenting to an emergency department (ED) without computed tomography angiography (CTA) with TIA/stroke, may require transfer to another hospital for imaging to rule out carotid artery stenosis. The objective of this study was to determine the test characteristics of carotid artery point-of-care ultrasound (POCUS) in detecting greater than 50% stenosis in patients presenting with TIA/stroke.Methods: We conducted a prospective cohort study on a convenience sample of adult patients presenting to a comprehensive stroke centre with TIA or stroke between June–October 2017. Carotid POCUS was performed. Primary outcome measure, stenosis ≥ 50%, was determined by the final radiology report of CTA. A blinded POCUS expert separately reviewed the archived carotid POCUS scans. We calculated sensitivity and specificity for stenosis ≥ 50%.Results: We conducted POCUS on 75 patients, of which 70 were included in our analyses. Of those 70, 14.3% were diagnosed with greater than 50% stenosis. Carotid POCUS performed as follows: sensitivity 70.0% (95% confidence interval [CI], 34.8%-93.3%); specificity 86.7% (95% CI, 75.4%-94.1%); positive likelihood ratio (LR +) 5.3 (95% CI, 1.2-9.3); negative likelihood ratio (LR -) 0.4 (95% CI, 0.0-0.7). The inter-rater reliability between POCUS performer interpretation and expert interpretation had moderate agreement (k = 0.68). Scans took a mean 6.2 ± 2.2 minutes to complete.Conclusion: Carotid POCUS has low to moderate association with CTA for detection of carotid artery stenosis ≥ 50%. Further research and investigation is needed prior to widespread use of carotid POCUS in patients with acute cerebral ischemia. Additionally, external validity is likely affected by availability of training, maintenance of competency, and experience in more rural centres.

Abstract Background Echocardiography is highly relevant in patients with ischemic stroke or TIA. Utilization of routine echocardiographic examinations [transthoracic (TTE) or transesophageal (TEE)] on stroke units remains however unknown. To representatively examine echocardiographic rates on stroke units in Germany and to evaluate structural factors that may influence the decision to conduct echocardiography. Methods A nationwide analysis was performed by using certification audit data of all primary and comprehensive stroke centers (pSC and cSC) in Germany. Results Structural and organizational requirements of 310 departments (cSCs: 42.6%) were extracted. Median TTE rate was 63.3% (IQR 39.3–80.8), median TEE rate 21.3% (IQR 16.4–29.5). A cardiological department on site was present in 74.2%, and they were associated with higher TEE rates. TTE rates decreased with increasing numbers of patients (p = 0.026). Likewise, TEE rates decreased with increasing numbers of patients (p = 0.006), mediated by departments with cSCs (p = 0.008 for cSCs vs p = 0.230 for pSCs). TTE rates were far more inhomogeneously distributed than TEE rates and higher in pSCs (p = 0.011). Overall, 12.9% of centers did not perform any echocardiographic examination in at least 50% of all stroke patients. Conclusion More detailed recommendations regarding echocardiography should be included in future guidelines. Moreover, evaluating the impact of echocardiographic examinations on long-term prognosis in stroke patients should be focus of further evaluations.