International Journal of Stroke最新文献

{"title":"Prognosis and predictors of fatigue after stroke. An individual patient data meta-analysis from three large multicentre trials of fluoxetine for stroke recovery.","authors":"Gillian Elizabeth Mead, Catriona Graham, Erik Lundström, Graeme J Hankey, Maree L Hackett, Laurent Billot, Per Näsman, John Forbes, Martin Dennis","doi":"10.1177/17474930261496637","DOIUrl":"https://doi.org/10.1177/17474930261496637","url":null,"abstract":"<p><p>BackgroundFatigue affects about half of stroke survivors, but its natural history and associations are uncertain. We aimed to determine the trajectory of fatigue between 6 and 12 months after stroke, and factors associated with changes in fatigue between 6 and 12 months after stroke, in patients recruited to three large clinical trials.MethodsWe performed three large randomised, placebo-controlled trials of fluoxetine 20mg daily for six months, for stroke recovery. Short Form 36 (SF-36) vitality scores measured post-stroke fatigue at 6 and 12 months. We undertook an individual patient data meta-analysis (IPDM) to explore the proportion of patients with fatigue at 6 months (SF-36 vitality score ≤45) who moved to a 'no fatigue' category at 12 months, the proportion with 'no fatigue' at 6 months who moved to a fatigue category, and the proportion experiencing a clinically relevant improvement in fatigue (increase in SF36 vitality of 10 points) from 6 to 12 months. We performed regression analyses to identify which baseline factors and whether the mood (self-assessed combined anxiety/depression) and pain components of EuroQol 5D-5L (EQ 5D-5L) at 6 months influenced fatigue trajectory between 6 and 12 months.ResultsA total of 5907 patients were included. Fatigue (SF-36 vitality scores) was recorded at 6 and 12 months in 5025 (85%) patients. Fatigue (SF-36 vitality ≤45) at 6 months was present in 1489 (29.6%, 95%CI: 28.4 to 30.9%) participants, of whom 568 (38.1%, 95%CI: 35.7% to 40.7%) had no fatigue at 12 months. Fatigue at 12 months was present in 1474 (29.3%, 28.0 to 30.6%) participants, of whom 553 (15.6%, 95% CI 14.5% to 16.9%) had no fatigue at 6 months.Patient consent (rather than proxy consent), being able to lift arms off bed at baseline, and severe/extreme pain at 6 months were independently associated with persistence of fatigue through to 12 months, whereas stroke type (embolic or small vessel disease vs haemorrhagic) at baseline and self-assessed slight anxiety/depression at 6 months were associated with fatigue resolution by 12 months.Among those without fatigue at 6 months, Asians (compared to whites), and those reporting moderate or severe anxiety/depression problems were less likely to have fatigue at 12 months.ConclusionMore than a third of patients with fatigue at 6 months experienced a clinically relevant reduction in fatigue between 6 and 12 months, whereas one sixth of patients without fatigue at 6 months developed fatigue at 12 months. Although the individual regression analyses identified statistically significant associations between some independent variables and fatigue at 12 months, there was no consistent pattern across the analyses. Future research should identify factors associated with the development and recovery of fatigue after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261496637"},"PeriodicalIF":6.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109542","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":"International Modified Delphi Consensus on Assessment and Management of Covert Brain Infarction.","authors":"Bruno Kusznir Vitturi, Terence Joseph Quinn, Götz Thomalla, Frank J Wolters, Frank-Erik de Leeuw, Silja Räty, Aristeidis H Katsanos, Deidre Anne De Silva, Gisele Sampaio Silva, Brett Cucchiara, Jelle Demeestere, Frederic Clarencon, Linxin Li, Salvatore Rudilosso, Yongjun Wang, P N Sylaja, Adriana Conforto, Hugues Chabriat, Jose M Ferro, J Biller, Rubens Gagliardi","doi":"10.1177/17474930261496691","DOIUrl":"https://doi.org/10.1177/17474930261496691","url":null,"abstract":"<p><p>BackgroundCovert brain infarction (CBI) is a frequent incidental neuroradiological finding increasingly recognized as clinically relevant due to its association with stroke, cognitive decline, and other adverse outcomes. However, substantial uncertainty remains regarding its optimal assessment and management, and existing guidelines provide limited and heterogeneous recommendations. We aimed to develop an international expert consensus on the evaluation and management of CBI using a modified Delphi methodology.MethodsA modified Delphi process was conducted with an international, multidisciplinary panel of 21 experts from 15 countries, including neurologists, neuroradiologists, neuroepidemiologists, and geriatricians. An initial questionnaire was developed from a structured literature review and identified clinical practice gaps. The survey included 91 statements across four domains: (1) prognosis, etiology, and screening; (2) neuroimaging-based management and follow-up; (3) cardiac evaluation; and (4) pharmacological management. Two iterative rounds were conducted, with anonymized responses, controlled feedback, and structured discussion. A five-point Likert scale was used. Consensus was defined a priori as ≥70% agreement.ResultsConsensus was reached on 33/91 statements (36.3%), moderate agreement on 43/91 (47.2%), and no consensus on 15/91 (16.5%). The panel agreed that CBI is associated with increased risk of ischemic stroke, cognitive impairment, and dementia, and that risk is higher with multiple lesions. Consensus supported targeted clinical evaluation, including a cardiac workup with transthoracic echocardiography in all patients and vascular imaging in selected cases. Routine population screening and systematic post-procedural imaging were not supported. Regarding management, consensus favored optimizing vascular risk factors, particularly strict blood pressure control in hypertensive patients. There was no consensus on routine antiplatelet therapy for incidental CBI, and anticoagulation was generally not supported in the absence of cardioembolic indications. Lipid-lowering showed limited consensus regarding specific benefits for CBI-related outcomes.ConclusionThis Delphi consensus highlights substantial variability in the perceived management of CBI and identifies areas of convergence, particularly in risk stratification and control of vascular risk factors. Key uncertainties remain regarding antithrombotic strategies, lipid-lowering therapy, and long-term surveillance. These results provide a pragmatic, expert-based framework to support clinical decision-making and further highlight the need for prospective studies and randomized trials in this rapidly evolving field.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261496691"},"PeriodicalIF":6.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109556","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":"Exercise and multidomain interventions for vascular cognitive impairment: A narrative review.","authors":"Kwong Hsia Yap, Rozene Cher Wei Yap, Evangeline Hui Jie Ong, Narayanaswamy Venketasubramanian, Christopher Li-Hsian Chen","doi":"10.1177/17474930261451077","DOIUrl":"10.1177/17474930261451077","url":null,"abstract":"<p><strong>Background: </strong>Vascular cognitive impairment (VCI) encompasses cognitive impairment attributable to cerebrovascular disease, including post-stroke cognitive impairment (PSCI). Exercise and multidomain interventions have been investigated in these populations; however, cognitive outcomes remain heterogeneous.</p><p><strong>Aims: </strong>To synthesize randomized controlled trials on exercise-based and exercise-inclusive multidomain interventions in VCI (including PSCI) and examine how population definition, intervention delivery, and outcome selection influence cognitive outcomes.</p><p><strong>Summary of review: </strong>A narrative review identified randomized or controlled trials reporting cognitive outcomes following exercise-only or multidomain interventions. Studies were grouped into three populations: documented cerebrovascular brain injury, vascular or metabolic risk-enriched populations without cognitively defined inclusion criteria, and cognitively defined risk states. The latter two groups were included as contextual comparators and were not assumed to meet criteria for VCI. In populations with documented cerebrovascular brain injury (<i>n</i> = 20), longer-duration multidomain interventions focused on vascular risk-factor optimization and lifestyle advice improved vascular targets without consistent cognitive benefit. In contrast, structured and supervised exercise in chronic stroke and cerebral small-vessel disease more often reported domain-specific cognitive improvements, commonly in executive functioning and attention. In risk-enriched and cognitively defined populations, cognitive effects were more detectable when exercise was actively delivered and cognition was the primary outcome.</p><p><strong>Conclusions: </strong>Detectability of cognitive effects in exercise and multidomain interventions for VCI depends on population definition, outcome selection, and whether exercise is prescribed and delivered rather than simply advised.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1274-1283"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814769","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":"Distinct perforator hemodynamic phenotypes differentiate mechanisms of single subcortical infarction: In vivo evidence from 7T phase-contrast MRI.","authors":"Ning Wei, Yu-Yuan Xu, Yue Suo, Zhe Zhang, Wanlin Zhu, Hui Qu, Xiping Gong, Kehui Dong, Zixiao Li, Yongjun Wang, Zihao Zhang, Jing Jing","doi":"10.1177/17474930261444936","DOIUrl":"10.1177/17474930261444936","url":null,"abstract":"<p><strong>Objective: </strong>Single subcortical infarction (SSI) arises from heterogeneous mechanisms, most commonly parent artery disease (PAD) or intrinsic small vessel pathology. However, whether these mechanisms produce distinct in vivo hemodynamic signatures within perforating arteries remains unknown. We aimed to determine whether lenticulostriate artery (LSA) hemodynamics differ between SSI subtypes and whether such differences provide mechanistic insight into SSI pathophysiology.</p><p><strong>Methods: </strong>Patients with recent SSI confined to the LSA territory were prospectively enrolled and underwent 7T magnetic resonance imaging. Based on intracranial vessel wall imaging, patients were classified as SSI + PAD (ipsilateral middle cerebral artery (MCA) plaque on T1-weighted vessel wall imaging defined by eccentric wall thickening) or SSI - PAD (no ipsilateral MCA plaque). LSA flow velocity was quantified at the arterial ostium and distal segment using phase-contrast magnetic resonance angiography (PC-MRA), and along-vessel velocity decline was calculated. LSA morphology was assessed with time-of-flight MRA. Linear mixed-effects models adjusted for age and sex were used for group comparisons.</p><p><strong>Results: </strong>Forty-two patients (21 SSI + PAD and 21 SSI - PAD) were included. In SSI + PAD, ostial velocity in the symptomatic hemisphere was significantly lower than in the contralateral hemisphere (7.25 vs. 9.61 cm/s; p < 0.001) and the symptomatic side of SSI - PAD (8.95 cm/s, p = 0.001), indicating proximal inflow restriction. In contrast, SSI - PAD preserved ostial inflow (8.95 vs. 9.15 cm/s, p = 0.70) but exhibited a greater along-vessel velocity decline on both hemispheres compared with SSI + PAD, suggesting distal microvascular dysfunction. Morphologically, the symptomatic hemisphere showed fewer visible LSA branches and shorter LSA length than the contralateral hemisphere in both groups. In addition, LSA diameter tended to be smaller in SSI - PAD than in SSI + PAD.</p><p><strong>Conclusion: </strong>7T PC-MRA revealed distinct hemodynamic patterns in SSI. SSI + PAD was characterized by proximal inflow limitation, whereas SSI - PAD reflected diffuse distal hypoperfusion characteristic of small vessel pathology. Quantitative perforator flow assessment may refine etiologic classification and guide secondary prevention in SSI.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1337-1347"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662684","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":"Sex differences in the clinical and surgical management after intracerebral hemorrhage: A post hoc analysis of the INTERACT3 clinical trial.","authors":"Ma Ignacia Allende, Cheryl Carcel, Paula Muñoz-Venturelli, Katie Harris, Menglu Ouyang, Lu Ma, Xiaoying Chen, Laurent Billot, Qiang Li, Alejandra Malavera, Xi Li, Asita de Silva, Thang Huy Nguyen, Kolawole W Wahab, Jeyaraj D Pandian, Mohammad Wasay, Octavio M Pontes-Neto, Carlos Abanto, Antonio Arauz, Chao You, Xin Hu, Lili Song, Craig S Anderson","doi":"10.1177/17474930261423639","DOIUrl":"10.1177/17474930261423639","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;As the management of intracerebral hemorrhage (ICH) shifts from historical inertia to more proactive, evidence-based care, ensuring sex-equitable access to best-practice stroke care is increasingly important. Data on sex differences in access to care for ICH remains limited and often conflicting. More robust evidence is required to understand where disparities may exist to inform targeted interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;We aimed to determine sex differences in the clinical and surgical management of patients with acute ICH who participated in the third Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a post hoc analysis of INTERACT3, an international stepped-wedge, cluster-randomised trial undertaken in 121 hospitals across 9 low- to middle-income countries and 1 high-income country. The trial aimed to evaluate a care bundle composed of intensive blood-pressure lowering, rapid correction of hyperglycemia, fever control, and reversal of anticoagulation; in adults presenting within 6 h of ICH onset. We used mixed-effects logistic regression to evaluate sex differences in access to surgical interventions, admission to an intensive care unit or acute stroke unit, assisted feeding, physiotherapy, occupational therapy, withdrawal of care, and use of pharmacological therapies (antiepileptic drugs, mannitol, dexamethasone, and statins). Patterns of care were further evaluated using latent class analysis, with sex differences analyzed using the same regression framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 7036 patients with ICH, 2533 (36%) were female. Females were older and had more severe neurological deficits. Overall care provision was similar across sexes. However, females were more likely to receive assisted feeding (odds ratio [OR] 1.15, 95% CI = 1.02-1.31), and were less likely to withdraw from active care (OR 0.41, 95% CI = 0.19-0.87) than males. Surgical interventions were accessed at similar rates among sexes, a finding that persisted in analyses restricted to supratentorial ICH with hematoma volumes ⩾ 30 mL. Three distinct care classes were identified: high-intensity, high-rehabilitation, and low-intensity, with females and males having comparable distributions within the classes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Following acute ICH, females generally receive similar active acute care interventions as males, except for observed differences in access to assisted feeding and decision to withdraw from active care. These findings suggest that equal access to ICH interventions for females and males is feasible and exists in some settings. However, disparities in certain key interventions remain and present actionable opportunities for improvement. Further research is needed to explore not only access but also the timing and frequency of these interventions.Data access statement:Individual, de-identified participant data us","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1150-1158"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124969","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":"Magnitude and temporal dynamics of dementia risk before and after stroke diagnosis.","authors":"Xinghe Huang, Xinqing Yang, Menghan Zhu, Xuyang Diao, Junyu Zhang, Yang Pan, Yiwen Dai, Jingya Ma, Yuling Liu, Fanfan Zheng","doi":"10.1177/17474930251397083","DOIUrl":"10.1177/17474930251397083","url":null,"abstract":"<p><strong>Background: </strong>Stroke is associated with an increased risk of dementia, but the temporal dynamics of dementia risk before and after stroke diagnosis remain uncertain. This study aimed to examine the risk of dementia from 10 years before through 30 years after stroke diagnosis, compared with non-stroke individuals.</p><p><strong>Methods: </strong>We performed a case-control study using the UK Biobank data. We identified all participants diagnosed with stroke who had disease occurrence data available in the database. Controls were matched 3:1 for year of birth, sex, and education level. Conditional logistic regression was applied to estimate odds ratios (ORs) for incident dementia across different time windows before and after stroke diagnosis.</p><p><strong>Results: </strong>This study included 24,056 individuals with stroke and 74,136 matched controls. The risk of dementia was higher in individuals with stroke compared to non-stroke controls in each time window before stroke diagnosis, with ORs ranging from 1.43 (95% confidence interval (CI): 1.02-2.01, <i>p</i> = 0.040) in 5-10 years before diagnosis to 5.11 (95% CI: 4.06-6.41, <i>p</i> < 0.001) in 1 year immediately before stroke. Within the first year after stroke diagnosis, the risk of incident dementia was the highest (OR: 6.39, 95% CI: 5.20-7.87, <i>p</i> < 0.001). Similar results have been observed across sexes and different age groups.</p><p><strong>Conclusions: </strong>Participants who developed stroke had a higher risk of dementia beginning a decade before stroke onset, with risk peaking in the year around the diagnosis of stroke. These findings suggest the importance of prevention strategies at much earlier stages in individuals who are at risk of developing stroke and dementia.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1311-1320"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421434","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":"Risk of peripartum cerebrovascular events in women with moyamoya disease: A multicenter cohort study.","authors":"Jong Seok Lee, Hyunjun Cho, Tae Keun Jee, Sang Hyo Lee, Jae Seung Bang, June Ho Choi, Sangjoon Chong, Jae Sung Ahn, Joo Whan Kim, Eun Jung Koh, Ji Yeoun Lee, Ji Hoon Phi, Sung Ho Lee, Won-Sang Cho, Jeong Eun Kim, Hee-Soo Kim, Kyu-Chang Wang, Joong Shin Park, Soo-Young Oh, Seung-Ki Kim","doi":"10.1177/17474930251405087","DOIUrl":"10.1177/17474930251405087","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy and delivery are known to increase the risk of cerebrovascular events (CVEs) in patients with moyamoya disease (MMD). This study determined the frequency, risk factors, and outcome of CVEs during pregnancy in MMD.</p><p><strong>Methods: </strong>We conducted a multicenter study involving 171 MMD patients with 196 deliveries across four Korean tertiary institutions between 1990 and 2023. Data on MMD-related clinical, imaging, and operative findings were collected. We analyzed CVEs and pregnancy outcomes, including delivery mode and anesthesia. Univariate and multivariate analyses were performed to identify risk factors for peripartum CVEs.</p><p><strong>Results: </strong>Peripartum CVEs occurred in 5.6% of pregnancies, with intracerebral hemorrhage being the most common, followed by cerebral infarction. CVEs were more common in women diagnosed with MMD during pregnancy (85.7% vs. 2.6% in women diagnosed before pregnancy) and in women who had not completed revascularization before pregnancy or were hemodynamically unstable: 55.6% versus 1.1%. Delivery mode and anesthesia showed no significant association with the occurrence of CVEs. Multivariate analysis revealed that the \"non-revascularized or hemodynamically unstable\" group remained a significant risk factor for peripartum CVEs (adjusted odds ratio (OR) = 353.23, <i>P</i> < 0.001). CVEs resulted in maternal functional impairment in 4 of 11 affected cases (36.4%) and fetal loss in 2 of 11 cases (18.2%).</p><p><strong>Conclusion: </strong>This study highlights the protective effect of revascularization on peripartum CVEs and proposes a structured clinical protocol, recommending prepregnancy hemodynamic assessment and neurosurgical consultation. Women diagnosed with MMD during pregnancy and those in the \"non-revascularized or hemodynamically unstable\" group should be considered a high-risk group for peripartum CVEs.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1159-1169"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604066","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":"Comparison of pragmatic post-thrombectomy prognostic scores not based on advanced imaging in a large national stroke registry.","authors":"Antonio Ciacciarelli, Umberto Pensato, Giovanni Pracucci, Valentina Saia, Ettore Nicolini, Manuela De Michele, Ciro Alberto Fasolino, Enrico Fainardi, Ilaria Casetta, Simona Marcheselli, Antonio Laiso, Patrizia Nencini, Stefano Vallone, Guido Bigliardi, Valerio Da Ros, Ilaria Maestrini, Mauro Bergui, Giovanni Bosco, Maria Ruggiero, Marco Longoni, Sandra Bracco, Rossana Tassi, Luigi Simonetti, Andrea Zini, Bruno Del Sette, Tiziana Benzi Markushi, Agostino Tessitore, Ludovica Ferraù, Roberto Menozzi, Alessandro Pezzini, Andrea Saletti, Alessandro De Vito, Andrea Boghi, Andrea Naldi, Guido Andrea Lazzarotti, Nicola Giannini, Nicola Milazzo, Alessandra Persico, Mauro Plebani, Manuel Cappellari, Alessio Comai, Enrica Franchini, Nicola Burdi, Giovanni Boero, Luca Allegretti, Tiziana Tassinari, Domenico Sergio Zimatore, Marco Petruzzellis, Nicola Cavasin, Adriana Critelli, Emilio Lozupone, Marcella Caggiula, Ivan Gallesio, Delfina Ferrandi, Edoardo Puglielli, Alfonsina Casalena, Marco Perri, Federica De Santis, Michele Besana, Alessia Giossi, Gianluca Galvano, Eleonora Saracco, Giuseppe Carità, Monia Russo, Massimiliano Allegritti, Stefano Caproni, Matteo Alberti, Paolo Invernizzi, Marco Filizzolo, Marina Mannino, Giuseppe Pelle, Michele Alessiani, Daniel Konda, Fabrizio Sallustio, Salvatore Mangiafico, Danilo Toni","doi":"10.1177/17474930261421043","DOIUrl":"10.1177/17474930261421043","url":null,"abstract":"<p><strong>Background: </strong>Nearly half of the patients who received endovascular thrombectomy (EVT) for large vessel occlusion experience poor functional outcomes. Reliable tools for early post-procedural prognostication are needed. We aimed to assess and compare the performance of existing, pragmatic post-EVT prognostic scores in a large national multicenter cohort.</p><p><strong>Methods: </strong>We conducted a systematic literature search to identify pragmatic post-thrombectomy prognostic scores predicting 90-day functional outcomes. Models relying on advanced imaging, small derivation samples, or machine learning were excluded. We analyzed data from the IRETAS registry-a prospective, multicenter Italian cohort of stroke patients treated with EVT. Inclusion criteria were pre-stroke modified Rankin Scale (mRS) ⩽ 2 and available 90-day mRS. The primary outcome was good functional outcome (mRS ⩽ 2). Prognostic performance was assessed using c-statistics in the samples where each individual score was measurable. Scores were compared using DeLong tests in the subset of patients for whom all scores were measurable.</p><p><strong>Results: </strong>Three scores were identified: HERMES-24, BET, and SNARL. Among 22,768 patients in the registry, 18,408 (89.1%) had a measurable HERMES-24 score, 13,593 (59.7%) had a measurable BET score, and 19,007 (83.5%) had a measurable SNARL score. Median age was 75 years (IQR 65-82), and 11,528 (50.6%) were female. In the subset in which each test was measurable, HERMES-24 showed the best performance for predicting mRS ⩽ 2 (c-statistic = 0.889), followed by BET (c-statistic = 0.794) and SNARL (c-statistic = 0.762) (<i>p</i> < 0.001). In the subset of 12,233 patients for whom all three prognostic scores were calculable, a head-to-head comparison confirmed the superior performance of the HERMES-24 model: HERMES-24 score versus BET score (c-statistic difference = 0.098 [95% CI = 0.092-0.105]; <i>p</i> < 0.001) and HERMES-24 score versus SNARL score (c-statistic difference = 0.124 [95% CI = 0.116-0.132]; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>In this large, multicenter, national cohort, the post-EVT HERMES-24 score-which accounts only for age and 24-h NIHSS-demonstrated the highest prognostic performance among existing, pragmatic post-EVT scores. Its simplicity and robust performance support its routine adoption in clinical practice.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1095-1107"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283564","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":"Cerebral venous thrombosis, moyamoya disease, and intracranial stenosis.","authors":"Hugh S Markus","doi":"10.1177/17474930261484226","DOIUrl":"https://doi.org/10.1177/17474930261484226","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"21 8","pages":"1052-1055"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038153","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":"Long-term outcomes and complications of cerebral venous sinus thrombosis: Findings from the Vellore CVT registry.","authors":"Sanjith Aaron, Angel Miraclin T, Mubasheera Sulthana, Mahasampath Gowri, Premkumar Asokan, Deepti Bal, George Abraham Ninan, Selvakumar Selvaganesan, Anitha Jasper, Harshad Arvind Vanjare, Pavithra Mannam, Santhosh Babu K B, Nidugala Shyamkumar Keshava, Shalini Nair, Kundavaram Paul P Abhilash, Aditya V Nair, Arun Mathai Mani, Shaikh Atif Iqbal Ahmed, Rohit Ninan Benjamin, Vivek Mathew, Prabhakar At, Ajith Sivadasan","doi":"10.1177/17474930261428115","DOIUrl":"10.1177/17474930261428115","url":null,"abstract":"<p><strong>Background: </strong>Although short-term outcomes are generally favorable in Cerebral venous sinus thrombosis (CVT), there are limited data on long-term complications and sequelae.</p><p><strong>Methods: </strong>This ambispective study is from the Vellore CVT Registry, the largest single-center CVT registry in the world. Two thousand four hundred and eighty-four adults with CVT enrolled between 2000 and 2024 were analyzed for functional status and complications with follow-up up to 12 years.</p><p><strong>Results: </strong>Of 2484 patients, 2380 (95.8%) survived the acute phase, with a mean follow-up of 3.2 years (range, 0-12 years). During follow-up, 41 patients (1.7%) died, the majority being within 1 year. Excellent functional outcomes (mRS ⩽ 2) were achieved by 92% of patients within 2 years. Complications were observed in 799 (33.5%) at follow-up, of whom 405 (50.6%) required rehospitalization. More than half (55.1%) of these complications occurred more than 2 years after the initial diagnosis of CVT. Common complications were seizures (9.6%) and headaches (7.7%). Bleeding events occurred in 3.9% of cases, predominantly due to anticoagulant use. Recurrent CVT developed in 1.3%, and other thrombotic events in 2.4%. Occurrences of malignancies (1%) and secondary dural arteriovenous fistulas (dAVFs) (0.6%) were significant complications that occurred after 2 years. Of the 108 pregnancies that occurred during follow-up, thrombotic events occurred in 2.7% in the absence of antithrombotic prophylaxis.</p><p><strong>Conclusions: </strong>Most patients with CVT achieve long-term functional independence, yet one-third develop delayed complications. These findings underscore the importance of long-term surveillance in CVT survivors and give important insights into the natural history of CVT.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1085-1094"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213229","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}