International Journal of Stroke最新文献

{"title":"Increased risk of cerebrovascular events in pseudoxanthoma elasticum.","authors":"Melanie Haverkamp, Ynte M Ruigrok, Pim A de Jong, Ilonca Vaartjes, Frank Lj Visseren, Mervyn DI Vergouwen, Wilko Spiering","doi":"10.1177/17474930261495889","DOIUrl":"10.1177/17474930261495889","url":null,"abstract":"<p><strong>Background: </strong>Pseudoxanthoma elasticum (PXE) is a rare, hereditary disease characterized by ectopic calcifications in the skin, eyes, and arteries. It is caused by pathogenic variants in the <i>ABCC6</i> gene, leading to lower plasma levels of inorganic pyrophosphate (PPi), a natural inhibitor of ectopic calcification. Patients with PXE often have cerebrovascular events, but the incidence and subtypes of these events have yet to be elucidated.</p><p><strong>Aim: </strong>This study aims to compare the incidence of cerebrovascular events in PXE with that in the general population and to assess the underlying subtypes of symptomatic ischemic cerebrovascular events in adult patients with PXE.</p><p><strong>Methods: </strong>Adult patients with a definitive or probable PXE diagnosis were included from the Dutch Expertise Center for PXE. All ischemic cerebrovascular events were systematically classified by two independent vascular neurologists according to the Trial of Org 10172 in Acute Cerebrovascular Event Treatment (TOAST) criteria. The incidence rate of cerebrovascular events in the PXE cohort was compared by calculating age- and sex-standardized incidence rates using data from Statistics Netherlands. Patient characteristics stratified by subtype according to the TOAST criteria were presented, and differences in patient characteristics were described.</p><p><strong>Results: </strong>In total, 381 patients with PXE (mean age 50 ± 14 years, 59% women) were included. During a median follow-up of 8.1 years (interquartile range = 5.3-11.0), 47 incident cerebrovascular events occurred in 34 patients. Of all events, 45 were of ischemic origin, and 2 were intracerebral hemorrhages. Patients with PXE were more likely to develop a cerebrovascular event, compared with the general Dutch population (standardized incidence ratio = 4.8, 95% confidence interval = 3.3-6.7). The most common subtype of ischemic strokes was small vessel disease (SVD) (10/29, 34%), followed by cardioembolic stroke (5/29, 17%) and large artery atherosclerosis (3/29, 10%).</p><p><strong>Conclusion: </strong>Patients with PXE have a 4.8-fold higher risk of cerebrovascular events compared with the general population. Various ischemic cerebrovascular event subtypes occur in patients with PXE, with SVD being the most common subtype.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261495889"},"PeriodicalIF":6.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069648","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":"Cardiovascular risk management through a community-based digital health stroke education platform (Love Your Brain): a multi-arm randomized controlled trial.","authors":"Monique F Kilkenny, Catherine Burns, Rosanne Freak-Poli, Tara Purvis, Muideen T Olaiya, Lachlan Lee Dalli, Dominique Cadilhac, Amanda G Thrift, Mark R Nelson, Janet E Bray, Jan Cameron, Timothy Kleinig, Lisa Murphy, Christine Farmer, Belinda Bullas, Eleanor Horton, Brenda Booth, Stephanie Ho, Seana Gall","doi":"10.1177/17474930261494297","DOIUrl":"https://doi.org/10.1177/17474930261494297","url":null,"abstract":"<p><strong>Background: </strong>Stroke affects one in four people globally, highlighting the need for novel approaches to primary prevention. The Love Your Brain digital platform comprises an online course and text messages to improve stroke knowledge and motivate behavior change for stroke prevention.</p><p><strong>Aims: </strong>To evaluate the efficacy of the platform over 12 weeks in increasing medical practitioner visits for cardiovascular risk assessment/management.</p><p><strong>Methods: </strong>We conducted a single-blinded, multi-arm randomized controlled trial. Eligible participants were community-dwelling Australians aged ≥45 years with no history of cardiovascular events. Participants were randomized (1:1:1) to interventions (either online course or text messages) or control, stratified by age and gender. The primary outcome was a change from baseline to 12 weeks in self-reported medical practitioner visits for cardiovascular risk assessment/management. Secondary outcomes were knowledge of stroke, uptake of risk-modifying behaviors, and medication adherence. Log-binomial/generalized linear model regression was used, adjusting for stratification variables. Analysis was based on intention-to-treat.</p><p><strong>Results: </strong>941 participants (median age 67 years; 82·4% women) were randomized between 18 Feb 2025 and 17 Sep 2025 to control (n=311), online course (n=318) or text messages (n=312). At 12 weeks, 82.6% completed follow-up. Self-reported visits to a medical practitioner at 12 weeks exceeded those of the control (29·0%) in the text message arm (41·3%; RR: 1·43, 95% CI: 1·14-1·80, p=0·002), but not the online course arm (31·2%; RR: 1·08, 95% CI: 0·83-1·40). Stroke knowledge increased in both intervention arms (Online: Coeff: 1·13, 95%CI: 0·75-1·50; Text message: Coeff: 0·58, 95%CI: 0·19-0·96) compared to the control. No differences were observed for other outcomes.</p><p><strong>Conclusions: </strong>The text message intervention increased medical practitioner visits for cardiovascular risk assessment/management among community-dwelling adults without prior cardiovascular events. The online course was ineffectual, potentially due to low completion. The text message intervention warrants scale-up to support primary stroke prevention.</p><p><strong>Registration: </strong>ACTRN12625000124437.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261494297"},"PeriodicalIF":6.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A roadmap for somatosensory rehabilitation and research after stroke: Consensus-based core recommendations from the fourth Stroke Recovery and Rehabilitation Roundtable.","authors":"Ali M Aries, Leeanne M Carey, Ingvars Birznieks, Christina Brogårdh, Liana S Cahill, Leonid Churilov, Louise Connell, Sean P Dukelow, Urvashy Gopaul, Susan Hillier, Susan M Hunter, Gakeemah Inglis-Jassiem, Valerie M Pomeroy, John Rothwell, Kanta Sandhu, Isuru Senadheera, Mary Ellen Stoykov, Jun-Ichi Uemura, Geert Verheyden, Tadeusz Wieloch, Sarah Zandvliet","doi":"10.1177/17474930261494430","DOIUrl":"10.1177/17474930261494430","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke somatosensory impairments, including deficits in touch and proprioception, are common. They alter body perception and can be a hidden cause of motor disability. They are often underrecognized in clinical care, highlighting the need for consensus recommendations.</p><p><strong>Aim: </strong>The Somatosensory Roundtable aimed to provide:A. A framework for understanding somatosensationB. Expert-informed consensus recommendations for somatosensory interventions that have potential for use in clinical practice with stroke survivorsC. Consensus recommendations for research priorities to advance clinical practice and accelerate targeted research in somatosensory recovery and rehabilitation post-stroke.</p><p><strong>Methods: </strong>An international group of clinical, research, pre-clinical and lived experience experts was established. A systematic search of the literature and opinions of Somatosensory Roundtable members, clinicians, and people with lived experience of stroke, were used to generate lists of somatosensory interventions and research priorities for ranking in separate consensus ranking surveys. A structured consensus and voting process was adopted, with consensus ranks established through independent, individual ranking by Somatosensory Roundtable members.</p><p><strong>Results: </strong>An agreed definition and framework for understanding somatosensation was developed. Somatosensory discrimination training was ranked highest for perceived effectiveness and feasibility, with plantar tactile/proprioceptive stimulation and hands-on mechanoreceptor stimulation ranked second and third. Research priority consensus ranks were: 1) effectiveness of somatosensory interventions (highest); 2) standardized measures of impairment and impact; 3) somatosensation and recovery; 4) lived experience of sensory impairment and rehabilitation; 5) individualized therapy development; 6) knowledge translation; and 7) biomarkers.</p><p><strong>Conclusions: </strong>A framework for understanding somatosensation, and consensus-based recommendations for somatosensory interventions and for research priorities are provided to advance the science and practice of evidence-based rehabilitation of somatosensation after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261494430"},"PeriodicalIF":6.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024863","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":"STRIVE-2 MRI-defined brain frailty and functional outcomes after thrombectomy: A multicenter study.","authors":"Thiago O Goulart, Markus D Schirmer, Yuan Ma, Anna K Bonkhoff, Erik Lindgren, Penina Krieger, Ben Teasdale, Alvin S Das, Adam A Dmytriw, James D Rabinov, Christopher J Stapleton, Aman B Patel, Vincent M Tutino, Michael I Nahhas, Sunil A Sheth, Claus Z Simonsen, Natalia S Rost, Robert W Regenhardt","doi":"10.1177/17474930261490798","DOIUrl":"10.1177/17474930261490798","url":null,"abstract":"<p><strong>Background and objectives: </strong>Mechanical thrombectomy (MT) is the standard of care for large vessel occlusion (LVO) stroke, yet nearly half of patients fail to achieve functional independence. Cerebral small vessel disease (CSVD) represents a marker of brain frailty that may impair recovery. We aimed to evaluate whether comprehensive magnetic resonance imaging (MRI)-defined CSVD markers before MT predict 90-day functional outcomes and hemorrhagic transformation.</p><p><strong>Methods: </strong>This retrospective, multicenter cohort study analyzed consecutive patients with anterior circulation LVO treated with MT (2015-2022) at two tertiary centers. CSVD markers (white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), enlarged perivascular spaces (EPVS), and brain atrophy) were assessed on pre-treatment MRI according to STRIVE-2 criteria. The primary outcome was functional dependence or death at 90 days (modified Rankin Scale (mRS) score 3-6). Bayesian logistic regression models estimated adjusted odds ratios (aORs) and 95% credible intervals (CrI), adjusting for age, sex, thrombolysis, infarct volume, time-to-puncture, and reperfusion status. A composite CSVD score including all five markers was also evaluated.</p><p><strong>Results: </strong>Among 479 patients (median age 72 years (interquartile range = 59-80); 46% female), successful reperfusion (modified thrombolysis in cerebral infarction 2b-3) was achieved in 83% and 47% had 90-day mRS 3-6. Functional dependence was independently associated with the presence of lacunes (aOR = 2.07; 95% CrI = 1.22-3.59; posterior probability (PP) > 99%), moderate-to-severe brain atrophy (aOR 1.92; 95% CrI = 1.09-3.40; PP 99%), and moderate-to-severe WMH (aOR = 1.63; 95% CrI = 0.94-2.84; PP = 96%). Furthermore, every 1-point increase in the five-item composite CSVD score demonstrated a dose-dependent increase in the odds of functional dependence (aOR = 1.44; 95% CrI = 1.23-1.69; PP > 99%) and symptomatic intracerebral hemorrhage (aOR = 1.33; 95% CrI = 0.92-1.93; PP = 94%).</p><p><strong>Discussion: </strong>Pre-existing lacunes, atrophy, and WMH are independent determinants of worse functional recovery after MT. Importantly, cumulative total CSVD burden acts as a strong, dose-dependent predictor of functional outcomes and symptomatic hemorrhage. While these findings support that CSVD assessment improves post-thrombectomy prognostication, they do not support CSVD be used as a criterion to preclude patients from MT eligibility.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261490798"},"PeriodicalIF":6.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956035","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":"Adherence to anticoagulants in people with stroke and atrial fibrillation: Implementation of standardized analytic methods in Australia and Canada.","authors":"Lachlan L Dalli, Monique F Kilkenny, Anna Chu, Jenni Ilomaki, Cynthia A Jackevicius, Moira K Kapral, Manav V Vyas, Dominique A Cadilhac, Adam C Livori, Seana L Gall, Amy Yx Yu","doi":"10.1177/17474930261489902","DOIUrl":"10.1177/17474930261489902","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke medication adherence can be assessed using dispensing data; however, variations in methods hinder reliable comparisons across regions.</p><p><strong>Aim: </strong>To develop and implement standardized methods to compare medication adherence to direct oral anticoagulant post-stroke between countries.</p><p><strong>Methods: </strong>An observational study was conducted across two countries participating in the International Network for Standardised Population Insights and Real-world Evidence for STROKE. Australia and Canada, with population-based linked administrative data, provided the case example. Metadata structures were shared to harmonize variables and response options in linked administrative data. Patients admitted with incident ischemic stroke and atrial fibrillation (Victoria, Australia (July 2014-June 2017); Ontario, Canada (July 2014-March 2022)), aged ⩾65 years, who survived ⩾90 days post-discharge were included. The proportion of days covered of direct oral anticoagulants was measured from initiation to 1-year post-discharge. Adherence was measured using a standardized code from the TEN-SPIDERS pharmacoepidemiology framework. Seven simulations were undertaken adjusting for different proportion of days covered measurement parameters (e.g. in-hospital stays, pre-supply, survival, and early refills and switching). Aggregated outputs were compared between countries.</p><p><strong>Results: </strong>Among 2471 Australians (50% female; 36% aged 85+ years) and 16,622 Canadians (51% female; 34% aged 85+ years), 50% and 65% were dispensed a direct oral anticoagulant within 90 days post-stroke, respectively. Among initiators, median 1-year direct oral anticoagulant proportion of days covered was 86.8% (interquartile range: 75.9-92.6%) in Australia versus 96.2% (interquartile range: 89.6-98.6%) in Canada. Simulations adjusting for pre-supply, early refills, and switching increased median proportion of days covered by +10.3% in Australia and +3.5% in Canada. Further adjustment for in-hospital stays had negligible impacts on proportion of days covered.</p><p><strong>Conclusion: </strong>Implementation of standardized methods across two countries revealed high levels of adherence to direct oral anticoagulants in patients with ischemic stroke and atrial fibrillation. Scale-up of these methods to other countries and medications is warranted to reliably measure and compare trends in post-stroke medication adherence.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261489902"},"PeriodicalIF":6.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919777","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":"Remote ischemic conditioning in the acute treatment of ischemic and hemorrhagic stroke: A systematic review and meta-analysis of randomized controlled trials.","authors":"Kaden Lam, Bogna Anna Drozdowska, Ryan Rosentreter, William Betzner, Jianhai Zhang, Mahesh Kate, Carlos Camara-Lemarroy, Zahinoor Ismail, Eric E Smith, Aravind Ganesh","doi":"10.1177/17474930261487798","DOIUrl":"10.1177/17474930261487798","url":null,"abstract":"<p><strong>Background: </strong>Remote ischemic conditioning, a low-cost, non-invasive therapy involving brief cycles of limb ischemia and reperfusion, may be a neuroprotective adjuvant or alternative to reperfusion therapies in acute ischemic stroke and may also have therapeutic effects in hemorrhagic stroke. This systematic review and meta-analysis evaluated the efficacy of remote ischemic conditioning in acute ischemic stroke and hemorrhagic stroke.</p><p><strong>Methods: </strong>This review was conducted in accordance with Preferred Reporting for Systematic review and Meta-Analyses guidelines and was registered in PROSPERO (CRD42024549594). Literature searches were conducted on MEDLINE, Embase, and Web of Science from inception to 9 December 2025. Randomized controlled trials involving adults with acute ischemic stroke or hemorrhagic stroke were included in the study. We focused on functional outcomes; secondary measures included cerebral hemodynamics and neuroimaging. Outcomes were analyzed using the DerSimonian-Laird model, while study heterogeneity was evaluated using Cochran's Q.</p><p><strong>Results: </strong>Overall, 35 studies (6304 patients) were included. Functional outcomes were significantly better in acute ischemic stroke patients who received remote ischemic conditioning versus those who did not, as indicated by lower Modified Rankin Scale scores (standardized mean difference = -0.18, 95% confidence interval: -0.35 to -0.01, n = 11 studies) and higher odds for favorable (odds ratio = 1.28, 95% confidence interval: 1.05 to 1.57, n = 17 studies) and excellent (odds ratio = 1.27, 95% confidence interval: 1.06 to 1.51, n = 12 studies) outcomes; furthermore, post-treatment stroke severity (indicated by National Institutes of Health Stroke Scale scores) was also lower in acute ischemic stroke patients receiving remote ischemic conditioning (standardized mean difference = -0.64, 95% confidence interval: -0.96 to -0.31, n = 16 studies). The Modified Rankin Scale scores and outcomes were better when remote ischemic conditioning was initiated beyond 24 h, and the protocol involved bilateral application and/or use beyond 7 days. Favorable Modified Rankin Scale outcomes were only better in patients receiving remote ischemic conditioning without reperfusion.</p><p><strong>Conclusion: </strong>Remote ischemic conditioning appears to improve functional and neurological outcomes in acute ischemic stroke patients. However, the quality of evidence is limited by regional generalizability (i.e. most studies came from China), small sample sizes, and methodological heterogeneity. We encourage future trials to include patients presenting beyond 4.5 h and to incorporate bilateral remote ischemic conditioning application and to extend remote ischemic conditioning use beyond 7 days. We also encourage studies to focus on patients who are not eligible for reperfusion therapy.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261487798"},"PeriodicalIF":6.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872880","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":"Clinical outcomes among patients with active cancer and acute ischemic stroke treated with antiplatelet versus anticoagulant therapy.","authors":"Gianluca Costamagna, Andreas F Hottinger, Francoise Livio, Babak B Navi, Davide Strambo, Patrik Michel","doi":"10.1177/17474930261487275","DOIUrl":"10.1177/17474930261487275","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with acute ischemic stroke and active cancer face high risks of recurrent stroke and death. Evidence guiding antithrombotic selection remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To investigate post-acute ischemic stroke prescribing patterns of antiplatelet versus anticoagulant therapy in acute ischemic stroke patients with active cancer and their associated clinical characteristics and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively analyzed 2003-2024 data from the Acute Stroke Registry and Analysis of Lausanne. We included patients with active cancer discharged after index acute ischemic stroke on antiplatelet therapy (single or dual) or anticoagulation (±antiplatelet therapy). We excluded patients with no or inactive cancer, missing data on discharge antithrombotics, cancer diagnosed after hospitalization, and those who died or entered palliative care before treatment decisions. The primary outcome was a recurrent ischemic cerebrovascular event within 12 months. Secondary outcomes included 3-month ischemic cerebrovascular recurrence, modified Rankin Scale shift, and all-cause mortality. The safety outcome was symptomatic intracranial hemorrhage at 3 and 12 months. We used multivariable regression models adjusted for prognostic variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 8035 patients with acute ischemic stroke, 313 had active cancer and met eligibility criteria. Median age was 73 years (interquartile range = 63-79), and 111 (35%) were women. At discharge, 178 (57%) received antiplatelet therapy and 135 (43%) anticoagulation. Patients previously naïve to antithrombotic therapy (&lt;i&gt;n&lt;/i&gt; = 150) more often received antiplatelet therapy (68% vs 32%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). At 12 months, ischemic cerebrovascular recurrence occurred in 28/160 (18%) patients in the antiplatelet group and 33/118 (28%) in the anticoagulation group (subdistribution hazard ratio = 0.59, 95% confidence interval = 0.33-1.04). At 3 months, the antiplatelet group had lower risks of ischemic cerebrovascular recurrence (subdistribution hazard ratio = 0.45, 95% confidence interval = 0.25-0.82) and all-cause mortality (adjusted hazard ratio = 0.61, 95% confidence interval = 0.41-0.90). Mortality at 12 months (adjusted hazard ratio = 1.16, 95% confidence interval = 0.62-2.16) and modified Rankin Scale shift at 3 months (adjusted odds ratio = 0.79, 95% confidence interval = 0.49-1.26) and 12 months (adjusted odds ratio = 0.81, 95% confidence interval = 0.48-1.37) were similar between groups. No intracranial hemorrhages were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In a registry spanning two decades, most patients with active cancer were discharged on antiplatelet therapy after acute ischemic stroke. Antiplatelet and anticoagulant groups showed similar long-term risks of ischemic cerebrovascular recurrence. Antiplatelet therapy was associated with reduced medium-term ischemic cerebrovascular recurrences and mortality, altho","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261487275"},"PeriodicalIF":6.9,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864690","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":"MRI-derived oxygen extraction fraction is associated with cognitive impairment in cerebral small vessel disease.","authors":"Chaofan Sui, Meng Li, Qihao Zhang, Jing Li, Mengmeng Feng, Haotian Xin, Yian Gao, Nan Zhang, Yena Che, Changhu Liang, Lingfei Guo, Yi Wang","doi":"10.1177/17474930261485653","DOIUrl":"https://doi.org/10.1177/17474930261485653","url":null,"abstract":"<p><strong>Background: </strong>Conventional MRI markers of cerebral small vessel disease (CSVD) capture accumulated structural injury but may not fully reflect ongoing physiological dysfunction associated with cognitive impairment.</p><p><strong>Aims: </strong>We investigated whether MRI-derived oxygen extraction fraction (OEF), a non-invasive marker of cerebral oxygen extraction, is associated with cognitive impairment in CSVD beyond conventional structural MRI burden.</p><p><strong>Methods: </strong>In this hospital-based observational study, 448 adults with CSVD underwent 3T multiecho gradient-echo MRI for whole-brain OEF mapping using a quantitative susceptibility mapping/quantitative blood oxygen level-dependent framework. Participants were classified as having mild cognitive impairment (MCI) or no MCI by a blinded clinical consensus panel. Whole-brain voxelwise analyses compared OEF between groups and examined associations with the composite cognitive score, Fazekas score, and total CSVD score; post hoc ROI-based analyses examined associations with conventional CSVD burden markers and a composite cognitive score. In an exploratory longitudinal subset of 82 participants, we assessed whether baseline OEF or within-subject OEF change was associated with cognitive change.</p><p><strong>Results: </strong>Participants with CSVD-MCI showed higher OEF in distributed cortical-subcortical regions than cognitively preserved participants after adjustment for demographic, vascular, and conventional CSVD burden variables. The largest cross-sectional cluster showed higher OEF in the CSVD-MCI group than in the CSVD-no-MCI group (0.342±0.045 vs. 0.294±0.027). Complementary whole-brain analyses and post hoc analyses of the largest group-difference cluster showed that higher OEF was associated with lower composite cognitive scores after covariate adjustment, whereas no associations with Fazekas score or total CSVD score were identified. In the longitudinal subset, baseline OEF was not associated with follow-up composite cognitive score or cognitive change, whereas greater within-subject OEF increase was associated with greater cognitive decline (standardised β=-0.229, p=0.030).</p><p><strong>Conclusions: </strong>MRI-derived OEF was associated with cognitive impairment in CSVD independently of conventional structural MRI burden. These findings suggest that OEF may provide complementary physiological information for characterising cognitive vulnerability in CSVD. Larger multicentre longitudinal studies incorporating quantitative perfusion imaging and validated amyloid and tau biomarkers are warranted.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261485653"},"PeriodicalIF":6.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850702","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 future of high-dose, high-intensity neurorehabilitation: Consensus-based core recommendations from the fourth Stroke Recovery and Rehabilitation Roundtable.","authors":"Meret Branscheidt, Wala J Mahmoud, Christoph Bauer, Juan C Cortés, R James Cotton, Steven C Cramer, Sebastian Gallegos-Berrios, Gert Kwakkel, Olivier Lambercy, Kate Laver, Alessandro Picelli, Nancy M Salbach, John M Solomon, Robert Teasell, Tamaya Van Criekinge, Vivian Weerdesteyn, John W Krakauer","doi":"10.1177/17474930261483951","DOIUrl":"10.1177/17474930261483951","url":null,"abstract":"<p><strong>Objective: </strong>Convergent evidence indicates that high-dose, high-intensity rehabilitation (HDHI) improves outcomes beyond usual care after stroke, yet implementation remains limited. While questions of optimal dose, timing, and delivery format continue to be refined, the biological plausibility and clinical rationale for HDHI are well established. The fourth Stroke Recovery and Rehabilitation Roundtable convened to identify principal barriers to wider HDHI uptake and derive actionable solutions.</p><p><strong>Methods: </strong>Sixteen international experts from nine countries used a structured consensus process, including surveys, barrier ranking, targeted evidence reviews, and a 2-day in-person meeting.</p><p><strong>Results: </strong>Four interrelated barriers were identified: (1) a conceptual knowledge gap persists regarding HDHI's targets, mechanisms, and effects; (2) scale and delivery constraints prevent the required dose from being delivered by current conventional care models, making home- and community-based hybrid pathways essential; (3) resistance to change despite the evidence because it places strain on clinicians given their time constraints, inflexible remuneration, and low levels of administrative support; and (4) insufficient system-level enablers to provide longitudinal continuity, patient coordination, and readily accessible technology.</p><p><strong>Recommendations: </strong>The primary limitation to HDHI is implementation capacity, not biological plausibility, or lack of evidence. Implementation research should now proceed in parallel with ongoing efficacy refinement. Priorities include building mechanistic and evidentiary literacy, clarifying professional roles, enabling home-based delivery, aligning reimbursement with long-term economic evaluation, and developing the infrastructure and protocols for scalable longitudinal care.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261483951"},"PeriodicalIF":6.9,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793119","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":"Telestroke care in resource-limited settings: A World Stroke Organization scientific statement.","authors":"Christine Tunkl, Leonardo Augusto Carbonera, Gordian Hubert, Ayush Agarwal, Amelia K Adcock, Bernardo Liberato, Laetitia Yperzeele, Tamer Roushdy, Epifania Maria Collantes, Dulce Maria Bonifacio Delgadillo, Christopher Bladin, Anna Ranta","doi":"10.1177/17474930261480603","DOIUrl":"10.1177/17474930261480603","url":null,"abstract":"<p><strong>Background: </strong>Telestroke services represent a crucial strategy for expanding access to acute stroke care in regions with limited local stroke expertise. However, existing recommendations and guidelines are predominantly derived from evidence generated in high-income countries and based on generally resource-intensive models. Such models and evidence may not be directly transferable to resource-limited settings. This Scientific Statement aims to summarize current knowledge on telestroke in resource-limited settings, highlight key considerations for establishing networks, and provide practical recommendations to guide future implementation and research.</p><p><strong>Methods: </strong>Evidence from a systematic literature review of telestroke networks in resource-limited settings was integrated with results of a structured survey and consensus-building process involving the World Stroke Organization (WSO) Telestroke Committee, who also served as the writing panel. Key domains relevant to the organization, setup, and quality assurance of telestroke services were identified and synthesized into pragmatic, context-sensitive recommendations.</p><p><strong>Results: </strong>The panel defines telestroke as a model of care that includes hyperacute decision-making but also extends toward comprehensive stroke unit support. Recommendations are structured around essential and advanced components, covering organizational setup, technical requirements, clinical workflows, and quality assurance. Emphasis is placed on pragmatic, minimum viable solutions, suggesting adaptable technical configurations, standardized operating procedures, and feasible quality-monitoring frameworks.</p><p><strong>Conclusion: </strong>This statement provides practical guidance to support the safe and feasible implementation of telestroke services across diverse resource settings. Future research should focus on defining minimum effective models, evaluating individual components of telestroke systems, and addressing economic, regulatory, and cross-border implementation challenges. This scientific statement has been reviewed and approved by the WSO Executive.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261480603"},"PeriodicalIF":6.9,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793111","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}