{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T15:08:35Z","timestamp":1777907315547,"version":"3.51.4"},"reference-count":56,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Scarce evidence is available in Asia for estimating the long-term risk and prognostic factors of major complications such as re-rupture, vasospasm, or re-stroke for patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing endovascular coil embolization or surgical clipping. This is the first head-to-head propensity score-matched study in an Asian population to demonstrate that endovascular coil embolization for aneurysmal SAH treatment is riskier than surgical clipping in terms of re-rupture, vasospasm, or re-stroke. In addition, the independent poor prognostic factors of vasospasm or re-stroke were endovascular coil embolization, male sex, older age (\u226565 years; the risk of vasospasm increases with age), hypertension, congestive heart failure, diabetes, previous transient ischemic attack, or stroke in aneurysmal SAH treatment. Background: To estimate the long-term complications and prognostic factors of endovascular coil embolization or surgical clipping for patients with ruptured aneurysmal subarachnoid hemorrhage (SAH). Methods: We selected patients diagnosed with aneurysmal SAH between 1 January 2011 and 31 December 2017. Propensity score matching was performed, and Cox proportional hazards model curves were used to analyze the risk of re-rupture, vasospasm, and re-stroke in patients undergoing the different treatments. Findings: Multivariate Cox regression analysis revealed that the adjusted hazard ratio (aHR) of re-rupture for endovascular coil embolization compared with surgical clipping was 1.36 (95% confidence interval [CI]: 1.17\u20131.57; p &lt; 0.0001). The aHRs of the secondary endpoints of vasospasm and re-stroke (delayed cerebral ischemia) for endovascular coil embolization compared with surgical clipping were 1.14 (1.02\u20131.27; p = 0.0214) and 2.04 (1.83\u20132.29; p &lt; 0.0001), respectively. The independent poor prognostic factors for vasospasm and re-stroke were endovascular coil embolization, male sex, older age (\u226565 years; risk increases with age), hypertension, congestive heart failure, diabetes, and previous transient ischemic attack or stroke. Interpretation: Endovascular coil embolization for aneurysmal SAH carries a higher risk than surgical clipping of both short- and long-term complications including re-rupture, vasospasm, and re-stroke.<\/jats:p>","DOI":"10.3390\/jpm11111209","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T02:42:28Z","timestamp":1637116948000},"page":"1209","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Risk of Re-Rupture, Vasospasm, or Re-Stroke after Clipping or Coiling of Ruptured Intracranial Aneurysms: Long-Term Follow-Up with a Propensity Score-Matched, Population-Based Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Jiaqiang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, People\u2019s Hospital of Zhengzhou University, Henan Provincial People\u2019s Hospital, Zhengzhou 450052, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang-Lan","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 26546, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Chang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 26546, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Hui","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 26546, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5637-558X","authenticated-orcid":false,"given":"Szu-Yuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan"},{"name":"Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 26546, Taiwan"},{"name":"Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 26546, Taiwan"},{"name":"Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan"},{"name":"Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei 242062, Taiwan"},{"name":"Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1161\/STROKEAHA.108.191395","article-title":"Guidelines for the management of aneurysmal subarachnoid hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association","volume":"40","author":"Bederson","year":"2009","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1161\/STR.0b013e3182587839","article-title":"Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the American Heart Association\/american Stroke Association","volume":"43","author":"Connolly","year":"2012","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1001\/archneur.58.4.559","article-title":"Guglielmi detachable coiling for intracranial aneurysms: The story so far","volume":"58","author":"Dovey","year":"2001","journal-title":"Arch. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1186\/s13054-016-1447-6","article-title":"Management of delayed cerebral ischemia after subarachnoid hemorrhage","volume":"20","author":"Francoeur","year":"2016","journal-title":"Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3171\/jns.2002.97.4.0771","article-title":"Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: A prospective randomized study","volume":"97","author":"Hillman","year":"2002","journal-title":"J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1001\/archneur.62.3.410","article-title":"Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage","volume":"62","author":"Naidech","year":"2005","journal-title":"Arch. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1161\/01.STR.32.5.1176","article-title":"Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management","volume":"32","author":"Ohkuma","year":"2001","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1227\/00006123-198311000-00001","article-title":"Aneurysmal rebleeding: A preliminary report from the Cooperative Aneurysm Study","volume":"13","author":"Kassell","year":"1983","journal-title":"Neurosurgery"},{"key":"ref_9","first-page":"299","article-title":"Aneurysm rupture during angiography: Does acute vasospasm occur?","volume":"5","author":"Wilkins","year":"1976","journal-title":"Surg. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1161\/01.STR.0000144654.79393.cf","article-title":"Early vasospasm on admission angiography in patients with aneurysmal subarachnoid hemorrhage is a predictor for in-hospital complications and poor outcome","volume":"35","author":"Baldwin","year":"2004","journal-title":"Stroke"},{"key":"ref_11","first-page":"1263","article-title":"Diagnosis and Management of Subarachnoid Hemorrhage","volume":"21","author":"Suarez","year":"2015","journal-title":"Continuum (Minneap Minn)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1093\/bja\/aes264","article-title":"Delayed cerebral ischaemia after subarachnoid haemorrhage: Looking beyond vasospasm","volume":"109","author":"Rowland","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1136\/jnnp-2012-302804","article-title":"Early neurological deterioration after subarachnoid haemorrhage: Risk factors and impact on outcome","volume":"84","author":"Helbok","year":"2013","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1161\/STROKEAHA.107.484360","article-title":"Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage","volume":"38","author":"Rosengart","year":"2007","journal-title":"Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1161\/STROKEAHA.111.634071","article-title":"Quality of life and healthcare resource use associated with angiographic vasospasm after aneurysmal subarachnoid hemorrhage","volume":"43","author":"Macdonald","year":"2012","journal-title":"Stroke"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1161\/01.STR.0000133132.76983.8e","article-title":"Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage","volume":"35","author":"Rabinstein","year":"2004","journal-title":"Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1093\/brain\/awy102","article-title":"The negative ultraslow potential, electrophysiological correlate of infarction in the human cortex","volume":"141","author":"Luckl","year":"2018","journal-title":"Brain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1038\/nm.2333","article-title":"The role of spreading depression, spreading depolarization and spreading ischemia in neurological disease","volume":"17","author":"Dreier","year":"2011","journal-title":"Nat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"258","DOI":"10.7326\/0003-4819-148-4-200802190-00004","article-title":"A 10-year experience with universal health insurance in Taiwan: Measuring changes in health and health disparity","volume":"148","author":"Wen","year":"2008","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/apt.14835","article-title":"Association between proton pump inhibitors and the risk of hepatocellular carcinoma","volume":"48","author":"Shao","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3904","DOI":"10.1002\/cncr.30823","article-title":"Value and application of trimodality therapy or definitive concurrent chemoradiotherapy in thoracic esophageal squamous cell carcinoma","volume":"123","author":"Lin","year":"2017","journal-title":"Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1002\/cncr.30565","article-title":"Effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinoma receiving definitive radiotherapy or concurrent chemoradiotherapy through intensity-modulated radiation therapy techniques","volume":"123","author":"Yen","year":"2017","journal-title":"Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chang, S.C., Chen, H.M., and Wu, S.Y. (2020). There Are No Differences in Positive Surgical Margin Rates or Biochemical Failure-Free Survival among Patients Receiving Open, Laparoscopic, or Robotic Radical Prostatectomy: A Nationwide Cohort Study from the National Cancer Database. Cancers, 13.","DOI":"10.3390\/cancers13010106"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Chang, S.C., Hsu, C.H., Lin, Y.C., and Wu, S.Y. (2021). Effects of 1-Year Hospital Volume on Surgical Margin and Biochemical-Failure-Free Survival in Patients Undergoing Robotic versus Nonrobotic Radical Prostatectomy: A Nationwide Cohort Study from the National Taiwan Cancer Database. Cancers, 13.","DOI":"10.3390\/cancers13030488"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ejca.2018.11.032","article-title":"Mortality associated with statins in men with advanced prostate cancer treated with androgen deprivation therapy","volume":"112","author":"Wu","year":"2019","journal-title":"Eur. J. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Liu, W.C., Liu, H.E., Kao, Y.W., Qin, L., Lin, K.C., Fang, C.Y., Tsai, L.L., Shia, B.C., and Wu, S.Y. (2020). Definitive intensity-modulated radiotherapy or surgery for early oral cavity squamous cell carcinoma: Propensity-score-matched, nationwide, population-based cohort study. Head Neck.","DOI":"10.1016\/j.radonc.2020.08.016"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.ijcard.2016.12.074","article-title":"Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation: A population-based cohort study","volume":"232","author":"Liu","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.jfma.2018.10.002","article-title":"Comorbidity profiles among patients with recurrent aphthous stomatitis: A case-control study","volume":"118","author":"Lin","year":"2019","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/0895-4356(94)90129-5","article-title":"Validation of a combined comorbidity index","volume":"47","author":"Charlson","year":"1994","journal-title":"J. Clin. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e3268","DOI":"10.1097\/MD.0000000000003268","article-title":"Curative-Intent Aggressive Treatment Improves Survival in Elderly Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma and High Comorbidity Index","volume":"95","author":"Chen","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/978-1-4615-2009-2_5","article-title":"Goodness-of-fit and diagnostics for proportional hazards regression models","volume":"75","author":"Grambsch","year":"1995","journal-title":"Cancer Treat Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1002\/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B","article-title":"Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group","volume":"17","year":"1998","journal-title":"Stat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1093\/aje\/kwp107","article-title":"Competing risk regression models for epidemiologic data","volume":"170","author":"Lau","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat. Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Nguyen, T.L., Collins, G.S., Spence, J., Daures, J.P., Devereaux, P.J., Landais, P., and Le Manach, Y. (2017). Double-adjustment in propensity score matching analysis: Choosing a threshold for considering residual imbalance. BMC Med. Res. Methodol., 17.","DOI":"10.1186\/s12874-017-0338-0"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"16","DOI":"10.21037\/atm.2018.12.10","article-title":"Balance diagnostics after propensity score matching","volume":"7","author":"Zhang","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1161\/STROKEAHA.108.524751","article-title":"Long-term recurrent subarachnoid hemorrhage after adequate coiling versus clipping of ruptured intracranial aneurysms","volume":"40","author":"Schaafsma","year":"2009","journal-title":"Stroke"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e799","DOI":"10.1016\/j.wneu.2018.01.160","article-title":"Mortality after Spontaneous Subarachnoid Hemorrhage: Causality and Validation of a Prediction Model","volume":"112","author":"Abulhasan","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1212\/WNL.0000000000002239","article-title":"Time trends in causes of death after aneurysmal subarachnoid hemorrhage: A hospital-based study","volume":"86","author":"Vergouwen","year":"2016","journal-title":"Neurology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1136\/jnnp.68.3.337","article-title":"Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: A prospective hospital based cohort study in the Netherlands","volume":"68","author":"Roos","year":"2000","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/00006123-199802000-00091","article-title":"Acute vasoconstriction after subarachnoid hemorrhage","volume":"42","author":"Bederson","year":"1998","journal-title":"Neurosurgery"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1097\/00006123-199905000-00017","article-title":"Prognostic value and determinants of ultraearly angiographic vasospasm after aneurysmal subarachnoid hemorrhage","volume":"44","author":"Qureshi","year":"1999","journal-title":"Neurosurgery"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1038\/jcbfm.2011.7","article-title":"Effect of pharmaceutical treatment on vasospasm, delayed cerebral ischemia, and clinical outcome in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis","volume":"31","author":"Etminan","year":"2011","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1177\/0271678X16641424","article-title":"Oxygen availability and spreading depolarizations provide complementary prognostic information in neuromonitoring of aneurysmal subarachnoid hemorrhage patients","volume":"37","author":"Winkler","year":"2017","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S1474-4422(09)70080-8","article-title":"Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): Long-term follow-up","volume":"8","author":"Molyneux","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1161\/01.STR.0000221331.01830.ce","article-title":"Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment","volume":"37","author":"Investigators","year":"2006","journal-title":"Stroke"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1161\/STROKEAHA.107.495747","article-title":"Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: The Cerebral Aneurysm Rerupture After Treatment (CARAT) study","volume":"39","author":"Johnston","year":"2008","journal-title":"Stroke"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1161\/01.STR.30.7.1402","article-title":"Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage","volume":"30","author":"Charpentier","year":"1999","journal-title":"Stroke"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1097\/01.CCM.0000168054.60538.2B","article-title":"Relationship between hyperglycemia and symptomatic vasospasm after subarachnoid hemorrhage","volume":"33","author":"Badjatia","year":"2005","journal-title":"Crit. Care Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e725","DOI":"10.1016\/j.wneu.2013.08.017","article-title":"Treatment modality and vasospasm after aneurysmal subarachnoid hemorrhage","volume":"82","author":"Gross","year":"2014","journal-title":"World Neurosurg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1161\/STROKEAHA.110.579383","article-title":"Endovascular treatment or neurosurgical clipping of ruptured intracranial aneurysms: Effect on angiographic vasospasm, delayed ischemic neurological deficit, cerebral infarction, and clinical outcome","volume":"41","author":"Dumont","year":"2010","journal-title":"Stroke"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.surneu.2005.12.031","article-title":"Endovascular embolization vs surgical clipping in treatment of cerebral aneurysms: Morbidity and mortality with short-term outcome","volume":"66","author":"Taha","year":"2006","journal-title":"Surg. Neurol."},{"key":"ref_53","first-page":"22","article-title":"Comparison between clipping and coiling on the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis","volume":"30","author":"Beck","year":"2007","journal-title":"Neurosurg. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.wneu.2016.11.032","article-title":"Coiling Is Not Superior to Clipping in Patients with High-Grade Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis","volume":"98","author":"Xia","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1136\/neurintsurg-2014-011374","article-title":"Cerebral vasospasm patterns following aneurysmal subarachnoid hemorrhage: An angiographic study comparing coils with clips","volume":"7","author":"Jones","year":"2015","journal-title":"J. Neurointerv. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1161\/STROKEAHA.110.589275","article-title":"Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: Proposal of a multidisciplinary research group","volume":"41","author":"Vergouwen","year":"2010","journal-title":"Stroke"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/11\/1209\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:30:49Z","timestamp":1760167849000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/11\/1209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,16]]},"references-count":56,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jpm11111209"],"URL":"https:\/\/doi.org\/10.3390\/jpm11111209","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,16]]}}}