The awareness on ischemic heart disease (IHD) in women with dysmenorrhea is insufficient. We utilized the National Health Insurance Research Database (NHIRD) of Taiwan to evaluate this relationship. From the claims data, we established a cohort of women aged 15–50 years with primary dysmenorrhea diagnosed from 2000 to 2008 (n = 18,455) and a comparison cohort (n = 36,910) without dysmenorrhea, frequency matched by age and diagnosis date. Both cohorts were followed until the end of 2013 to assess IHD events. With 75% of study population aged 15–29 years, the incidence of IHD was greater in the dysmenorrheal cohort than in the comparison cohort (1.93 versus 1.18 per 10,000 person-years), with an adjusted hazard ratio of 1.60 (95% confidence interval [CI] = 1.38–1.85). The incidence increased with age and the rate of increase was greater in the dysmenorrheal cohort than the comparison cohort. Nested case-control analysis in the dysmenorrhea cohort showed that IHD risk was also associated with hypertension and arrhythmia, with adjusted odds ratios of 2.50 (95% CI = 1.64–3.81) and 3.30 (95% CI = 2.25–4.86), respectively. Women with dysmenorrhea are at a higher risk of developing IHD, particularly for older patients and patients with comorbidity.

Mechanical thrombectomy has emerged as a promising treatment for acute ischemic stroke caused by large vessel occlusion. However, cases involving cancerous emboli retrieved during endovascular embolectomy are rare. We present a case of a 65-year-old man with a history of heavily treated rectal cancer, who developed a middle cerebral artery (MCA) infarction due to metastatic adenocarcinoma. The patient presented with sudden onset right-side weakness, right facial palsy, global aphasia, and left gaze deviation, with a National Institutes of Health Stroke Scale (NIHSS) score of 16. Following intravenous thrombolysis, endovascular thrombectomy was performed, achieving nearly complete recanalization. Pathological examination of the retrieved thrombus revealed metastatic adenocarcinoma of rectal origin. The patient’s neurological deficits gradually improved, and he was successfully discharged to undergo further palliative therapy. This case underscores the importance of considering mechanical thrombectomy for patients with advanced solid organ malignancy presenting with acute ischemic stroke, even when the etiology could be a tumor embolus. Our findings highlight the potential for mechanical thrombectomy to restore neurological function in such cases, allowing patients to proceed to the next level of care with a reasonably good post-stroke quality of life.

Recanalizing acute ischemic stroke with carotid tandem occlusion (CTO) is technically challenging because distal embolic migration during revascularization can significantly influence outcomes. In this study, we aimed to introduce our coaxial balloon technique using a balloon-guiding catheter (BCG), angioplasty catheter, and aspiration catheter sequentially to prevent thrombus migration to a new vascular territory. We used this technique for six patients with CTO. Technical success with good revascularization of the CTO was achieved in all six patients (100%) without neurological complications, including one and five cases of modified Thrombolysis in Cerebral Infarction 2b and 3, respectively. The median duration of the procedure was 61 (interquartile range, 52–90) min. The mean National Institutes of Health Stroke Scale score at discharge was 3.5 (2–8), with favorable clinical outcomes at 90 days for three of six patients (50%). The coaxial balloon technique for CTO is safe and effective for revascularization in patients with acute ischemic stroke. Thrombectomy before proximal stenting was associated with shorter reperfusion times and better clinical outcomes. Therefore, this approach is recommended for tandem occlusions requiring stent angioplasty.

Background: Studies on strokes associated with dysmenorrhea are limited. We conducted a propensity-score-matched retrospective cohort study to assess the risk of stroke in women with primary dysmenorrhea (PD). Methods: From the claims data of one million people in Taiwan’s insurance program, we identified 18,783 women aged 15–40 years, newly diagnosed with PD in 2000–2010, without a history of stroke. We randomly selected a comparison cohort without stroke history and dysmenorrhea, with the same sample size matched by age, index date, and propensity score. We began a follow-up with individuals one year after cohort entry to the end of 2013 to capture stroke events. Results: The two study cohorts were well-matched for age and comorbidities, with 54% of women aged 15–24. Stroke incidence was 1.5-fold higher in the PD cohort than in the comparison cohort (6.05 vs. 4.01 per 10,000 person-years, or 99 vs. 65 cases), with an adjusted hazard ratio (aHR) of 1.51 (95%CI 1.11–2.06) after adjustment for matched pairs. Nearly 70% of strokes were ischemic strokes, which occurred 1.6 times more frequently in the PD cohort than in the comparison cohort (4.40 vs. 2.71 per 10,000 person-years, or 72 vs. 44 cases), aHR = 1.61 (95% CI 1.11–2.33), after adjustment for matched pairs. The incidence of hemorrhagic stroke was also higher in the PD cohort than in the comparison cohort (1.65 vs. 1.29 per 10,000 person-years, or 27 versus 21 cases), but the difference was not significant. Conclusion: Women of reproductive age with PD are at increased risk for ischemic stroke.

This paper presents a convolutional neural network (CNN) model, underpinned by deep learning principles, tailored to predict endovascular intervention outcomes in patients with acute anterior circulation ischemic stroke. Recognizing the crucial role of predictive models in guiding patient prognosis and treatment selection, we partitioned our dataset into training and testing subsets. The proposed CNN model exhibited outstanding performance during its training phase, reaching a stellar accuracy rate of 100%. This performance was maintained during the testing phase, with an accuracy surpassing 94.12%. Such minimal deviation between training and testing accuracies underscores the robustness of our model and suggests a reduced likelihood of overfitting, enhancing its relevance for real-world clinical scenarios. These promising results signify a leap forward in harnessing the power of deep learning for medical prognostication, particularly in stroke intervention outcomes.

Introduction: The clinical factor impact on outcomes after endovascular thrombectomy (EVT) in patients aged ≥70 years remains incompletely understood. We aimed to identify predictors of good outcomes after EVT in patients aged ≥70 years, defined as a modified Rankin Scale (mRS) score of 0–2. Methods: This retrospective, single-center cohort study included 94 patients aged ≥70 years with acute ischemic stroke who underwent EVT. Participants were stratified into septuagenarians ( n = 44) and octo/nonagenarians ( n = 50). We evaluated post-EVT modified thrombolysis in cerebral infarction reperfusion grade, symptomatic intracerebral hemorrhage, and mRS score at 3 months follow-up as outcomes. Both multivariable (LR) and Bayesian logistic regression (BLR) and sensitivity analyses were conducted to derive adjusted odds ratio (aOR) and assess the probabilistic associations between clinical variables and outcomes. Results: At presentation, the median ischemic core was higher in octo/nonagenarians compared to septuagenarians (20 mL vs. 4 mL, p = 0.0464); median Alberta Stroke Program Early CT Score was lower (7 vs. 8, p = 0.0112). Higher Fazekas grades of leukoaraiosis were more frequent in octo/nonagenarians ( p = 0.0297) than in septuagenarians. Good mRS outcomes were achieved by 27.3% of septuagenarians vs. 8.0% of octo/nonagenarians ( p = 0.0274). In the multivariable LR, age was not an independent predictor of poor outcomes (aOR 2.40; 95% CI, 0.65–10.08; p = 0.1991). BLR identified higher National Institutes of Health Stroke Scale scores [odds ratio (OR) 0.90; 95% credible interval, 0.81–0.98] associated with poorer outcomes, whereas prior intravenous thrombolysis (OR 6.59; 1.16–23.09) predicted better outcomes. BLR did not show probabilistic certainty of age as a predictor of functional outcomes. Including infarct core in the model did not impact sensitivity analysis results. Conclusion: Age was not independently associated with functional outcomes. Age-related differences in outcomes may be mediated by initial stroke characteristics rather than age. Clinical trial registration: ClinicalTrials.gov , identifier NCT06953427.