International Journal of Stroke最新文献

{"title":"Effect of drug-coated balloon in patients with severe vertebral artery origin stenosis: A multicenter randomized controlled trial.","authors":"Jichang Luo, Changchun Jiang, Haibo Wang, Rixuan Peng, Tao Wang, Dong Kuai, Guobiao Liang, Feng Wang, Shouchun Wang, Chenghua Xu, Wenhuo Chen, Jianping Deng, Xingyue Hu, Shu Wan, Bing Li, Bo Yin, Yifeng Du, Guangsen Cheng, Jieqing Wan, Xingyu Chen, Yabing Wang, Liqun Jiao","doi":"10.1177/17474930251377055","DOIUrl":"https://doi.org/10.1177/17474930251377055","url":null,"abstract":"<p><strong>Background: </strong>Vertebral artery origin stenosis (VAOS) is a common cause of posterior circulation ischemic events, and endovascular treatment serves as an alternative treatment. However, conventional endovascular treatment methods are related to high risk of restenosis. It is unclear whether the drug-coated balloon (DCB) can reduce restenosis risk of VAOS.</p><p><strong>Methods: </strong>This was a prospective, multicenter, randomized trial conducted from 6 January 2020 to 1 October 2023 in China. Symptomatic patients with severe VAOS were randomly allocated in a 1:1 ratio to undergo either DCB or bare-metal stent (BMS) and followed up for 12 months. The primary safety endpoint was the incidence of transient ischemic attack, stroke, or death related to target vessel within 30 days post-procedure. The primary efficacy endpoint was the rate of 12-month restenosis.</p><p><strong>Results: </strong>A total of 179 patients were enrolled with 91 in the DCB group and 88 in the BMS group. No significant difference was observed in the rates of transient ischemic attack, stroke, or death related to target vessel within 30 days between the DCB and BMS groups (0 (0.0%) vs. 1 (1.1%); P = 0.49). The 12-month restenosis rate was significantly lower in the DCB group compared to the BMS group (10/76 (13.2%) vs. 27/76 (35.5%); risk ratio = 0.37; 95% confidence interval = 0.19 to 0.71; P = 0.001).</p><p><strong>Conclusion: </strong>This trial demonstrated that DCB may reduce restenosis risk in symptomatic patients with severe VAOS compared to BMS.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov (unique identifier: NCT03910166).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251377055"},"PeriodicalIF":8.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of cervical fibromuscular dysplasia among aneurysmal subarachnoid hemorrhage patients.","authors":"Stijn Rietkerken, Jan Willem Dankbaar, Wilko Spiering, Ynte Ruigrok","doi":"10.1177/17474930251387614","DOIUrl":"https://doi.org/10.1177/17474930251387614","url":null,"abstract":"<p><strong>Background and objectives: </strong>Fibromuscular dysplasia (FMD) is a vascular disorder affecting medium-sized arteries, including the extracranial cervical arteries, and can lead to aneurysmal subarachnoid hemorrhage (aSAH). We aimed to determine the prevalence of cervical FMD in aSAH patients and assess whether cervical FMD in these patients is associated with more severe aneurysmal disease and internal carotid artery (ICA) elongation.</p><p><strong>Methods: </strong>We retrospectively reviewed computed tomography angiography (CTA) scans acquired on admission in a consecutive series of aSAH patients (2019-2024). The prevalence of FMD in the extracranial segments of the ICA and vertebral arteries (VA) was determined. In addition differences in aneurysm size, number of aneurysms, rebleeding rates and ICA elongation were assessed between patients with and without FMD using logistic regression, adjusting for potential confounders.</p><p><strong>Results: </strong>Cervical FMD was identified in 40 of 485 aSAH patients (prevalence 8.3%, 95% confidence interval [CI] 6.0%-11.1%). aSAH patients with FMD were older, more frequently women and more likely to have hypertension than those without FMD. We found no statistically significant differences in aneurysm size, number of aneurysms, rebleeding rates, or ICA elongation.</p><p><strong>Discussion: </strong>We report a high prevalence (8.3%) of cervical FMD among aSAH patients, but no clear differences in aneurysm severity and ICA elongation compared to those without. Given the high prevalence, we recommend routine screening for cervical FMD in aSAH patients on CTA (or another angiography modality). If FMD is suspected, full-body CTA (or other angiographic modality) should be considered for further vascular assessment.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251387614"},"PeriodicalIF":8.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reperfusion-dependent treatment effects of thrombectomy in patients with large ischemic infarcts.","authors":"Lukas Meyer, Susanne Gellißen, Götz Thomalla, Martin Bendszus, Gabriel Broocks, Matthias Bechstein, Christian Thaler, Fabien Subtil, Susanne Bonekamp, Anne Hege Aamodt, Blanca Fuentes, Elke Gizewski, Michael D Hill, Antonin Krajina, Laurent Pierot, Claus Ziegler Simonsen, Kamil Zelenak, Rolf Ankerlund Blauenfeldt, Bastian Cheng, Angelique Denis, Hannes Deutschmann, Franziska Dorn, Fabian Flottmann, Johannes Gerber, Mayank Goyal, Jozef Haring, Christian Herweh, Silke Hopf-Jensen, Vi Tuan Hua, Märit Jensen, Andreas Kastrup, Fee Keil, Andrej Klepanec, Egon Kurča, Ronni Mikkelsen, Markus Möhlenbruch, Stefan Müller-Hülsbeck, Nico Münnich, Paolo Pagano, Panagiotis Papanagiotou, Gabor Petzold, Mirko Pham, Volker Puetz, Jan Raupach, Gernot Reimann, Peter Ringleb, Maximilian Schell, Eckhard Schlemm, Silvia Schönenberger, Bjørn Tennøe, Christian Ulfert, Katerina Valis, Eva Vitkova, Dominik F Vollherbst, Wolfgang Wick, Jens Fiehler, Helge Kniep","doi":"10.1177/17474930251387613","DOIUrl":"https://doi.org/10.1177/17474930251387613","url":null,"abstract":"<p><strong>Background: </strong>While thrombectomy benefits patients with large infarcts, it is unclear whether this benefit persists across different levels of reperfusion.</p><p><strong>Aims: </strong>This study investigates how the degree of reperfusion influences the effectiveness of endovascular thrombectomy (EVT) combined with best medical treatment (BMT), compared to BMT alone, in patients with large infarcts.</p><p><strong>Methods: </strong>This post-hoc analysis of the TENSION trial, a randomized controlled study, assessed EVT versus BMT in patients with extensive infarction (Alberta Stroke Program Early CT-Score [ASPECTS] 3-5).Primary outcome was the modified Rankin Scale (mRS) score at 90-days. Secondary outcomes included infarct volume at 24 hours, mortality, and symptomatic hemorrhage. Outcomes were stratified by final reperfusion level, measured with the modified thrombolysis in cerebral infarction (mTICI) scale. Confounder-adjusted common odds ratios (cOR) and average treatment effects (ATE) were estimated using inverse probability weighting with regression adjustment.</p><p><strong>Results: </strong>A total of 246 patients (median age, 74 years [IQR, 65-80]; median baseline ASPECTS, 4 [IQR, 3-5]) were included. Compared to BMT alone, unsuccessful EVT (mTICI≤2a) was not associated with worse functional outcomes (cOR:1.2, 95%-CI, 0.95 to 1.52; P=.131), higher mortality (ATE:-11.6%; 95%-CI, -28.82 to 5.61; P=.187), or larger infarct volumes on follow-up (ATE:0.99 mL; 95%-CI, -45.30 to 45.32; P=.965). First-pass complete reperfusion (mTICI 3) showed the greatest treatment benefit, significantly improving all endpoints, with a cOR of 4.85 (95% CI, 3.74-6.31; P<.001) for improved mRS scores and a 29% absolute reduction in mortality.</p><p><strong>Conclusion: </strong>In this post-hoc analysis of the TENSION trial, unsuccessful EVT did not worsen outcomes compared to BMT alone. The highest benefit of EVT occurred with first-pass complete reperfusion, emphasizing the importance of achieving optimal reperfusion in this vulnerable stroke subgroup. These findings do not justify general treatment recommendations.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251387613"},"PeriodicalIF":8.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty and stroke: Global implications for assessment, research, and clinical care-A WSO scientific statement.","authors":"Nicholas R Evans, João Pinho, Lucy Beishon, Tu Nguyen, Aravind Ganesh, Bharathi Balasundaram, Ragnhild Munthe-Kaas, Jonathan Hewitt, Dorcas B C Gandhi, Terry J Quinn, Richard I Lindley","doi":"10.1177/17474930251345295","DOIUrl":"10.1177/17474930251345295","url":null,"abstract":"<p><p>Frailty is common in stroke and has important disease- and treatment-modifying effects. The need to develop clinical practice and research for the impact of frailty on stroke is likely to increase in the coming decades as the global population ages, resulting in a higher burden of frailty that is likely to be borne disproportionately by lower- and middle-income countries.The global nature of frailty in stroke necessitates global action. This World Stroke Organization Scientific Statement synthesizes the current evidence relating to the prevalence and effects of frailty across the stroke pathway. Furthermore, it includes expert consensus on priority areas from a global panel: standardization of frailty assessments for research, explicit measurements of frailty (in addition to disability) in large clinical trials, dedicated studies investigating the treatment-modifying effects of frailty in acute stroke and secondary prevention, research investigating the impact of frailty on the different aspects of recovery and rehabilitation after stroke, and understanding the mechanisms underpinning the relationship between frailty and stroke for potential therapeutic exploitation.This scientific statement has been reviewed and approved by the World Stroke Organization Executive.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"905-917"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke etiology was associated with tirofiban efficacy in acute ischemic stroke without endovascular treatment: A pre-specified subgroup analysis of the TREND trial.","authors":"Yue Qiao, Min Zhao, Jing Wang, Sijie Li, Ting Yang, Pingping Wang, Xunming Ji, Qingfeng Ma, Wenbo Zhao","doi":"10.1177/17474930251326423","DOIUrl":"10.1177/17474930251326423","url":null,"abstract":"<p><strong>Background: </strong>Different stroke etiologies are associated with varied incidences of early neurological deterioration (END) in patients with acute ischemic stroke (AIS). The Tirofiban for the Prevention of Neurological Deterioration in Acute Ischemic Stroke (TREND) trial demonstrated the efficacy of tirofiban in preventing END in patients with AIS. Herein, we conducted a pre-specified subgroup analysis of this trial data to investigate whether stroke etiologies influenced the effects of tirofiban.</p><p><strong>Methods: </strong>We performed a pre-specified subgroup analysis of the TREND trial, including 413 patients with AIS classified into large-artery atherosclerosis (n = 114), small-vessel occlusion (n = 124), and undetermined etiology (n = 175). The primary outcome was the incidence of END₄ (defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score by ⩾ 4 points) within 72 h. Other outcomes included END₂ (increase in NIHSS score by ⩾ 2 points), early improvement, functional outcomes at 90 days, and safety profiles.</p><p><strong>Results: </strong>Tirofiban significantly reduced the risk of END₄ in patients with large-artery atherosclerosis (4.1% vs. 21.5%; adjusted odds ratio (OR), 0.17; 95% confidence interval (CI), 0.04-0.78; P = 0.023), while no significant differences were observed in small-vessel occlusion (adjusted OR, 0.24; 95% CI, 0.02-2.67; P = 0.248) and undetermined etiology (adjusted OR, 0.53; 95% CI, 0.18-1.55; P = 0.247) subgroups (P for interaction = 0.376). Similar trends were observed for END₂, with a significant benefit observed in the large-artery atherosclerosis (adjusted OR 0.24; 95% CI 0.08-0.72; P = 0.011). The early improvement rates and 90-day functional outcomes were comparable between the treatment groups across all stroke subtypes. Safety outcomes were similar between antiplatelet therapies in each subgroup.</p><p><strong>Conclusions: </strong>In patients who developed ischemic stroke within 24 h of symptom onset, there was no evidence of a treatment interaction across stroke etiologies when comparing intravenous tirofiban to oral aspirin for reducing END. However, the absolute risk reduction observed with tirofiban was greatest in patients with large-artery atherosclerosis compared with those with small-vessel occlusion or undetermined etiology.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"977-986"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled trial of Scanning Eye trAining as a Rehabilitation Choice for Hemianopia after stroke (SEARCH).","authors":"Fiona J Rowe, Ella Brayshaw, Michaela Brown, Kausik Chatterjee, Avril Drummond, Christine Hazelton, Brin Helliwell, Lauren R Hepworth, Claire Howard, Stevie Johnson, Carmel Noonan, Catherine Sackley, Laura Wright","doi":"10.1177/17474930251330140","DOIUrl":"10.1177/17474930251330140","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hemianopia is common after stroke. We aimed to evaluate clinical effectiveness of visual scanning training (VST) versus sham training, for homonymous hemianopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Randomized controlled, parallel, double-blind, two-arm trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Prospective, multicentre randomized controlled trial (RCT) with 34 UK stroke units.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Adult stroke survivors with confirmed stable homonymous hemianopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Inclusion criteria: &lt;/strong&gt;Clinically diagnosed stroke, 18+ years, stable hemianopia, &gt;4 weeks and &lt;26 weeks post-stroke onset, able to engage in training, informed/proxy consent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Arm A (VST) or arm B (sham training) for minimum 30 minutes, 7 days per week over 6 weeks. Follow-up to 26 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Evaluate clinical effectiveness of VST versus sham training, for homonymous hemianopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Primary outcome measurement was change in the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) score from baseline to 26 weeks. Secondary outcome measurements were change in the Nottingham Extended Activities of Daily Living (NEADL), EuroQoL (EQ-5D-5L), Brain Injury-Related Visual Impairment-Impact Questionnaire (BIVI-IQ), visual field measurement (Esterman program), visual scanning performance, and adverse events from baseline to 26 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Randomization: &lt;/strong&gt;Web-based randomization system stratified by partial/complete hemianopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Blinding: &lt;/strong&gt;Participants and primary outcome assessor blinded to treatment allocation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 161 participants were randomized; 80 to the VST group and 81 to the sham group. One participant was randomized in error and two withdrew consent to use data so were not included. Of 158 participants, 78 were in the VST group and 80 in the sham group. No participants were unblinded. All participants began their training allocation. During the first 6 weeks of training, 56 (72%) and 58 (73%) undertook training every day or most days in the VST and sham groups, respectively. There were 37 withdrawals from the trial: 18 in the VST group and 19 in the sham group. Both groups were comparable in terms of baseline characteristics. Primary analysis of covariance (ANCOVA) analysis was carried out on 104 participants with VFQ-25 data at both baseline and 26 weeks; sensitivity analysis was undertaken for 120 participants. Estimated mean difference at 26 weeks, adjusting for baseline score and hemianopia type was -4.04 (95% confidence interval (CI): -9.45 to 1.36; p = 0.141) for primary analysis and -2.33 (95% CI: -7.42 to 2.75; p = 0.365) for sensitivity analysis. There were no significant differences between groups for primary and secondary outcome measure comparisons from baseline to 26 weeks. Adverse events, reported for 20 participants, included eye ","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"968-976"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital stroke care in low- and middle-income countries: A World Stroke Organization (WSO) scientific statement.","authors":"Jacqueline Bosch, Radhika Lotlikar, Rita Melifonwu, Tamer Roushdy, Ivy Sebastian, Siju V Abraham, Laura Benjamin, Dou Li, Gary Ford, Mirjam Heldner, Peter Langhorne, Renyu Liu, Emmie Malewezi, Olubukola A Olaleye, Jeyaraj Pandian, Gerard Urimubenshi, David Waters, Jing Zhao, Anthony Rudd","doi":"10.1177/17474930251351867","DOIUrl":"10.1177/17474930251351867","url":null,"abstract":"<p><p>Evidence-based prehospital stroke care is effective in reducing stroke-related mortality and morbidity. The crucial period from symptom awareness to presentation at the hospital, the first step in the World Stroke Organization Road Map to Quality Care, is under-resourced in the majority of low- and middle-income countries (LMICs). Key challenges focus on a lack of stroke action awareness as well as human resources trained in stroke care. We aimed to identify prehospital stroke practices in LMICs and identify where innovation may address service gaps. We conducted scoping reviews focused on key domains of prehospital stroke care in LMICs that include organization of services, stroke action awareness in the community, educating primary care physicians and traditional/faith healers, diagnostic tools for prehospital stroke detection, and emergency medical service (EMS) provision. We sought to determine current practices and gaps in LMICs and evidence on effective interventions to address gaps in each domain. Recommendations are provided identifying priority considerations in each domain, based on evidence, and where lacking, expert opinion. Key recommendations include the need for adequately funded national-level strategies for prehospital stroke care; stroke action awareness education for the public, primary care physicians, community health workers, EMSs, and traditional and faith healers; affordable imaging solutions; and approaches to create or improve prehospital EMS (e.g., protocols). We found that efforts, although few, have been made to address gaps in LMICs; however, they have rarely been evaluated, and it is unclear if they are sustained. The required elements necessary to improve prehospital services and stroke outcomes are known. Creativity is and perseverance are required for implementation to ensure sustainability. This scientific statement has been reviewed and approved by the World Stroke Organization Executive.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"918-927"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare genetic variants in <i>PKD1</i> and <i>SMAD2</i> are associated with intracranial aneurysms in the general population.","authors":"Bibi M Wolters, Mark K Bakker, Kristiina Rannikmäe, Paul J Hop, Ynte M Ruigrok","doi":"10.1177/17474930251334501","DOIUrl":"10.1177/17474930251334501","url":null,"abstract":"<p><strong>Introduction: </strong>Family studies identified several rare genetic risk variants for intracranial aneurysms (IAs) and aneurysmal subarachnoid hemorrhage (ASAH). In addition, certain monogenic disorders caused by rare penetrant genetic variants predispose individuals to IA and ASAH. We investigated the effect of these variants on IA and ASAH in the general population.</p><p><strong>Patients and methods: </strong>We tested the association between genetic variants within IA-associated genes and IA and ASAH using a burden test, sequence kernel association test (SKAT), and variant-level aggregated Cauchy association test (ACAT-V) in the UK Biobank. Variants were stratified by allele frequency and predicted impact on the protein structure. Sensitivity analyses were performed on only ASAH patients and excluding participants diagnosed with an aforementioned monogenic disorder.</p><p><strong>Results: </strong>In the group of 1656 IA cases, including 928 ASAH cases, and 391,948 controls, associations were identified for ultrarare variants with moderate or high impact in <i>PKD1</i> (odds ratio (OR) = 1.42; 95% confidence interval (95% CI)= 1.06-1.85, p = 4.28 × 10^-7 (SKAT)) and <i>SMAD2</i> (OR = 4.89; 95% CI = 1.63-11.05, p = 7.10 × 10^-5 (SKAT)). Upon excluding participants diagnosed with the respective monogenic disorders, these associations remained. When considering only ASAH cases, the association with <i>SMAD2</i> was similar (OR = 4.85; 95% CI = 1.02-13.7; p = 9.0 × 10^-4) while for <i>PKD1</i> the association diminished (OR = 1.29; 95% CI = 0.85-1.87; p = 0.043).</p><p><strong>Discussion and conclusion: </strong>Ultrarare damaging variants in <i>PKD1</i>, a gene causing autosomal dominant polycystic kidney disease, and <i>SMAD2</i>, a gene causing Loeys-Dietz syndrome, were associated with IA in the general population, even in the absence of a diagnosis of these disorders. Our results may contribute to the development of genetic screening methods for IA in a clinical setting.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1011-1020"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke care in indigenous populations: A World Stroke Organization (WSO) scientific statement.","authors":"Anna Ranta, Margaret Hart, Angela Dos Santos, Anna H Balabanski, Susanna Ragnhild Andersdatter Siri, Carol Zavaleta-Cortijo, Seira Duncan, Amy Yx Yu, C U Thresia, Tereki Stewart, Allison Kelliher, Donald Warne, Bernadette Jones","doi":"10.1177/17474930251347394","DOIUrl":"10.1177/17474930251347394","url":null,"abstract":"<p><strong>Background: </strong>Indigenous Peoples have been reported to experience higher rates of stroke, poorer access to high-quality acute and rehabilitation stroke services, and worse post-stroke outcomes compared to dominant cultures residing in the same countries. The aim of this statement is to summarize available evidence on access barriers contributing to these inequities, effective solutions that have been deployed and tested, and present key recommendations to advance the field.</p><p><strong>Methods: </strong>We conducted a scoping review searching Medline, Embase, CINHAL, PubMed, Scopus, and Informit Indigenous Collection using the broad search terms \"stroke\" and \"Indigenous\" without date restriction until 1 August 2024. We screened 673 unique titles, 96 abstracts, and 80 full-text papers of which we retained 41. We added 10 additional key references known to authors. Articles were analyzed to identify key cross-cutting themes.</p><p><strong>Results: </strong>We identified five key themes: (1) Historical context, colonization and racism; (2) wholistic strength-based approaches to health, well-being, and recovery; (3) communication, health literacy, and cultural safety; (4) Indigenous knowledge systems, research principles, and community-led action; (5) achieving local acceptance versus wide generalizability.</p><p><strong>Recommendations: </strong>Key priority areas, detailed in the form of 11 specific recommendations and based on six core values, include improving stroke service responsiveness, Indigenous Peoples empowerment, and Indigenous research support to better meet the needs of Indigenous Populations globally. The statement has been reviewed and approved by the WSO Executive Committee.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"928-948"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing important challenges in global stroke care: World Stroke Organization scientific statements.","authors":"Hugh S Markus","doi":"10.1177/17474930251377644","DOIUrl":"https://doi.org/10.1177/17474930251377644","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"20 8","pages":"902-904"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}