International Journal of Stroke最新文献

{"title":"Cognitive impairment after cerebral venous thrombosis: A systematic review and meta-analysis.","authors":"Luisa Medeiros Visentini, Gustavo Nascimento de Medeiros, Aluisio D'lucas Alves E Gomes, Wellisson Rodrigues Silva, Fernanda Alcântara Nascimento Aguiar, Julie de Lima Loiola, Giovanna Nina Ueda, Gabriel Marinheiro, Gabriel Barroso Cunha, Joao Brainer Clares de Andrade, Diana Aguiar de Sousa, Thales Pardini Fagundes","doi":"10.1177/17474930251411472","DOIUrl":"10.1177/17474930251411472","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous thrombosis (CVT) is a less common type of stroke that predominantly affects young adults, particularly women. Although CVT is generally associated with more favorable functional outcomes than other stroke subtypes, its cognitive consequences remain poorly understood.</p><p><strong>Aims: </strong>We aimed to perform a systematic review and meta-analysis evaluating the prevalence and characteristics of cognitive impairment in patients after CVT.</p><p><strong>Summary of review: </strong>A systematic review was conducted in accordance with PRISMA guidelines. We searched PubMed, Embase, and Cochrane databases up to May 2025 for studies assessing cognitive impairment in patients with cerebral venous thrombosis (CVT), with a minimum follow-up of 6 months. Data extraction was performed independently by two reviewers. Pooled prevalence estimates were calculated using random-effects generalized linear mixed models with logit transformation as the primary approach, with Freeman-Tukey (double arcsine) transformation applied only in analyses with zero events or extreme proportions. Heterogeneity was evaluated using the I² statistic. All statistical analyses were conducted in R (version 4.5.2). Eleven observational studies and one randomized clinical trial involving 801 post-CVT patients were included. The pooled prevalence of cognitive impairment after CVT ranged from 19.25% (95% CI: 7.15-42.47%) among studies at low risk of bias to 29.20% (95% CI: 14.91-49.27%) in the overall analysis. Memory loss and affected executive function and visuospatial domains occurred in 39.21% (95% CI: 18.70-64.40%) and 35.94% (95% CI: 21.86-52.94%) of patients, respectively. Among functionally independent patients, cognitive impairment was observed in 28.6% (95% CI: 21.0-37.6%) of those with mRS 0, 36.3% (95% CI: 26.5-47.5%) with mRS 1, and 32.7% (95% CI: 15.5-56.3%) with mRS 2.</p><p><strong>Conclusions: </strong>Cognitive impairment affects roughly one-fifth to one-third of CVT survivors (19-29%), including those with minimal or no functional disability. These findings highlight the need to move beyond the mRS when assessing recovery and planning follow-up care.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1056-1066"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793697","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":"Two distinct patterns of progression of sporadic cerebral small vessel disease.","authors":"Yutong Chen, Hui Hong, Daniel Tozer, Zihan Sun, Lupei Cai, Hao Li, Anil Man Tuladhar, Frank-Erik De Leeuw, Hugh S Markus","doi":"10.1177/17474930261459792","DOIUrl":"10.1177/17474930261459792","url":null,"abstract":"<p><strong>Background: </strong>Sporadic cerebral small vessel disease (cSVD) is the most common cause of vascular dementia. cSVD features a wide range of neuroimaging markers, including white matter hyperintensity (WMH), lacunes, perivascular spaces, microbleeds, and diffusion magnetic resonance imaging (MRI)-based markers of white matter (WM) injury, and is accompanied by progressive cognitive decline. However, few studies have systematically investigated how and when various imaging and cognitive markers change along the complete cSVD progression trajectory.</p><p><strong>Aims: </strong>To establish changes in imaging and cognitive markers along the cSVD progression trajectory.</p><p><strong>Methods: </strong>In this cohort study, we selected 496 participants from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUNDMC) cohort as the discovery data set. The subtype and stage inference model was used to identify cSVD subtypes and their progression patterns. Five neuroimaging markers (WMH volume, median mean diffusivity (MD) in WM, WM volume, gray matter (GM) volume, and ventricle volume) were used in trajectory construction. The validation cohort was Cambridge cSVD (CamcSVD; n = 330).</p><p><strong>Results: </strong>We identified two subtypes in RUNDMC and replicated this finding in CamcSVD. One subtype displayed early WMH increase, followed by increased WM MD and tissue volume loss. The other subtype, which we termed \"atrophy predominant,\" showed early loss of GM and WM and ventricle enlargement, followed by WMH increase and increased WM MD. This subtype displayed an increase in markers of idiopathic normal pressure hydrocephalus (iNPH).</p><p><strong>Conclusion: </strong>We have delineated two distinct progression patterns in sporadic cSVD. Further studies are needed to investigate the relationship between the atrophy-predominant cSVD subtype and iNPH.Data access statement:Datasets may be shared upon request to the corresponding author.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1348-1357"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156560","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":"Lesion network mapping for post-stroke cognitive impairment.","authors":"Yijun Zhou, Yue Wang, Jing Jing, Jiawei Li, Hao Liu, Yongjun Wang, Tao Liu, Shiping Li","doi":"10.1177/17474930261425249","DOIUrl":"10.1177/17474930261425249","url":null,"abstract":"<p><strong>Background: </strong>While infarcts and white matter hyperintensities (WMHs) are critical determinants of post-stroke cognitive impairment (PSCI), their comprehensive network disconnection mechanisms remain poorly characterized.</p><p><strong>Aims: </strong>This study aimed to systematically map the functional and structural network disconnection patterns underlying PSCI, elucidate the relationship between network disconnection and cognitive status-particularly the mediating role of WMH-and identify potential neuromodulation targets based on the disconnection maps.</p><p><strong>Methods: </strong>In a cohort of 376 mild-to-moderate first acute ischemic stroke patients without pre-stroke dementia, we employed connectome-based lesion-symptom mapping (CLSM) to construct comprehensive disconnection maps derived from infarct and WMH lesions. The distinctiveness was validated against an independent cohort of 78 cerebral small vessel disease patients. CLSM-derived lesion impact scores were analyzed using regression models to assess their domain-specific cognitive relationships and using mediation modeling to quantify the mediating effects of WMH. Potential neuromodulation targets were subsequently identified based on the disconnection patterns.</p><p><strong>Results: </strong>Results revealed that spatially heterogeneous infarcts and WMH converge on functionally/structurally coherent disconnection patterns through distinct pathological mechanisms, with attention and processing speed (APS) deficits emerging as the most sensitive domain. Lesion impact scores were significantly correlated with cognitive deficits and demonstrated greater predictive contribution for 3-month cognitive outcomes than traditional volumetric measures. WMH-induced disconnections significantly mediated the relationship between infarct and PSCI/APS deficits. The left temporo-parieto-occipital junction could be considered a potential neuromodulation target for PSCI.</p><p><strong>Conclusion: </strong>This study establishes a network-level pathophysiological framework for PSCI, demonstrating distinct yet synergistic roles of acute and chronic vascular lesions.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1321-1336"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124890","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":"The concordance and correlation of Global Burden of Disease stroke incidence rates with stroke incidence rates from population-based stroke registers.","authors":"Daniel Youkee, Charles DA Wolfe","doi":"10.1177/17474930261423425","DOIUrl":"10.1177/17474930261423425","url":null,"abstract":"<p><strong>Background: </strong>The Global Burden of Disease (GBD) 2021 study and population-based stroke registers are principal sources of stroke incidence estimates. This study aims to assess the concordance and correlation between GBD stroke incidence rates and stroke incidence rates from population-based stroke registers.</p><p><strong>Methods: </strong>Crude and age-standardized stroke incidence rates were sourced from high-quality population-based stroke registers and compared to GBD estimates matched by year and location, using GBD subnational data where available. Studies were categorized by country income group status using the World Bank country classifications: high-income countries (HICs); upper middle-income countries (UMICs), and lower middle-income countries (LMICs). Studies were categorized as to whether they were reported as informing the GBD 2021 model, using the online GBD 2021 sources tool. Concordance and correlation were assessed using Lin's concordance correlation coefficient and Pearson's correlation coefficient, respectively. Bland-Altman plots were created to display 95% limits of agreement.</p><p><strong>Findings: </strong>Fifty crude matched incidence rates and 31 matched age-standardized rates were compared. Concordance and correlation for crude stroke incidence were 0.67 and 0.68 overall, 0.66 and 0.68 for HICs, 0.59 and 0.77 for UMICs and 0.03 and 0.97 for LMICs respectively. Overall, 11 (22.0%) GBD estimates, accounting for UIs, matched population-based stroke register crude incidence rates. 95% limits of agreement were -110.2/100,00 to 134.1/100,000 overall. Concordance and correlation for age-standardized incidence rates were 0.56 and 0.59 overall, 0.59 and 0.63 for HICs, 0.12 and 0.17 for UMICs, and 0.25 and 0.42 for LMICs. 95% limits of agreement were from -94.6 to 84.1/100,000. Subgroup analysis including only studies where more specific subnational geographical GBD estimates were available marginally improved crude incidence (n = 18) concordance (0.67 to 0.71) but not age-standardized incidence (n = 13) concordance (0.53 to 0.49). Subgroup analysis limited to population-based stroke registers included as GBD 2021 sources, did not significantly improve correlation or concordance.</p><p><strong>Interpretation: </strong>Our findings demonstrate limited concordance and correlation in crude and age-standardized stroke incidence rates between population-based stroke registers and the GBD 2021 model, with lower concordance for UMICs and LMICs, compared to HICs. The wide 95% limits of agreement demonstrated should provide caution in the use of GBD stroke incidence estimates to guide policy or assess progress in the primary prevention of stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1140-1149"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113153","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":"Decompressive hemicraniectomy for large hemispheric infarction after endovascular therapy.","authors":"Ximing Nie, Qixuan Lu, Jinjie Liu, Hongyi Yan, Yufei Wei, Mengxing Wang, Jinxu Yang, Yaqi Liu, Xiaochuan Huo, Yuesong Pan, Zhongrong Miao, Bernard Yan, Liping Liu","doi":"10.1177/17474930261419218","DOIUrl":"10.1177/17474930261419218","url":null,"abstract":"<p><strong>Background: </strong>Although endovascular therapy (EVT) improves functional outcomes in acute ischemic stroke patients, some with large hemispheric infarction (LHI) post-EVT may still require decompressive hemicraniectomy (DHC). This study aimed to explore whether DHC benefits all patients with post-EVT LHI and to identify which patients are more likely to benefit from DHC.</p><p><strong>Methods: </strong>This pooled analysis of the RESCUE-RE study and the ANGEL-ASPECT trial enrolled patients with LHI and severe neurological deficits after EVT. According to the treatment received, patients were categorized into DHC and conservative therapy groups. The primary outcome was 90-day mortality. Propensity score matching (PSM) analysis was used to control for differences between groups.</p><p><strong>Results: </strong>In total, 136 of 2036 EVT-treated patients (6.7%) in the RESCUE-RE study and 59 of 230 (25.6%) in the ANGEL-ASPECT trial met inclusion criteria. Among the 195 patients included, 50 (25.6%) underwent DHC (41 after PSM), while 145 (74.4%) received conservative therapy (41 after PSM). Patients undergoing DHC after EVT had significantly lower 90-day mortality rates compared with those receiving conservative therapy (odds ratio (OR) = 0.26; 95% confidence interval (CI), 0.10-0.66; <i>p</i> = 0.005), but no significant improvement was observed in 90-day modified Rankin Scale (mRS) distribution (common OR = 0.47; 95% CI = 0.21-1.05; <i>p</i> = 0.06). Patients within an overlapping range of post-EVT midline shift (approximately 10-17 mm) or infarct volume (approximately 250-330 mL), where both 90-day mortality and ordinal mRS distribution models favored DHC, appeared more likely to derive a comprehensive clinical benefit. Baseline infarct-core volume was not associated with the treatment effect of DHC.</p><p><strong>Conclusion: </strong>In patients with LHI after EVT, DHC was associated with reduced mortality when performed in accordance with current guidelines. Moreover, patients within a higher, but not the most extreme, range of injury severity after EVT might be more likely to benefit from DHC.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1108-1118"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018409","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":"Contrasting patterns of leptomeningeal and parenchymal gadolinium extravasation in cerebral amyloid angiopathy: An MRI-based evaluation.","authors":"S Voigt, Jja de Jong, Phm Voorter, E A Koemans, M R Schipper, M C van der Plas, K Kaushik, Rgj van der Zwet, R van Dort, H van den Brink, S J van Veluw, Mjp van Osch, Maa van Walderveen, W H Backes, Mjh Wermer, W M Freeze","doi":"10.1177/17474930261424089","DOIUrl":"10.1177/17474930261424089","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest that blood-brain barrier (BBB) disruption may play a role in the pathophysiology of vessel rupture in cerebral amyloid angiopathy (CAA). Here, in a cross-sectional cohort study, we apply contrast-enhanced 3 Tesla magnetic resonance imaging (MRI) to test the hypothesis that the BBB is damaged in patients with CAA and to determine whether BBB leakage is associated with hemorrhagic brain injury in CAA.</p><p><strong>Methods: </strong>Parenchymal BBB leakage rate (K_i) was assessed in the cortex and white matter with dynamic contrast-enhanced (DCE)-MRI and quantified with pharmacokinetic modeling. Leptomeningeal BBB leakage was assessed visually on post-contrast heavily T2-weighted fluid attenuation inversion recovery (FLAIR) images. Cortical cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS) were assessed on susceptibility-weighted images. Analyses included descriptive statistics, group comparisons using the Mann-Whitney U test and Spearman's rank correlation for associations with imaging markers.</p><p><strong>Results: </strong>In total, 25 patients with a clinical diagnosis of probable CAA without prior intracerebral hemorrhage and 19 age- and sex-matched controls were included. In patients with CAA, BBB leakage rates were lower in the cortex (4.2 × 10^-4 min^-1 vs 5.6 × 10^-4 min^-1; p = 0.004) and in the white matter (1.2 × 10^-4 min^-1 vs 2.1 × 10^-4 min^-1; p < 0.001) compared with controls. The presence of leptomeningeal enhancement was higher in patients with CAA (68%) compared with controls (47%) (p = 0.007). Within the group with CAA, we did not find a correlation between the number of cortical leakage and cortical CMBs (Spearman's ρ = 0.06, p = 0.79) or the number of foci of leptomeningeal enhancement and cSS hemisphere score (Spearman's ρ = 0.30, p = 0.15).</p><p><strong>Discussion: </strong>Our results suggest that global parenchymal gadolinium extravasation across the BBB is lower in patients with CAA compared with controls. This observation can be explained in terms of limited capillary blood perfusion and/or raising the possibility that vascular amyloid-β deposition impairing molecular transport across the BBB. In contrast, focal leptomeningeal enhancement was higher in CAA, reflecting vessel wall infiltration.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1368-1376"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124923","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":"The role of glymphatic dysfunction in cerebral small vessel disease and vascular cognitive impairment, and therapeutic implications.","authors":"Hui Hong, Yutong Chen, Peiyu Huang, Hugh S Markus","doi":"10.1177/17474930261475465","DOIUrl":"10.1177/17474930261475465","url":null,"abstract":"<p><strong>Background: </strong>The glymphatic system is a brain-wide perivascular clearance pathway that facilitates cerebrospinal fluid-interstitial fluid (CSF-ISF) exchange and the removal of metabolic waste from the brain parenchyma. Increasing evidence indicates that glymphatic transport is critically dependent on the integrity and function of cerebral small vessels, suggesting a close link with cerebral small vessel disease (cSVD). Structural and functional alterations of small vessels may disrupt glymphatic flow, while impaired glymphatic clearance may in turn exacerbate small vessel-related brain injury, indicating a bidirectional interaction between these two processes.</p><p><strong>Methods: </strong>In this review, we synthesize current evidence on the relationship between cSVD and glymphatic dysfunction, integrating findings from experimental models and in vivo human studies. We discuss shared pathophysiological mechanisms linking small vessel pathology to impaired perivascular fluid transport, summarize associations between glymphatic dysfunction and established cSVD imaging markers, and evaluate emerging therapeutic strategies aimed at restoring or enhancing glymphatic function. We highlight areas of convergence and inconsistency in the existing literature and identify key knowledge gaps that warrant further investigation. We also review potential therapeutic approaches, both behavioral and pharmacological to improve glymphatic function.</p><p><strong>Conclusion: </strong>Current evidence supports a close but incompletely understood bidirectional relationship between cSVD and glymphatic dysfunction. Targeting glymphatic function may represent a possible therapeutic strategy for cSVD and vascular cognitive impairment.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1260-1273"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591089","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":"Low-dose rivaroxaban plus antiplatelet therapy for symptomatic intracranial atherosclerotic stenosis: A prospective cohort study.","authors":"Ding Zhang, Zhaoyang Zhao, Yiwei Qian, Lulu Pei, Kai Liu, Yuan Cao, Wenzheng Rong, Haiman Hou, Yige Zhang, Wan Zhang, Ce Zong, Yifang Zhou, Jiaxin Wang, Chao Lan, Xinsheng Han, Duolao Wang, Yuesong Pan, MingMing Ning, Ferdinando S Buonanno, Xinyi Leng, Yuming Xu, Bo Song","doi":"10.1177/17474930261423387","DOIUrl":"10.1177/17474930261423387","url":null,"abstract":"<p><strong>Background: </strong>The antithrombotic strategies for symptomatic intracranial atherosclerotic stenosis (sICAS) remains challenging. Dual pathway inhibition (DPI) has demonstrated clinical benefit in coronary and peripheral artery disease.</p><p><strong>Aims: </strong>This study aimed to evaluate the efficacy of DPI with low-dose rivaroxaban plus antiplatelet therapy (APT) compared with APT alone on recurrent stroke with sICAS.</p><p><strong>Methods: </strong>This prospective cohort study included patients with sICAS identified from the Ischemic Cerebrovascular Disease Database of the First Affiliated Hospital of Zhengzhou University between January 2019 to August 2023. Low-dose rivaroxaban was prescribed off-label to patients in the DPI group. The outcomes were ischemic stroke, transient ischemic attack (TIA), acute coronary syndrome (ACS), all-cause death and cardio-cerebrovascular death within 1 year of discharge. Cox regression with inverse probability of treatment weighting (IPTW) was applied to compare outcomes between the DPI and APT groups. The win-ratio method was used to assess the major adverse cardiovascular events (MACE), prioritized in the order of all-cause death, recurrent ischemic stroke or TIA, and ACS.</p><p><strong>Results: </strong>Among the 1217 patients with sICAS, 131 (10.8%) received DPI therapy. The recurrence rate of ischemic stroke was lower in the DPI group compared to the APT group (8/131 [6.1%] vs 136/1086 [12.5%]). DPI significantly reduced the risk of ischemic stroke recurrence (HR = 0.46, 95% CI: 0.23-0.94, <i>p</i> = 0.034) and the incidence of MACE (HR = 0.53, 95% CI: 0.29-0.97, <i>p</i> = 0.041) during the 1-year follow-up, consistent with the IPTW-based cohort (HR = 0.35, 95% CI: 0.16-0.76, <i>p</i> = 0.008; HR = 0.43, 95% CI: 0.22-0.83, <i>p</i> = 0.012). The win-ratio analysis of MACE favored DPI therapy (win ratio = 2.34, 95% CI: 1.41-3.90, <i>p</i> = 0.001). Symptomatic intracranial hemorrhage, fatal bleeding, and hospitalization for gastrointestinal bleeding were infrequent in this cohort.</p><p><strong>Conclusions: </strong>DPI therapy may be associated with a lower risk of recurrent stroke compared with antiplatelet therapy alone in patients with sICAS. These findings warrant further investigation through large-scale randomized controlled trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1130-1139"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124893","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":"Chinese guidelines for diagnosis and treatment of intracranial atherosclerotic stenosis.","authors":"Xinyi Leng, Binbin Sui, Caiyan Liu, Tao Wang, Mingli Li, Xuan Tian, Yuying Liu, Bo Song, Qinjian Sun, Hebo Wang, Yi Yang, Thomas W Leung, Yuxiang Gu, Liping Liu, Liqun Jiao, Weihai Xu","doi":"10.1177/17474930261419812","DOIUrl":"10.1177/17474930261419812","url":null,"abstract":"<p><p>Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke and transient ischemic attack (TIA), which is also associated with increased risks of cognitive impairment and dementia. The prevalence of both asymptomatic and symptomatic ICAS (asICAS and sICAS) is significantly higher in Asian populations than in Western populations. In recent years, substantial new evidence has emerged regarding the epidemiology, diagnosis, assessment, prognosis, and treatment of asICAS and sICAS. The China ICAS Research Group has developed this guideline based on published research and relevant domestic and international guidelines or expert consensus, to further clarify the definition, epidemiology, and prognosis of ICAS and the profiles of high-risk ICAS patients and provide evidence-based recommendations on screening, diagnosis, assessment, and treatment strategies of asICAS and sICAS. For imaging exams, noninvasive and contrast-independent modalities are generally suitable for screening and assessment of ICAS in stroke-free individuals with multiple risk factors as well as for routine exams of stroke patients, while contrast-dependent or invasive imaging methods may be employed for further assessment or guiding treatment decision-making in sICAS patients. In addition, vessel wall imaging is valuable for distinguishing the etiology of intracranial stenosis, particularly in young stroke patients. Multiple imaging modalities or methods are available for the assessment of cerebral perfusion, hemodynamics, and collateral circulation that may meet different needs. Regarding interventions, lifestyle modifications (healthy diet, safe exercise, smoking cessation) are recommended for both asICAS and sICAS patients. For stroke-free individuals with asICAS, controlling vascular risk factor is the primary strategy, while routine aspirin or endovascular treatment for primary stroke prevention is not recommended. For sICAS patients, the cornerstone is intensive medical management, including short-term dual antiplatelet therapy in high-risk patients (such as those with severe luminal stenosis, minor stroke, or high-risk TIA) followed by lifelong monotherapy, aggressive lipid control (targeting low-density lipoprotein cholesterol < 1.8 mmol/L), blood pressure control (<140/90 mmHg), and glycemic control (targeting HbA1c < 7.0%), with structured follow-up to enhance treatment adherence. Endovascular treatment is not recommended for sICAS with mild to moderate luminal stenosis (<70%) but may be considered for carefully selected patients with severe (70-99%), medically refractory sICAS, particularly those with hypoperfusion, with a preference to delay the intervention for more than 21 days after stroke to enhance safety.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1182-1195"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018411","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":"Small vessel disease burden and response to induced hypertension therapy in small vessel occlusion stroke with early neurological deterioration.","authors":"Wookjin Yang, Keon Yeup Kim, Jeong Kyu Lee, Hyun Sun Oh, Jeong Yun Song, Bum Joon Kim, Dong-Wha Kang, Sun U Kwon, Jun Young Chang","doi":"10.1177/17474930261461834","DOIUrl":"10.1177/17474930261461834","url":null,"abstract":"<p><strong>Background: </strong>Induced hypertension therapy (iHT) is used to rescue early neurological deterioration (END) in small vessel occlusion (SVO) stroke. However, underlying perforator dysfunction reflected by small vessel disease (SVD) burden may attenuate its therapeutic effect.</p><p><strong>Aim: </strong>To investigate whether white matter hyperintensity (WMH) volume and total SVD score are associated with neurological response to iHT.</p><p><strong>Methods: </strong>Consecutive patients with acute SVO stroke who developed END and received iHT were identified from a prospective registry (January 2017-July 2025). Regional WMH volumes were quantified on magnetic resonance imaging fluid-attenuated inversion recovery images. Outcomes included early neurological improvement (ENI) following iHT and 3-month modified Rankin Scale (mRS). Associations were evaluated using binary and ordinal logistic regression.</p><p><strong>Results: </strong>Among 178 patients (median age, 68 years; 55.6% men), 93 (52.2%) achieved ENI. Higher WMH volumes were independently associated with a lower likelihood of ENI (odds ratio (OR) per twofold increase [95% confidence interval]: total, 0.57 [0.43-0.76]; periventricular, 0.57 [0.43-0.76]; deep, 0.68 [0.54-0.86]). Periventricular WMH volume was also associated with an unfavorable shift in 3-month mRS (common OR, 0.80 [0.65-0.99]). Increasing total SVD score was associated with worse 3-month mRS shift (common OR, 0.61 [0.43-0.85]) and a non-significant trend against ENI (OR, 0.70 [0.48-1.01]; <i>p</i> = 0.056).</p><p><strong>Conclusion: </strong>Greater SVD burden was associated with a poorer neurological response to iHT in SVO stroke with END. Imaging markers of SVD may help identify patients less likely to achieve neurological improvement following iHT, suggesting a need for alternative individualized rescue strategies.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1358-1367"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211280","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}