Umeå University's logo

umu.sePublications
Change search
Link to record
Permanent link

Direct link
Alternative names
Publications (10 of 129) Show all publications
Garoff, M., Ahlqvist, J., Levring Jäghagen, E., Wester, P. & Johansson, E. (2025). Carotid calcifications in panoramic radiographs can predict vascular risk. Dento-Maxillo-Facial Radiology, 54(1), 28-34
Open this publication in new window or tab >>Carotid calcifications in panoramic radiographs can predict vascular risk
Show others...
2025 (English)In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 54, no 1, p. 28-34Article in journal (Refereed) Published
Abstract [en]

Objectives: Carotid artery calcification (CAC) is occasionally detected in panoramic radiographs (PRs). Bilateral vessel-outlining (BVO) CACs are independent risk markers for future vascular events and have been associated with large plaque area. If accounting for plaque area, BVO CACs may no longer be an independent risk marker for vascular events. The aim of this study was to explore the association between BVO CACs and vascular events and its relationship with carotid ultrasound plaque area.

Methods: In this cohort study we prospectively included 212 consecutive participants with CACs detected in PR that were performed to plan and evaluate odontologic treatment. Of these 212, 43 (20%) had BVO CACs. Plaque area was assessed with ultrasound at baseline. Primary outcome was major adverse cardiovascular events (MACEs) during follow-up.

Results: Vessel-outlining CAC was associated with larger plaque area on the same side (P = .03) and BVO CACs were associated with larger total plaque area (both sides summed) than other CAC features (P = .004). Mean follow-up was 7.0 years and 72 (34%) participants had more than 1 MACE. In bivariable analyses, both BVO CACs (HR 2.5, P < .001) and total plaque area (HR 1.8 per cm2, P = .008) were associated with MACE. When entering BVO CACs, plaque area and other relevant co-variates in a multivariable model, BVO CACs were virtually unchanged (HR 2.4, P = .001), but total plaque area was no longer significant (HR 1.0, P = .92).

Conclusion: Present results support the contention that BVO CACs are a stronger predictor for future vascular events than carotid ultrasound plaque area.

Place, publisher, year, edition, pages
Oxford University Press, 2025
Keywords
atherosclerosis, cardiovascular disease, carotid arteries, radiography panoramic, ultrasonography carotid arteries
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:umu:diva-233983 (URN)10.1093/dmfr/twae057 (DOI)001378133900001 ()39565902 (PubMedID)2-s2.0-85214318635 (Scopus ID)
Funder
Swedish Heart Lung FoundationThe Swedish Stroke AssociationRegion VästerbottenKnut and Alice Wallenberg Foundation
Available from: 2025-01-13 Created: 2025-01-13 Last updated: 2025-02-10Bibliographically approved
Ennab Vogel, N., Andersson Granberg, T., Wester, P. & Levin, L.-Å. (2025). Optimizing prehospital acute transfer of patients with presumed stroke given economic constraints. European Journal of Neurology, 32(3), Article ID e70112.
Open this publication in new window or tab >>Optimizing prehospital acute transfer of patients with presumed stroke given economic constraints
2025 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 32, no 3, article id e70112Article in journal (Refereed) Published
Abstract [en]

Background: Treatment with mechanical thrombectomy (MT) remains inaccessible for many patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) and under-utilization prevails across healthcare systems. Increasing the number of thrombectomy centers and ambulance helicopters may alleviate these issues. Aim: This study aims to determine the most effective combination of optimally located ambulance helicopters and thrombectomy centers for the economically constrained healthcare system.

Methods: This nation-wide, observational study analyses anonymized patient-level registry data stretching over a 6-year study period in Sweden. It combines optimization modeling with cost-effectiveness analysis to generate combinations of optimally located thrombectomy centers and ambulance helicopters to compare with the current eight locations of thrombectomy centers in Sweden and no ambulance helicopters. The analysis extends to evaluate the cost-effectiveness of increasing the number of thrombectomy centers and ambulance helicopters when the current eight locations remain fixed.

Results: The most cost-effective solution comprises 11 thrombectomy centers and 14 ambulance helicopters, corresponding to densities of 1.05 and 1.34 per one million inhabitants, respectively. It yields an estimated annual incremental net monetary benefit (INMB) close to €13.6 million. In the extended scenario analysis, the most cost-effective solution comprised nine thrombectomy centers and 13 ambulance helicopters, with an estimated annual INMB of €3.8 million.

Conclusions: The most cost-effective combination of optimally located thrombectomy centers and ambulance helicopters brings about substantial health gains for patients with AIS due to LVO, compared with the current eight locations of thrombectomy centers in Sweden and ambulance helicopters.

Place, publisher, year, edition, pages
John Wiley & Sons, 2025
Keywords
acute ischemic stroke, ambulance, cost-effectiveness, endovascular therapy, helicopter emergency medical services, large vessel occlusion, optimization, thrombectomy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-237327 (URN)10.1111/ene.70112 (DOI)001444279000001 ()40084618 (PubMedID)2-s2.0-105000325119 (Scopus ID)
Available from: 2025-04-25 Created: 2025-04-25 Last updated: 2025-04-25Bibliographically approved
Norberg, M., Liv, P., Näslund, U., Wester, P., Andersson, E. M. & Nordin, S. (2025). The path for men from young adulthood results of cognitive tests to subclinical atherosclerosis at age 60: the mediating role of socioeconomic status, lifestyle and cardiovascular disease risk factors–results from a VIPVIZA study. Reviews in Cardiovascular Medicine, 26(3), Article ID 26312.
Open this publication in new window or tab >>The path for men from young adulthood results of cognitive tests to subclinical atherosclerosis at age 60: the mediating role of socioeconomic status, lifestyle and cardiovascular disease risk factors–results from a VIPVIZA study
Show others...
2025 (English)In: Reviews in Cardiovascular Medicine, ISSN 1530-6550, Vol. 26, no 3, article id 26312Article in journal (Refereed) Published
Abstract [en]

Background: The role of cognitive abilities in the development of arteriosclerotic disease is still not fully understood. The purpose of the present study was to evaluate the mediating role of lifestyle, socioeconomic status (SES) and conventional cardiovascular disease (CVD) risk factors in the association between cognitive ability at age 19 and subclinical atherosclerosis at age 60 years.

Methods: An observational study design was employed. Data on the results from cognitive tests of conscripts tested at age 19 were collected for 1009 men. At the age of 60, they were included in the trial VIsualiZation of asymptomatic Atherosclerotic disease for optimum cardiovascular prevention, which was conducted as part of the Västerbotten Intervention Program (VIPVIZA). VIPVIZA is a randomised controlled trial, aimed at primary prevention of CVD in Västerbotten County, Sweden. Prior to any intervention, they underwent carotid ultrasonography and CVD risk factor assessment. Lifestyle habits and marital status were self-reported, and education and urban or rural residency were registered. Crude associations between cognitive ability at age 19 and the risk of CVD, assessed with the European Systematic Coronary Risk Evaluation 2 (SCORE2), as well as subclinical atherosclerosis, as demonstrated by the presence of carotid plaques (no plaque, plaque unilateral, or plaque bilateral), were evaluated. A path-analytic model tested mediating factors from cognitive ability in young adulthood to subclinical atherosclerosis at age 60.

Results: Results from cognitive tests at age 19 were in separate unadjusted analyses inversely and linearly associated with SCORE2 and with subclinical atherosclerosis. The association with carotid plaque at age 60 was mainly indirect and mediated by adult SES, which in turn had its main effect through adherence to healthy lifestyle habits via CVD risk of carotid plaques.

Conclusions: Cognitive ability at age 19 is a factor that is upstream of adult SES and our study indicates that cognitive ability at a young age has long-term consequences via SES and lifestyle habits for CVD risk and atherosclerosis.

Place, publisher, year, edition, pages
IMR Press, 2025
Keywords
atherosclerosis, cardiovascular risk, cognitive ability, lifestyle, socioeconomic status
National Category
Cardiology and Cardiovascular Disease Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-238454 (URN)10.31083/RCM26312 (DOI)40160597 (PubMedID)2-s2.0-105002055602 (Scopus ID)
Available from: 2025-05-06 Created: 2025-05-06 Last updated: 2025-05-06Bibliographically approved
Selg, J., Holmlund, T., Levring Jäghagen, E., McGreevy, J., Svanberg, S., Wester, P. & Hägglund, P. (2025). Validity and reliability of the Swedish version of the gugging swallowing screen for use in acute stroke care. Dysphagia (New York. Print), 40, 176-186
Open this publication in new window or tab >>Validity and reliability of the Swedish version of the gugging swallowing screen for use in acute stroke care
Show others...
2025 (English)In: Dysphagia (New York. Print), ISSN 0179-051X, E-ISSN 1432-0460, Vol. 40, p. 176-186Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96 h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29–93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78–0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.

Place, publisher, year, edition, pages
Springer, 2025
Keywords
Stroke, Dysphagia screening, Validation, Sensitivity, Specificity, The Gugging swallowing screen
National Category
Otorhinolaryngology Neurology
Identifiers
urn:nbn:se:umu:diva-225527 (URN)10.1007/s00455-024-10717-y (DOI)001226594800001 ()38753206 (PubMedID)2-s2.0-85193223225 (Scopus ID)
Available from: 2024-06-03 Created: 2024-06-03 Last updated: 2025-05-28Bibliographically approved
Söderström, M., Grönlund, C., Liv, P., Nyman, E., Näslund, U. & Wester, P. (2024). Aortic arterial stiffness associates with carotid intima-media thickness and carotid plaques in younger middle-aged healthy people. Blood Pressure, 33(1), Article ID 2405161.
Open this publication in new window or tab >>Aortic arterial stiffness associates with carotid intima-media thickness and carotid plaques in younger middle-aged healthy people
Show others...
2024 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 33, no 1, article id 2405161Article in journal (Refereed) Published
Abstract [en]

Purpose: Aortic stiffness, assessed as estimated aortic pulse wave velocity (aPWV), and carotid intima-media thickness (cIMT) are markers of vascular age, and carotid plaques are a marker of early atherosclerosis. In this cross-sectional study we aimed to investigate the association between aPWV, cIMT and plaques across different age groups and in women and men, in a middle-aged healthy population.

Materials and methods: Participants in the 6.5-year follow-up of the VIPVIZA trial who were aged 47, 57 and 67 underwent an oscillometric measurement which estimates aPWV between 2020 and 2023. Carotid ultrasound examinations were also performed. Linear and ordinal regression models were used to investigate how aPWV associates with cIMT and with carotid plaques, for the overall study group and stratified for age groups and sex.

Results: A total of 1046 subjects were included in the analyses. Linear associations between aPWV and cIMT (β = 0.018, 95% CI: 0.006–0.030, p = 0.003), and between aPWV and plaques (OR: 1.19, 95% CI: 1.03–1.38, p = 0.018), were seen in the 57-year-olds. In the 47-year-olds a significant association was seen between aPWV and plaques (OR: 2.98 95% CI: 1.44–6.14, p = 0.003). No significant associations were seen in the 67-year-olds. For women, a significant association between aPWV and cIMT (β = 0.011, 95% CI: 0.004–0.017, p = 0.002) was shown.

Conclusion: Estimated aPWV was positively associated with increasing cIMT and the presence of carotid plaques in younger middle-aged individuals, and with cIMT in women, suggesting that measurement of estimated aPWV may improve cardiovascular risk assessment in younger middle-aged individuals and women.

Clinical Trial Registration date 8 May 2013: URL: www.clinicaltrials.gov. Unique identifier: NCT01849575.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Aortic pulse wave velocity, arterial stiffness, cardiovascular disease prevention, carotid intima-media thickness, carotid plaques, vascular ageing
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:umu:diva-230114 (URN)10.1080/08037051.2024.2405161 (DOI)001329955100001 ()39291635 (PubMedID)2-s2.0-85204513110 (Scopus ID)
Funder
Region Västerbotten, 98001Region Västerbotten, 643391Region Västerbotten, 7004571Swedish Research Council, 521-2013-2708Swedish Research Council, 2017-0289Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 371130519Swedish Heart Lung Foundation, 37113052Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Available from: 2024-10-15 Created: 2024-10-15 Last updated: 2025-04-24Bibliographically approved
Vogel, N. E., Wester, P., Andersson Granberg, T. & Levin, L.-Å. (2024). Cost-effectiveness of prehospital ambulance helicopter transportation of patients with presumed stroke in the era of mechanical thrombectomy. Stroke: vascular and interventional neurology, 4(5), Article ID e001343.
Open this publication in new window or tab >>Cost-effectiveness of prehospital ambulance helicopter transportation of patients with presumed stroke in the era of mechanical thrombectomy
2024 (English)In: Stroke: vascular and interventional neurology, ISSN 2694-5746, Vol. 4, no 5, article id e001343Article in journal (Refereed) Published
Abstract [en]

Background: Mechanical thrombectomy has emerged as standard of care in treatment of patients with acute ischemic stroke attributable to large-vessel occlusion. Efforts to reduce the time from symptom onset to treatment initiation remain critically important to improve functional outcomes in patients treated with either intravenous thrombolysis, mechanical thrombectomy, or both. The use of ambulance helicopters in prehospital acute stroke care could potentially reduce symptom onset to treatment time to mechanical thrombectomy. This study aims to optimize the use of ambulance helicopters in prehospital transportation of patients with presumed acute stroke attributable to large-vessel occlusion given economic constraints in health care budget.

Methods: By means of an economic model within a decision-analytical framework, this study evaluates the cost-effectiveness of complementary ambulance helicopters compared with road ambulances only for prehospital acute transportation of patients with presumed stroke and potential eligibility for mechanical thrombectomy, in regard to the number and locations of ambulance helicopters in Sweden.

Results: A single, optimally located complementary ambulance helicopter was cost-effective compared with road ambulances only. The most cost-effective solution in the base-case scenario with the current 8 thrombectomy centers comprised 13 optimally located helicopters. It reduced mean onset to treatment time with intravenous thrombolysis and onset to treatment time with mechanical thrombectomy by 7.9 and 32.1 minutes, respectively, and produced health gains equal to 91 quality-adjusted life-years per year. When the willingness to pay per quality-adjusted life-years gained was set at Euro (EUR) 80 000, the incremental net monetary benefit per patient reached EUR 2240. The solution with 13 optimally located helicopters prevailed as the most cost-effective in the extended scenario analysis with 11 thrombectomy centers, reaching an estimated incremental net monetary benefit per patient at EUR 1754. Furthermore, mean incremental net monetary benefit per patient reached global maximum (EUR 6046) at the geodesic distance of 165.2 km between patient location and the nearest thrombectomy center in the base-case scenario, and at 238.5 km in the extended scenario with an estimated incremental net monetary benefit per patient at EUR 7994.

Conclusion: This study demonstrates the cost-effectiveness of ambulance helicopters as a complementary mode of transportation to road ambulances. The most cost-effective solution of complementary ambulance helicopters comprises 13 optimally located heliports across Sweden.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
air ambulances, ambulances, cost-effectiveness analysis, decision making, ischemic stroke, organizational, thrombectomy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Neurology
Identifiers
urn:nbn:se:umu:diva-232445 (URN)10.1161/SVIN.124.001343 (DOI)001304321900003 ()
Funder
Linköpings universitet
Available from: 2024-11-29 Created: 2024-11-29 Last updated: 2024-11-29Bibliographically approved
Strååt, K., Isaksson, E., Laska, A. C., Rooth, E., Svennberg, E., Åsberg, S., . . . Engdahl, J. (2024). Large variations in atrial fibrillation screening practice after ischemic stroke and transient ischemic attack in Sweden: a survey study. BMC Neurology, 24(1), Article ID 120.
Open this publication in new window or tab >>Large variations in atrial fibrillation screening practice after ischemic stroke and transient ischemic attack in Sweden: a survey study
Show others...
2024 (English)In: BMC Neurology, E-ISSN 1471-2377, Vol. 24, no 1, article id 120Article in journal (Refereed) Published
Abstract [en]

Background: Atrial fibrillation (AF) screening after ischemic stroke or transient ischemic attack (TIA) is given high priority in clinical guidelines. However, patient selection, electrocardiogram (ECG) modality and screening duration remains undecided and current recommendations vary.

Methods: The aim of this study was to investigate the clinical practice of AF screening after ischemic stroke or TIA at Swedish stroke units. In collaboration with the stakeholders of the Swedish Stroke Register (Riksstroke) a digital survey was drafted, then tested and revised by three stroke consultants. The survey consisted of 17 multiple choice/ free text questions and was sent by e-mail to the medical directors at all stroke units in Sweden.

Results: All 72 stroke units in Sweden responded to the survey. Most stroke units reported that ≥ 75% of ischemic stroke (69/72 stroke units) or TIA patients (67/72 stroke units), without previously known AF, were screened for AF. Inpatient telemetry ECG was the method of first-choice in 81% of the units, but 7% reported lack of access. A variety of standard monitoring durations were used for inpatient telemetry ECG. The second most common choice was Holter ECG (17%), also with considerable variations in monitoring duration. Other AF screening modalities were used as a first-choice method (handheld and patch ECG) but less frequently.

Conclusions: Clinical practice for AF screening after ischemic stroke or TIA differed between Swedish stroke units, both in choice of AF screening methods as well as in monitoring durations. There is an urgent need for evidence and evidence-based recommendations in this field. 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Atrial fibrillation, Event loop recorder, Handheld ECG, Holter ECG, Implantable loop recorder, Inpatient telemetry ECG, Ischemic stroke, Screening, Transient ischemic attack
National Category
Neurology Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:umu:diva-223639 (URN)10.1186/s12883-024-03622-2 (DOI)001200738700001 ()38605308 (PubMedID)2-s2.0-85190109644 (Scopus ID)
Available from: 2024-04-24 Created: 2024-04-24 Last updated: 2025-04-24Bibliographically approved
Ennab Vogel, N., Wester, P., Andersson Granberg, T. & Levin, L.-Å. (2024). Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke. Journal of NeuroInterventional Surgery, 16, 156-162
Open this publication in new window or tab >>Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke
2024 (English)In: Journal of NeuroInterventional Surgery, ISSN 1759-8478, Vol. 16, p. 156-162Article in journal (Refereed) Published
Abstract [en]

Background: Despite the proven cost effectiveness of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion, treatment within 6 hours from symptom onset remains inaccessible for many patients. We aimed to find the optimal number and location of treatment facilities with respect to the cost effectiveness of MT in patients with AIS, first by the most cost effective implementation of comprehensive stroke centers (CSCs), and second by the most cost effective addition of complementary thrombectomy capable stroke centers (TSCs).

Methods: This study was based on nationwide observational data comprising 18 793 patients with suspected AIS potentially eligible for treatment with MT. The most cost effective solutions were attained by solving the p median facility location-allocation problem with the objective function of maximizing the incremental net monetary benefit (INMB) of MT compared with no MT in patients with AIS. Deterministic sensitivity analysis (DSA) was used as the basis of the results analysis.

Results: The implementation strategy with seven CSCs produced the highest annual INMB per patient of all possible solutions in the base case scenario. The most cost effective implementation strategy of the extended scenario comprised seven CSCs and four TSCs. DSA revealed sensitivity to variability in MT rate and the maximum willingness to pay per quality adjusted life year gained.

Conclusion: The combination of optimization modeling and cost effectiveness analysis provides a powerful tool for configuring the extent and locations of CSCs (and TSCs). The most cost effective implementation of CSCs in Sweden entails 24/7 MT services at all seven university hospitals.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
economics, intervention, stroke, thrombectomy, thrombolysis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-209175 (URN)10.1136/jnis-2023-020299 (DOI)000981480100001 ()37072170 (PubMedID)2-s2.0-85160234118 (Scopus ID)
Funder
Linköpings universitetUmeå UniversitySwedish Heart Lung Foundation
Available from: 2023-06-22 Created: 2023-06-22 Last updated: 2024-07-02Bibliographically approved
Sefastsson, A., Marklund, I., Littbrand, H., Wester, P., Stålnacke, B.-M., Sörlin, A., . . . Hu, X.-L. (2024). Positive effects of lower extremity constraint-induced movement therapy on balance, leg strength and dual-task ability in stroke patients: a longitudinal cohort study. Journal of Rehabilitation Medicine, 56, Article ID jrm24168.
Open this publication in new window or tab >>Positive effects of lower extremity constraint-induced movement therapy on balance, leg strength and dual-task ability in stroke patients: a longitudinal cohort study
Show others...
2024 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 56, article id jrm24168Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate whether high-intensity lower extremity constraint-induced movement therapy can improve balance, leg strength, and dual-task ability.

Design: A longitudinal cohort study in a real-world outpatient clinic.

Patients: 147 community-dwelling participants in the subacute and chronic poststroke phases.

Methods: Participants received lower extremity constraint-induced movement therapy for 6 hours/day during 2 consecutive weeks, including balance, strength, and functional training. The Berg Balance Scale (BBS), Single-Leg-Stance (SLS) bilaterally, one Repetition Maximum (1RM) in a leg press, symmetry of leg strength (Diff-1RM), Timed Up and Go (TUG), and the TUG Manual test were assessed before, after, and 3 months after lower extremity constraint-induced movement therapy.

Results: Compared with preintervention data, statistically significant improvements after lower extremity constraint-induced movement therapy (p < 0.001) were demonstrated for balance with an absolute value in BBS at 1.9 points (effect size 0.38) and SLS at 2.4 s (effect size 0.24), and for leg strength at 10.2 kg (effect size 0.54) for the affected leg. Diff 1RM decreased significantly at 5.8 kg (effect size 0.39) and improvements on dual-task ability at 2.7 s were significant (effect size 0.14). The effects persisted at the 3-month follow-up.

Conclusions: High-intensity lower extremity constraint-induced movement therapy may be a feasible treatment option for middle-aged stroke patients to affect balance, leg strength, and dual-task ability positively in an out-patient clinical setting.

Place, publisher, year, edition, pages
Medical Journals Sweden, 2024
Keywords
balance, constraint-induced movement therapy, dual-task, high-intensity training, lower extremity, physical therapy, strength training, stroke rehabilitation
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-230509 (URN)10.2340/jrm.v56.24168 (DOI)001329749100001 ()39360525 (PubMedID)
Funder
Region VästerbottenThe Swedish Stroke Association
Available from: 2024-10-04 Created: 2024-10-04 Last updated: 2025-04-24Bibliographically approved
Nordanstig, A., Gu, T., Henze, A., Wester, P., Fox, A. J. & Johansson, E. (2024). Risk of stroke recurrence after intravenous thrombolysis in patients with symptomatic carotid stenosis. Canadian Journal of Neurological Sciences, 51(4), 521-528
Open this publication in new window or tab >>Risk of stroke recurrence after intravenous thrombolysis in patients with symptomatic carotid stenosis
Show others...
2024 (English)In: Canadian Journal of Neurological Sciences, ISSN 0317-1671, Vol. 51, no 4, p. 521-528Article in journal (Refereed) Published
Abstract [en]

Objective: To assess if intravenous thrombolysis (IVT) affects the risk of recurrent preoperative cerebrovascular events before carotid surgery or stenting in patients with symptomatic ≥ 50% carotid stenosis.

Methods: Three cohorts of symptomatic ≥ 50% carotid stenosis patients were merged. To make the control group relevant, we excluded patients not presenting with stroke on the day of symptom onset. The risk of preoperative cerebrovascular events up to 30 days were compared between the IVT-treated and non-IVT-treated.

Results: 316 patients were included, 64 (20%) treated with IVT. Those treated with IVT had similar risk of recurrent ipsilateral ischemic stroke or retinal artery occlusion (12% at day 7, 12% at day 30) as those not treated (9% at day 7, 15% at day 30; adjusted HR 0.9, 95%CI 0.4-2.2). There was a tendency (p=0.09) towards time-dependency in the data where the recurrence risk was higher in IVT treated at day 0 (6% in IVT-treated, 1% in non-IVT-treated, OR 5.5, 95%CI 1.2-25.4, p=0.03). This was not significant when adjusting for co-factors (adjusted OR 4.4, 95%CI 0.9-21.8, p=0.07) and was offset by a later risk decrease, with no remaining risk difference between IVT-treated and non-IVT treated at day 7.

Conclusions: IVT treatment does not seem to affect the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic ≥ 50% carotid stenosis: The risk is high in both IVT-treated and non-IVT-treated. However, there might be a risk increase on the day of IVT treatment that is offset by a risk decrease during the first week.

Place, publisher, year, edition, pages
Cambridge University Press, 2024
Keywords
Carotid stenosis, Intravenous thrombolysis, Risk, Stroke
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-214694 (URN)10.1017/cjn.2023.284 (DOI)001078279300001 ()37681233 (PubMedID)2-s2.0-85171265322 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationRegion VästerbottenSwedish Heart Lung FoundationThe Swedish Medical Association
Available from: 2023-09-27 Created: 2023-09-27 Last updated: 2025-01-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0394-5096

Search in DiVA

Show all publications