Impact of vascular aging on stroke prognosis: the novel severity and arterial stiffness (SASt) score

Nikolaos Kakaletsis¹, Athanase D Protogerou², Naohisa Hosomi³, Tomohisa Nezu³, Patrik Michel⁴, Thevoz Guillaume⁴, Davide Strambo⁴, Young Seo Kim⁵, Wonjae Sung⁵, Konstantinos Vemmos⁶, Eleni Korompoki⁶, Maurizio Acampa⁷, Jukka Putaala⁸, Lauri Tulkki⁸, Matthias Hermann⁹, Protazy Rejmer⁹, Philip M Bath¹⁰, Lisa J Woodhouse¹⁰, Elpida Athanasopoulou², Haralampos Milionis¹¹, George Ntaios¹², Vasilios Kotsis¹³, Christos Savopoulos¹⁴

Affiliations

¹ First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece. kakaletsisnikos@yahoo.gr.
² Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
³ Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
⁴ Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
⁵ Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
⁶ Department of Clinical Therapeutics of Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁷ Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, "Santa Maria Alle Scotte" General Hospital, University of Siena, Siena, Italy.
⁸ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁹ Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
¹⁰ Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.
¹¹ Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece.
¹² Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹³ Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece.
¹⁴ First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.

PMID: 41053532
DOI: 10.1007/s10072-025-08527-7

Impact of vascular aging on stroke prognosis: the novel severity and arterial stiffness (SASt) score

Nikolaos Kakaletsis et al. Neurol Sci. 2025 Dec.

. 2025 Dec;46(12):6607-6620.

doi: 10.1007/s10072-025-08527-7. Epub 2025 Oct 7.

Authors

Affiliations

¹ First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece. kakaletsisnikos@yahoo.gr.
² Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
³ Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
⁴ Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
⁵ Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
⁶ Department of Clinical Therapeutics of Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁷ Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, "Santa Maria Alle Scotte" General Hospital, University of Siena, Siena, Italy.
⁸ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁹ Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
¹⁰ Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.
¹¹ Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece.
¹² Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹³ Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece.
¹⁴ First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.

PMID: 41053532
DOI: 10.1007/s10072-025-08527-7

Abstract

Introduction: Assessing vascular aging to identify and categorize the residual risk of adverse outcomes in acute ischemic stroke (AIS) is important for improving AIS prognoses. This study aimed to investigate the prognostic value and correlation among three indirect measures of vascular aging derived from 24-hour blood pressure monitoring (24 h-BPM) following AIS. Furthermore, it aimed to develop a new score that includes vascular aging metrics to enhance the prognostic accuracy for stroke outcomes.

Methods: A total of 2,730 AIS patients with a mean age of 72.0 ± 14.4 years who underwent 24 h-BPM were included. Three vascular aging indexes derived from 24 h-BPM: estimated pulse wave velocity (ePWV), early vascular aging ambulatory score (EVAAs), and 24-hour pulse pressure (24 h-PP) were evaluated. Primary outcome was the modified Rankin Scale (mRS) score > 2 at 3 months post-stroke.

Result: ePWV showed superior predictive value for poor functional outcome (AUC: 0.77, 95% CI: 0.74-0.79) at 3 months post-stroke. Optimal cutoff points for predicting poor functional outcome at 3 months were 12.2 m/s for ePWV (sensitivity: 79.4%, specificity: 61.7%), 65% for EVAAs (sensitivity: 66.4%, specificity: 51.5%), and 51.1mmHg for 24 h-PP (sensitivity: 66.7%, specificity: 46.6%). A new "Severity and Arterial Stiffness" (SASt) score was formulated: SASt = NIHSS + 2*ePWV, which demonstrated excellent discriminatory power for predicting poor functional outcome (AUC: 0.87, 95% CI: 0.85-0.88) at 3 months post-stroke.

Conclusions: The ePWV and the new SASt score show promising potential as tools for identifying patients at higher risk for poor outcomes at 3 months post-stroke. While these findings are encouraging, further prospective studies are needed to validate their utility before they can be adopted in clinical practice.

Keywords: Acute ischemic stroke; Estimated arterial stiffness; Outcome; Prediction; Vascular aging.

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Conflict of interest statement

Declarations. Ethical statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Aristotle University of Thessaloniki (1270/29-10-2020). Competing Interests: The authors declare no competing interest directly or indirectly related to this study.

References

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Impact of vascular aging on stroke prognosis: the novel severity and arterial stiffness (SASt) score

Affiliations

Impact of vascular aging on stroke prognosis: the novel severity and arterial stiffness (SASt) score

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous