International Journal of Stroke最新文献

{"title":"Vascular dementia and vascular cognitive impairment-current treatments and future prospects.","authors":"Hugh S Markus","doi":"10.1177/17474930261492876","DOIUrl":"10.1177/17474930261492876","url":null,"abstract":"<p><p>Vascular cognitive impairment (VCI) and vascular dementia (VaD) represent a substantial and growing global health burden, yet remain under-recognized and comparatively under-researched. Two broad categories are post-stroke cognitive impairment, and VCI secondary to chronic cerebrovascular disease of which the most common cause is cerebral small vessel disease (SVD). In addition, cerebrovascular pathology frequently coexists with Alzheimer's disease (AD), increasing the probability that AD pathology will manifest as clinical dementia. Current management focuses primarily on prevention through modification of cardiovascular risk factors and lifestyle interventions. Intensive blood-pressure control has shown the strongest evidence, reducing future all-cause dementia while slowing progression of white-matter abnormalities. Multidomain lifestyle interventions incorporating exercise, diet, cognitive training, and vascular risk monitoring may also preserve cognition, although results across trials remain variable. In established VCI and VaD, treatment options are limited; cholinesterase inhibitors and memantine lack convincing evidence of benefit, and no pharmacological therapy has definitively demonstrated symptomatic improvement or delayed disease progression. Advances in understanding SVD and VCI pathophysiology are, however, identifying promising therapeutic targets. Emerging evidence highlights endothelial dysfunction, impaired cerebral autoregulation, increased blood-brain barrier permeability, inflammation, and glymphatic dysfunction as possible mechanisms underlying SVD. Current trials are evaluating treatment approaches based on this framework including cerebral vasodilators such as cilostazol, isosorbide mononitrate and phosphodiesterase-5 inhibitors, anti-inflammatory therapies, glucagon-like peptide-1 receptor agonists, remote ischemic conditioning, and strategies targeting glymphatic function. Improved mechanistic understanding, appropriately targeted interventions, and adequately powered long-term clinical trials are required to translate these emerging approaches into effective treatments for VCI and VaD.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"21 9","pages":"1200-1210"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220339","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":"Systematic review and meta-analysis on mortality and functional outcome in patients with large cerebellar infarctions treated with neurosurgery.","authors":"Myriam Perla Mazloum, Hilde Henon, Alberto Coccia, Julien Labreuche, Patrick Devos, Fabien Almairac, Jean Dellamonica, Barbara Casolla","doi":"10.1177/17474930251404763","DOIUrl":"10.1177/17474930251404763","url":null,"abstract":"<p><strong>Background: </strong>Management of large cerebellar infarctions with potential malignant evolution is highly heterogeneous across physicians, and recommendations rely on low-evidence studies.</p><p><strong>Aim: </strong>We aimed to perform a systematic review and meta-analysis on patients with large cerebellar infarction undergoing neurosurgery, to study mortality and functional outcome, according to neurosurgical technique.</p><p><strong>Summary of review: </strong>We searched on PubMed and Embase according to pre-defined selection criteria and we assessed their quality according to a predefined risk of bias scale. Our primary outcomes were mortality and functional outcome rates. Favorable outcome was defined as a modified Rankin scale of 0-2, a Glasgow Outcome Scale of 4-5, or a Barthel Index > 90%. Pooled rates were obtained using random effect model and heterogeneity was quantified using <i>I</i>² statistics. Among 27 included studies (including 1173 patients), we studied the 662 patients undergoing neurosurgery. All studies were retrospective and observational; there was no randomized clinical trial (RCT). The median selection bias score was 5 (IQR, 4-6). Mortality rate was estimated at 18% [95% CI, 13-24%], <i>I</i>² 58%. Among survivors, 64% achieved a favorable functional outcome [95% CI, 51-77%], <i>I</i>² 82%. Study design and heterogeneity in patients' characteristics limited a meaningful comparison of mortality and functional outcome according to neurosurgical techniques.</p><p><strong>Conclusion: </strong>High-quality evidence on neurosurgical treatment for large cerebellar infarctions remains limited. Our systematic review and meta-analysis, despite moderate risk of bias, suggest that neurosurgery may reduce mortality and improve functional outcomes. These findings support its potential benefit, but RCTs are needed to confirm effectiveness and evaluate best surgical technique.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1067-1084"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604086","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":"Global burden of cerebral small vessel disease determined from large MRI studies: A systematic review and meta-analysis.","authors":"Bonnie Yin Ka Lam, Yuan Cai, Huijing Zheng, Jize Wei, Rufus Akinyemi, Geert Jan Biessels, Hilde van den Brink, Christopher Chen, Marco Duering, Deborah Gustafson, Saima Hilal, Vincent Ming Ho Hui, Rajesh Kalaria, SangYun Kim, Maggie Li Man Lam, Frank-Erik de Leeuw, Ami Sin Man Li, Hugh S Markus, Anna Marseglia, John O'Brien, Leonardo Pantoni, Perminder S Sachdev, Eric E Smith, Joanna M Wardlaw, Adrian Wong, Ho Ko, Vincent Chung Tong Mok","doi":"10.1177/17474930261441916","DOIUrl":"10.1177/17474930261441916","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cerebral small vessel disease (SVD) is a major cause of ischemic stroke, intracerebral hemorrhage, and dementia. Despite its importance, there are few studies of its prevalence and how cerebral SVD varies across the world, different age ranges, sexes, and magnetic resonance imaging (MRI) parameters. SVD can be estimated using MRI neuroimaging markers, including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and perivascular spaces (PVS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This study aimed to document the global prevalence of SVD based on population-based or large community-based MRI studies and to determine how SVD prevalence varies by region, mean age, and sex. With SVD neuroimaging markers being the standard to assess SVD prevalence, we aimed to investigate how different MRI acquisition parameters may influence its prevalence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary of review: &lt;/strong&gt;In this systematic review and meta-analysis, articles were searched from the Ovid MEDLINE and EMBASE databases between 1 January 2000 and 31 March 2024, without language restrictions. Title and abstract screening, full-text review, and data extraction were performed by at least two independent reviewers. The prevalence of SVD, subject demographic information, and MRI acquisition parameters were extracted. The Risk of Bias for Non-randomized Studies tool was used. The protocol was registered on PROSPERO (CRD42022311133). Of 14,582 studies identified, 246 studies spanning 40 countries were included in the systematic review. In the meta-analysis, 85 studies (88 cohorts) from 17 regions (n = 1,562,765) were included. The quality of studies was high (mean score 7.67 out of 8, ranging between 5 and 8). The pooled prevalence of moderate-to-severe WMH was 18.9%, and the pooled mean of WMH volume was 4.4 mL. Pooled prevalences of lacunes, cerebral microbleeds (CMBs), and moderate-to-severe perivascular spaces (PVS) were 11.2%, 10.3%, and 22.6%, respectively. A lower lacune prevalence (7.3% vs 13.3%; adjusted OR (aOR) [95% confidence interval (CI)]: 0.45 [0.30-0.68]) but higher PVS prevalence (30.9% vs 19.6%; aOR [95% CI]: 12.15 [2.12-69.46]) was found in Europe compared with Asia. A higher mean age of the studies was associated with a higher prevalence of most SVD markers, except for PVS. There was an overall trend of more lacunes and CMBs in males. MRI field strength, sequence used, and slice thickness could potentially influence the reported SVD prevalence, especially for WMH volume and CMB count. There was high heterogeneity in the studies (&gt;95%) that was not resolved by performing analyses stratified by Global Burden of Disease (GBD) regions, age groups, study design, or MRI parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This systematic review and meta-analysis based on large MRI studies demonstrated that SVD is a common health problem affecting about one-fifth of the adult population. SVD prevalence differs in regions separated by","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1284-1298"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618745","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 impaired autoregulation in cerebral small vessel disease and vascular cognitive impairment.","authors":"Alastair John Stewart Webb, Kevin Cheuk Yin Wong, Osian Llwyd","doi":"10.1177/17474930261456372","DOIUrl":"10.1177/17474930261456372","url":null,"abstract":"<p><p>Cerebral autoregulation is the fundamental mechanism that regulates cerebral blood flow in the face of blood pressure variability. It is a dynamic process that depends on vascular smooth muscle cell contractile function, driven by myogenic, chemical, and autonomic mechanisms. Cerebral small vessel disease (cSVD) is associated with increased blood pressure variation due to systemic hemodynamic dysfunction, as well as dysfunction of the cerebral small vessels, characterized by endothelial dysfunction and vascular reactivity. As such, cerebral autoregulation may be impaired in cSVD, either as a manifestation of the disease or as a cause. This narrative review addresses current clinical evidence for involvement of autoregulatory dysfunction in cSVD. It discusses the mechanisms of autoregulation; how these overlap with vascular mechanisms involved in cSVD; methods of measurement of autoregulation in these patients; evidence for altered autoregulation in patients with either sporadic cSVD, previous stroke, or specific forms of cSVD; and effects of potential therapies for cSVD on autoregulation. This review thereby identifies the potential importance of autoregulation in cSVD, highlights current limitations in our understanding, and outlines future research avenues.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1235-1245"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005259","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 inflammation in cerebral small vessel disease and vascular cognitive impairment, and therapeutic implications.","authors":"Robin B Brown, Stuart M Allan, Hugh S Markus","doi":"10.1177/17474930261461366","DOIUrl":"10.1177/17474930261461366","url":null,"abstract":"<p><strong>Background: </strong>Increasing evidence suggests that inflammation occurs in cerebral small vessel disease (SVD). Inflammation has been hypothesized to play a role in disease pathogenesis and also in progression to vascular cognitive impairment and dementia (VCID), suggesting that targeting inflammation may offer a novel treatment option.</p><p><strong>Aims: </strong>In this review, we aimed to summarize the evidence that both systemic and central nervous system (CNS) inflammation occur in SVD and VCID, critically examine whether associations are causal, and review the evidence that anti-inflammatory interventions might represent possible treatments. We include coverage of sporadic SVD, cerebral amyloid angiopathy, and genetic small vessel diseases.</p><p><strong>Summary of review: </strong>CNS inflammation has been demonstrated in SVD both in post-mortem brains and <i>in vivo</i> using positron emission tomography with radioligands targeted against the translocator surface proteins in microglia, but robust evidence showing such changes are causally related to disease progression is lacking. Peripheral inflammation can be measured in the blood using targeted assays and, more recently, large-scale proteomic panels. Proteins involved in coagulation, endothelial cell activation, and immune cell adhesion have been associated with SVD, as well as specific cytokines, although not all findings have been replicated, and there are limited data examining whether individual proteins predict future disease progression. Genetic data can be used to inform whether such associations are likely to be causal and prioritize treatment targets. However, to date, few treatment trials have investigated whether drugs that target specific inflammatory pathways can reduce SVD progression and onset of VCID, and those that have been performed have used non-specific inhibitors such as minocycline and colchicine.</p><p><strong>Conclusions: </strong>Considerable data support the presence of both systemic and CNS inflammation in SVD and VCID. However, whether these associations are causal remains unclear, and more longitudinal and interventional studies are required. A better understanding of the molecular basis of inflammation and immune dysfunction in SVD also allows more precise therapeutic targeting.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1246-1259"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198900","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":"Validation and simplification of the MR PREDICTS @24H model for outcome prediction after endovascular thrombectomy for acute ischemic stroke.","authors":"Xi Li, Bob Roozenbeek, Theo van Walsum, Daniel Bos, H Bart van der Worp, Bart J Emmer, Charles Bl Majoie, Robert J van Oostenbrugge, Diederik Wj Dippel, Hester F Lingsma","doi":"10.1177/17474930261430342","DOIUrl":"10.1177/17474930261430342","url":null,"abstract":"<p><strong>Background: </strong>Outcome prediction after endovascular thrombectomy (EVT) for ischemic stroke is important for patient counseling and rehabilitation planning. MR PREDICTS @24H, a nine-predictor model, showed excellent performance in predicting functional outcome at 90 days of patients with acute ischemic stroke. With the expanding treatment indications, we validated the model for patients receiving EVT within 24 hours after stroke onset and simplified it for easier clinical implementation.</p><p><strong>Methods: </strong>We used individual patient data from the Dutch MR CLEAN Registry (2014-2018), a prospective observational cohort enrolling patients treated with EVT, and three randomized controlled trials MR CLEAN-MED, MR CLEAN-NOIV, and MR CLEAN-LATE (2018-2022). We included patients with an intracranial large-vessel occlusion in the anterior circulation treated with EVT within 24 hours of symptom onset or last seen well. We assessed the effect of predictors on functional outcome (modified Rankin Scale [mRS]) at 90 days with ordinal logistic regression. Predicted probabilities of functional independence (mRS 0-2) and survival (mRS 0-5) were derived from the model formula. We evaluated predictive performance with discrimination (C statistic) and calibration (intercept, slope). The model was simplified by excluding predictors based on the Akaike information criterion (AIC). We applied leave-one-study-out cross-validation to evaluate heterogeneity in model performance between the cohorts.</p><p><strong>Results: </strong>The validation cohort included 6154 patients: 4737 from the Registry and 1417 from the trials. External validation of the original model showed excellent discrimination in predicting functional independence (C statistic 0.91, 95% CI 0.90-0.92) and survival (C statistic 0.90, 95% CI 0.89-0.91). The simplified model, comprising four predictors-NIHSS at 24 hours after EVT, age, pre-stroke mRS, and symptomatic intracranial hemorrhage-performed comparably (functional independence C statistic 0.91, 95% CI 0.90-0.92; and survival 0.89, 95% CI 0.88-0.90). Cross-validation revealed heterogeneity between LATE and the other cohorts, with the model overestimating the probability of functional independence in LATE (observed 39.1% vs predicted 44.2%), whereas the observed and predicted probability of survival was similar (75.5% vs 75.7%).</p><p><strong>Conclusions: </strong>A simplified version of MR PREDICTS @24H including only four predictors performed as good as the full model, providing a practical tool that can be applied one day after EVT for reliable outcome estimation. Further validation and updating of the model are needed for patients treated in the late time window (6-24 h).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1119-1129"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276349","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":"Incidence and outcome of pediatric moyamoya disease in the Republic of Korea: A nationwide study.","authors":"Sangwan Kim, Jong Seok Lee, Ji Hoon Phi, Ji Yeoun Lee, Joo Whan Kim, Jung Su Park, Jeong Pil Choi, Joongyub Lee, Seung-Ki Kim","doi":"10.1177/17474930251393573","DOIUrl":"10.1177/17474930251393573","url":null,"abstract":"<p><strong>Background: </strong>Moyamoya disease (MMD) is a rare cerebrovascular disorder for which nationwide epidemiological data on the pediatric population are limited. In Korea, the majority of published epidemiologic data on MMD entailed brief study periods and were published many years ago. Moreover, the majority of prior epidemiological studies on MMD have not examined the clinical outcomes associated with cerebral revascularization.</p><p><strong>Aims: </strong>To provide a comprehensive analysis of the recent epidemiological trends and cerebrovascular outcomes associated with pediatric moyamoya disease in the Republic of Korea.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the Korean National Health Insurance Database, analyzing 4323 pediatric patients diagnosed with MMD between 2006 and 2021. Prevalence and incidence were assessed in all 4323 patients, and cerebrovascular outcomes were analyzed in 3656 of these patients. Patients were categorized into surgical and non-surgical groups, with surgical techniques including indirect bypass (IB), direct bypass (DB), and combined bypass (CB). To evaluate year-to-year variations, linear regression analyses were performed to identify and quantify temporal trends for all measured outcomes.</p><p><strong>Results: </strong>The mean observation period for the subjects was 10.3 years, with 12.1 years for the non-surgical group and 9.7 years for the surgical group. The prevalence of pediatric MMD increased from 9.3 to 24.8 per 100,000 between 2006 and 2021. Concurrently, the incidence rate has remained stable at approximately 2.0 per 100,000 since 2010. The surgical rate among prevalent cases has exhibited a gradual increase and has remained at approximately 88% since 2018. Furthermore, the case event rate for stroke has exhibited a downward trend over time, and a statistically significant reduction in hemorrhagic stroke was observed.</p><p><strong>Conclusions: </strong>In Korea, the prevalence rate of MMD continues to rise, while the incidence rate remains stable despite a reduction in absolute case numbers, reflecting demographic shifts and improved survival. The mortality rate among pediatric MMD patients remained unchanged; however, the incidence of hemorrhagic stroke was found to have decreased. Further multi-institution-based cohort studies are needed to clarify long-term cerebrovascular outcomes in this population.Data access statement:Researchers can access the NHIS database by submitting a request to the National Health Insurance Service Big Data Platforms (http://nhiss.nhis.or.kr).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1170-1181"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367889","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":"Abstracts from the 18th World Stroke Congress, 21-23 October 2026, Seoul, Korea.","authors":"","doi":"10.1177/17474930261484004","DOIUrl":"https://doi.org/10.1177/17474930261484004","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"21 2_suppl","pages":"3-412"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227838","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 vascular contribution to dementia: World Stroke Organization scientific statement.","authors":"Geert Jan Biessels, Stephanie Debette, Fanny M Elahi, Fatemeh Geranmayeh, Gurpreet K Hansra, Timothy M Hughes, Masafumi Ihara, Jeremy D Isaacs, Hanna Jokinen, Alexi Nott, Sarah T Pendlebury, Ruth Peters, Julie A Schneider, Colin Smith, Eric E Smith, Prashanthi Vemuri, Joanna M Wardlaw, Alastair Js Webb, Donna M Wilcock, Atticus H Hainsworth","doi":"10.1177/17474930261470506","DOIUrl":"10.1177/17474930261470506","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease (AD) and cerebrovascular pathology are the two most common causes of dementia, frequently co-occurring in older people. Community-based neuropathology studies indicate that vascular disease accounts for approximately one-third of the population-attributable risk of dementia, controlling for other pathologies (including AD). The proportion with vascular disease as co-pathology is likely to be higher (50-70%). The most common vascular substrate is cerebral small vessel disease, which includes small artery fibrosis (arteriolosclerosis), vascular amyloid deposits (cerebral amyloid angiopathy), and monogenic forms of small vessel disease, the commonest being Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Post-stroke cognitive impairment following both ischemic stroke and intracerebral hemorrhage also contributes.</p><p><strong>Aims and methods: </strong>In this World Stroke Organization (WSO) scientific statement, we assembled a multi-disciplinary international group of experts to review the vascular contribution to dementia, encompassing both vascular and neurodegenerative dementia. This statement has been reviewed and approved by the WSO executive.</p><p><strong>Results: </strong>We summarize the epidemiology, neuropathology, cognitive profile, clinical impact and management of vascular disease in dementia and discuss the recent VasCog-2-WSO diagnostic criteria. We consider the substantial overlap with clinical stroke and with AD dementia. We catalog transcriptomic and proteomic studies that have revealed novel candidate molecules (<i>COL4A1/4A2, HTRA1, TRIM47, FOXF2</i>) as possible treatment targets. We appraise imaging-based biomarkers relevant to vascular disease and potential biochemical markers (vascular endothelial growth factor-A, placental growth factor, interleukin-6, matrix metalloproteinase-9, cathepsin-B). We highlight the potential for vascular interventions to treat not only vascular dementia but also the vascular component of neurodegenerative dementia. We review recent clinical trials targeting multiple pathways, including nitric oxide signaling, high blood pressure, the GABAergic system, angiogenic activity, microglial inhibition, PDE3 and PDE5 inhibition, as well as dietary supplementation with omega-3 fatty acids, s-equol and vitamin E. Finally, we consider upcoming opportunities and challenges relevant to vascular disease in dementia.</p><p><strong>Conclusion: </strong>The vascular contribution to dementia is i) substantial, ii) increasingly understood at molecular and mechanistic levels, iii) a source of potential treatment opportunities.Data Access Statement:no original data are presented in this document.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1211-1234"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446744","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":"Rates and determinants of incident lacunes: A systematic review and meta-analysis.","authors":"Fei Han, Ding-Ding Zhang, Joanna M Wardlaw","doi":"10.1177/17474930261421046","DOIUrl":"10.1177/17474930261421046","url":null,"abstract":"<p><strong>Background: </strong>Lacunes of presumed vascular origin are a key imaging marker of cerebral small-vessel disease (cSVD), predicting stroke and dementia risk. Their incidence and determinants have not been systematically quantified across different populations, and implications for clinical research remain unclear.</p><p><strong>Aims: </strong>This study aims to estimate the annualized incidence of new lacunes across diverse populations, identify study-level factors contributing to heterogeneity, summarize patient-level risk factors for incident lacunes, and provide empirical data to inform sample size estimation for studies using incident lacunes as an imaging outcome.</p><p><strong>Summary of review: </strong>Thirty-one studies comprising 12,646 participants and 56,073 person-years were included. The pooled overall incidence was 3.27 per 100 person-years (95% CI, 2.12-4.42), ranging from 1.50 to 8.03 across populations. Rates were highest in cSVD patients (8.03; 95% CI, 3.8-12.27), intermediate in stroke and memory-clinic patients, and lower in community-based, hypertensive, and non-specific artery disease cohorts. Meta-regression showed that baseline lacune prevalence was positively associated with incidence (β = 0.057; 95% CI, 0.006-0.108; <i>P</i> = 0.031). At the individual level, male sex, baseline lacunes, hypertension, and diabetes were associated with higher risk. In cSVD populations, detecting a 30% relative risk reduction required 563, 867, and 1782 participants per arm for 3-, 2-, and 1-year follow-up, respectively.</p><p><strong>Conclusion: </strong>Incident lacune rates vary substantially across populations and are strongly influenced by baseline lacune burden and vascular risk factors. These findings provide context for population selection and sample size considerations in studies using incident lacunes as an imaging outcome.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1299-1310"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179625","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}