{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T08:37:30Z","timestamp":1792917450254,"version":"4.5.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007847","name":"Natural Science Foundation of Jilin Province","doi-asserted-by":"publisher","award":["YDZJ202501ZYTS019"],"award-info":[{"award-number":["YDZJ202501ZYTS019"]}],"id":[{"id":"10.13039\/100007847","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2025ZD0546300"],"award-info":[{"award-number":["2025ZD0546300"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["NO.2024ZD0521601"],"award-info":[{"award-number":["NO.2024ZD0521601"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Long-term risk stratification for cryptogenic ischemic stroke (CIS) remains uncertain in patients with migraine and contrast-enhanced transcranial Doppler ultrasound-confirmed right-to-left shunting (RLS). Therefore, we aimed to develop and externally validate a simple baseline score for identifying individuals at low risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 10-year study included 978 and 237 patients in the development and external validation cohorts, respectively. Internal validation involved a five-fold cross-validation strategy. Multivariable Cox proportional hazards modeling was used to develop the Migraine Risk Stratification Score (MRSS). Model performance was comprehensively evaluated using time-dependent receiver operating characteristic (ROC) curves at 3, 5, and 7 years, calibration plots, and decision curve analysis. Model interpretation was based on the Cox regression coefficients, hazard ratios, and integer points assigned to each predictor. Survival divergence was assessed by Kaplan\u2013Meier analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Age \u226550 years (1 point), migraine with aura (2 points), and permanent and large RLS (2 points each) were identified as predictors. Patients were stratified into low- (0\u20134 points) and high-risk (5\u20137 points) groups based on total score. The high-risk group exhibited a significantly higher 10-year CIS risk (21.77% vs. 4.68%; hazard ratio: 5.06; 95% confidence interval: 3.31\u20137.74). The areas under the curve (AUCs) at 3, 5, and 7 years were 0.771, 0.777, and 0.751 in the development cohort; 0.753, 0.768, and 0.744 after five-fold cross-validation; and 0.917, 0.863, and 0.808 in external validation, respectively. The 3-year external AUC was based on only five events; therefore, it should be interpreted cautiously. Across evaluated horizons, the negative-predictive value was high (0.96\u20130.99), whereas the positive-predictive value (0.05\u20130.19) and F1 score (0.10\u20130.30) were low. Kaplan\u2013Meier curves confirmed significant long-term stroke-free survival stratification (log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090\u00b7001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MRSS exhibited characteristics consistent with a rule-out-oriented baseline risk stratification tool rather than a precise individualized absolute risk assessment for treatment selection. Further prospective validation and recalibration are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03331024261499744","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T12:28:13Z","timestamp":1792672093000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a prediction model for cryptogenic ischemic stroke risk in migraine patients with right-to-left shunt: A 10-year study"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7492-2919","authenticated-orcid":false,"given":"Lixia","family":"Zhu","sequence":"first","affiliation":[{"name":"The First Hospital of Jilin University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingqi","family":"Xing","sequence":"additional","affiliation":[{"name":"Capital Medical University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyu","family":"Fang","sequence":"additional","affiliation":[{"name":"The First Hospital of Jilin University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisi","family":"An","sequence":"additional","affiliation":[{"name":"Department of Vascular Ultrasonography, Electric Power Hospital of Jilin Province, Changchun, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7166-7729","authenticated-orcid":false,"given":"Lijuan","family":"Wang","sequence":"additional","affiliation":[{"name":"The First Hospital of Jilin University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25937"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.10946"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpain.2022.823595"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.231934"},{"key":"e_1_3_3_6_2","first-page":"33","article-title":"China Stroke surveillance report 2021","volume":"10","author":"Tu WJ","year":"2023","unstructured":"Tu WJ, Wang LD. 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