Radiation therapy (RT) causes radiation‐induced vasculopathy, which requires clinicians to identify and manage this side effect in pediatric and adult patients. This article reviews previous findings about the pathophysiology of RT‐induced vascular injury, including endothelial cell injury, oxidative stress, inflammatory cytokines, angiogenic pathways, and remodeling. The vasculopathy is categorized into ischemic vasculopathy, hemorrhagic vasculopathy, carotid artery injury, and other malformations (cavernous malformations and aneurysms) in populations of pediatric and adult patients separately. The prevention and management of this RT‐induced side effect are also discussed. The article summarizes the distribution and risk factors of different types of RT‐induced vasculopathy. This will help clinicians identify high‐risk patients with corresponding vasculopathy subtypes to deduce prevention and treatment strategies accordingly.

Background:The purpose of this study was to assess the impact of atrial fibrillation (AF) on stroke outcome in acute ischemic stroke (AIS) treated with thrombolysis or endovascular therapy (EVT). Method:Consecutive AIS treated at five stroke centers over 15 years was evaluated. Using multiple logistic regressions, we compared adjusted odds ratio (OR) with 95% confidence interval (CI) of symptomatic intracranial hemorrhage (sICH), thrombolysis in cerebral infarction (TICI), poor discharge disposition (hospice/skilled nursing facility), in-hospital mortality, and disability (modified Rankin Scale (mRS)) and death at 90 days. Patients were classified according to AF and treatment plans, including tissue plasminogen activator (tPA) or EVT. Results:We identified 720 patients treated in the study period (196 +AF, aged 78.2 ± 12.5 years and 524 -AF, aged 66.9 ± 15.2 years). In adjusted logistic regression, there was no difference in the rate of sICH (OR: 1.18, 95% CI: 0.44 -3.17), TICI (OR: 1.19, 95% CI: 0.29 -4.84), poor discharge disposition to hospice/skilled nursing facility (OR: 0.96, 95% CI: 0.56 -1.63) or in-hospital mortality (OR: 0.95, 95% CI: 0.46 -1.97). There was no significant difference in a 90-day mRS in those with and without AF. Likewise, there were no between group differences in sICH, discharge outcome, or 90-day mRS in the six groups based on the presence of AF and treatment plans (tPA, EVT, or both).Conclusions: AF did not significantly impact sICH, discharge outcome, or 90-day mRS in AIS patients treated with thrombolysis, EVT, or both. Age and baseline National Institutes of Health Stroke Scale (NIHSS) were significant predictors of outcome in this sample.

Background: Evidence of seasonal variations in the incidence of stroke is inconsistent with some studies reporting no association and some a significant rise in different months of the year. In addition, less is known about how seasonality impacts the incidence of stroke subtype. Methods: This was a cross-sectional, observational study of data from a multi-state health system’s stroke registry (n=40 hospitals) in Alaska, California, Montana, Oregon, Texas, and Washington state. We included all cases with acute ischemic stroke admitted from September 29, 2016, to November 30, 2021. Admission data were categorized according to four meteorological seasons: winter, spring, summer, and fall. Acute ischemic stroke was categorized into two sub-types as large vessel occlusion (LVO) or non-LVO. We calculated the aggregate number of individuals admitted with stroke by season. Using, linear regression models with generalized estimating equations (GEE), we assessed the relationship between meteorological season and daily hospitalization rate. We used R version 4.0.4 (2021-02-15) for both the descriptive and inferential analyses and the R gee pack package (version 1.2-1) to perform GEEs. Results: During the study period, we identified 18,886 patients with acute ischemic stroke (median age: 73; 49.5% women). Acute ischemic stroke was more commonly observed during winter compared with other seasons with some variations between the selected regions. Based on a generalized estimating equations model, stroke hospitalization increased during winter, with an additional 3.3 cases per day (95%, CI [2.4, 4.1]). Winter is also associated with a higher incidence of large vessel occlusion. Conclusion: The incidence of ischemic stroke, including cases of large vessel occlusion, increased during the winter months. The results are important for human resource allocation for better management of cases with ischemic strokes.