International Journal of Stroke最新文献

{"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}

{"title":"Molecular biomarkers in stroke recovery: Consensus-based core recommendations from the fourth Stroke Recovery and Rehabilitation Roundtable.","authors":"Matthew A Edwardson, Robynne G Braun, Chad M Aldridge, Rufus Akinyemi, Stefan T Engelter, Israel Fernández-Cadenas, Cristina Gallego-Fabrega, Quentin Le Grand, Jane Maguire, Alexander H Nave, Rajiv Ratan, Bradford B Worrall, Huichun Xu, Amy Brodtmann, Steven C Cramer, Kathryn S Hayward, Arne G Lindgren","doi":"10.1177/17474930261475960","DOIUrl":"https://doi.org/10.1177/17474930261475960","url":null,"abstract":"<p><strong>Rationale: </strong>The 2017 Stroke Recovery and Rehabilitation Roundtable (SRRR) consensus statement on biomarkers identified genetic and blood biomarkers as a developmental priority for stroke recovery and rehabilitation. While progress has been made, this nascent field still lags behind other medical disciplines. Further development is critical because molecular biomarkers hold great promise to provide key insights into the neurobiological mechanisms of both spontaneous and treatment-induced stroke recovery. Such insights could lead to effective recovery biotherapeutics and help optimize the timing and delivery of therapies.MethodsA multidisciplinary taskforce of international experts with expertise in omics and stroke recovery identified and prioritized key focus areas. Consensus opinion was developed across 15 virtual meetings, 2 rounds of anonymous polling and a 2-day in-person meeting. Key recommendations were iteratively refined until full consensus was achieved by all taskforce members.ResultsOur main recommendation is that there is a critical need for large-scale, multi-center, discovery-based omics studies to identify molecular targets in stroke recovery. To help achieve this goal we suggest ways to harmonize future studies including timepoints for data collection, outcome measures, and biospecimen selection. In addition, we address the limitations of current candidate biomarkers, translational challenges, emerging technologies, biomarker response to interventions, multi-site collaboration, and ethical concerns.ConclusionsThere is a great need for collaborative efforts by the international neurorehabilitation community to collect and harmonize molecular biomarker data. The resulting discoveries will be foundational to precision neurorehabilitation and the development of recovery biotherapeutics to enhance recovery for stroke survivors.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261475960"},"PeriodicalIF":6.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793005","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":"Factors associated with the presence, and longitudinal progression of, perivascular spaces: An exposome-wide analysis in the UK Biobank.","authors":"Shizuka Hayashi, Jing Du, Lei Fan, Jiyang Jiang, Yang Song, Dadong Wang, Perminder S Sachdev, Wei Wen","doi":"10.1177/17474930261479041","DOIUrl":"10.1177/17474930261479041","url":null,"abstract":"<p><strong>Background: </strong>Perivascular spaces (PVSs) are markers of cerebral small vessel disease (cSVD). While some vascular risk factors are known, broader determinants of regional PVS burden and progression remain unclear.</p><p><strong>Aim: </strong>This study aimed to identify exposome-wide determinants of cross-sectional regional PVS burden in the basal ganglia (BG) and centrum semiovale (CSO) and examine associations of identified exposures with PVS progression.</p><p><strong>Methods: </strong>We analyzed 44,938 UK Biobank participants (4568 with repeat imaging after 2.6 ± 1.0 years). Of 3767 candidate exposures across eight domains, 1289 were retained after preprocessing. The cross-sectional Exposome-Wide Association Study (ExWAS) used negative binomial regression with false discovery rate (FDR) correction. Surviving exposures were further examined with weighted quantile sum (WQS) regression to assess relative importance, Conway-Maxwell-Poisson longitudinal models, and structural equation modeling (SEM) linking exposures to cognition via PVS.</p><p><strong>Results: </strong>ExWAS identified 80 exposures for BG-PVS and 89 for CSO-PVS (P_{FDR-corrected} < 0.01). Higher diastolic blood pressure (BG: incident rate ratio (IRR) = 1.04, 95% confidence interval (CI) = 1.03-1.05; CSO: IRR = 1.07, 1.05-1.08) and greater left ventricular (LV) myocardial mass (BG: IRR = 1.05, 1.04-1.07; CSO: IRR = 1.09, 1.06-1.11) were associated with greater burden. WQS weights were dominated by cardiovascular exposures in BG (54.5%) but were more broadly distributed in CSO, including cardiovascular (31.9%), sociodemographic (20.9%), and environmental (12.7%). Longitudinally, cardiovascular and adiposity exposures were nominally associated with faster BG-PVS progression, with stronger effects in females. SEM demonstrated cardiovascular exposures linked to cognition through BG-PVS, but not CSO-PVS.</p><p><strong>Discussion: </strong>Determinants of PVS burden and progression showed regional heterogeneity: BG-PVS is more strongly associated with cardiovascular exposures and cognition, while CSO-PVS shows a broader, more heterogeneous pattern. These findings support the importance of regional PVS assessment and suggest cardiovascular risk management may be particularly relevant to BG-PVS-related cSVD.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261479041"},"PeriodicalIF":6.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706458","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":"Early versus delayed anticoagulation in acute ischemic stroke with atrial fibrillation according to infarct volume and location: A prespecified subgroup analysis of the OPTIMAS randomized controlled trial.","authors":"Philip S Nash, Jonathan G Best, James Lyon, James K Ruffle, Thanyalak Amornpojnimman, Rom Mendel, Chris Foulon, Hakim-Moulay Dehbi, Norin Ahmed, Liz Arram, Maryam Balogun, Kate Bennett, Ekaterina Bordea, Emilia Caverly, Marisa Chau, Hannah Cohen, Mairead Cullen, Caroline J Doré, Stefan T Engelter, Robert Fenner, Gary A Ford, Aneet Gill, Rachael Hunter, Martin James, Archana Jayanthi, Gregory Yh Lip, Sue Massingham, Macey L Murray, Iwona Mazurczak, Amalia Ndoutoumou, Bo Norrving, Jenny Philip, Hannah Sims, Nikola Sprigg, Tishok Vanniyasingam, Parashkev Nachev, Nick Freemantle, David Doig, David J Werring","doi":"10.1177/17474930261441297","DOIUrl":"10.1177/17474930261441297","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials have demonstrated that early anticoagulation after acute atrial fibrillation-associated ischemic stroke is safe and non-inferior to delayed initiation. Whether anticoagulation should be delayed in people with larger infarcts is uncertain.</p><p><strong>Aims: </strong>To investigate whether ischemic stroke infarct volume, measured precisely by segmentation, modifies the treatment effect of early anticoagulation with a direct oral anticoagulant (DOAC).</p><p><strong>Methods: </strong>We did a prespecified secondary analysis of OPTIMAS (NCT: 03759938), a randomized, parallel-group, open-label trial with blinded outcome assessment which randomized people with acute ischemic stroke and atrial fibrillation to early initiation of any licensed DOAC, within 4 days of onset, or delayed initiation 7-14 days from onset. The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage (ICH), and systemic arterial embolism within 90 days. A central neuroimaging laboratory determined infarct volume using diffusion-weighted magnetic resonance imaging (MRI) using a validated deep learning segmentation model; on computed tomography (CT), infarcts were segmented manually. We modeled infarct volume as a continuous variable using restricted cubic splines and tested for an interaction with treatment allocation in mixed effects logistic regression.</p><p><strong>Results: </strong>We included 3572 participants (mean age = 78 ± 10 years, 45% female), 98.6% of the main trial population. The effect of early versus delayed anticoagulation did not vary with infarct volume (p_interaction = 0.18). Rates of the primary outcome were 17/568 (3.0%) and 12/599 (2.0%) for early versus delayed initiation with infarcts of 0-5 mL; 6/220 (2.7%) and 11/229 (4.8%) with infarcts of 5-10 mL; 13/258 (4.6%) and 10/283 (3.5%) with infarcts of 10-25 mL; 6/145 (4.1%) and 8/145 (5.5%) with infarcts of 25-50 mL; 1/93 (1.1%) and 7/94 (7.4%) with infarcts of >50 mL; and 14/481 (2.9%) and 10/430 (2.2%) in participants with no infarct visible on clinically acquired brain imaging. Corresponding odds ratios and 95% confidence intervals were 1.52 (0.71-3.20), 0.55 (0.20-1.51), 1.29 (0.55-3.00), 0.74 (0.25-2.21), 0.13 (0.02-1.11), and 1.25 (0.55-2.86), respectively. There were no increased rates of symptomatic ICH with respect to anticoagulation timing for those with large infarcts (>25 mL); there were 3/238 (1.3%) events in the early group and 5/239 (2.1%) in the delayed group.</p><p><strong>Conclusion: </strong>The treatment effect of early anticoagulation with a DOAC in acute ischemic stroke associated with atrial fibrillation was not modified by infarct volume. Adverse outcomes were not increased with early anticoagulation in people with larger infarcts. Our results provide no evidence that anticoagulation initiation should be delayed beyond 4 days on the basis of infarct size.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"956-967"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147573952","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":"Timing of insertable cardiac monitor implantation after embolic stroke of undetermined source and its impact on atrial fibrillation detection: A target trial emulation analysis.","authors":"Lucio D'Anna, Fionn Maguidhir, Robert Simister, Arvind Chandratheva, Gaurav Desai, Maryam Haneef, Anne Idian, Francesco Favruzzo, Alessandra Pes, Claudio Baracchini, Diletta Rosin, Mariarosaria Valente, Gian Luigi Gigli, Liqun Zhang, Nathan Leung Mres, Manav Sohal, Simona Sacco, Raffaele Ornello, Federico De Santis, Ubaldo Coppola, Gabriele Prandin, Selina Edwards, Ceylan Safak, Roberto Avila, Joan Cruz, Ashley Laurie, Michele Romoli, Valentina Tudisco, Federica Nicoletta Sepe, Jianqun Guan, Asha Barnard, Lydia Jeffrey, Jake Dagan, Tsering Dolkar, Jonathan Hayton, Soma Banerjee, Matteo Foschi, Giovanni Merlino, Phang Boon Lim","doi":"10.1177/17474930261438742","DOIUrl":"10.1177/17474930261438742","url":null,"abstract":"<p><strong>Background: </strong>A substantial proportion of ischemic strokes remain classified as embolic stroke of undetermined source (ESUS) despite standard diagnostic evaluation. Prolonged cardiac monitoring with implantable cardiac monitors (ICMs) increases atrial fibrillation (AF) detection, but the optimal timing of ICM implantation after ESUS remains uncertain.</p><p><strong>Aims: </strong>To evaluate whether early versus delayed ICM implantation after ESUS influences AF detection and time to diagnosis.</p><p><strong>Methods: </strong>We conducted a multicenter observational cohort study emulating a target trial. Consecutive ESUS patients undergoing ICM implantation were classified as ICM_EARLY (⩽30 days) or ICM_DELAYED (31-365 days) implantation after the index event. Inverse probability weighting was applied to adjust for baseline confounding. Primary and secondary outcomes included AF detection within 30, 90, and 120 days after implantation, assessed using weighted logistic regression, Poisson models for detection rates per person-time, Cox proportional hazards models, and restricted mean survival time (RMST). Sensitivity analyses included center-level clustering and competing-risk models.</p><p><strong>Results: </strong>Among 333 patients (90 ICM_EARLY and 243 ICM_DELAYED), early implantation was associated with significantly higher AF detection within 30 days (7.8% vs 1.6%; odds ratio (OR) = 4.49, 95% confidence interval (CI) = 1.17-17.27; p = 0.028) and higher detection rates per person-time (incidence rate ratio (IRR) = 4.26, 95% CI = 1.16-15.60; p = 0.029). Consistent associations were observed at 90 and 120 days. Time-to-event analyses showed higher hazards of AF detection with early implantation (hazard ratio (HR) = 4.29 at 30 days; HR = 2.97 at 90 days; HR = 2.77 at 120 days; all p < 0.01). RMST analyses demonstrated progressively shorter time to AF diagnosis in the ICM_EARLY group across multiple time horizons. Results were robust across sensitivity analyses.</p><p><strong>Conclusion: </strong>Early ICM implantation after ESUS is associated with higher and faster AF detection compared with delayed implantation. When ICM monitoring is indicated, avoiding unnecessary delays may substantially enhance diagnostic yield.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"968-978"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512090","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":"Cardiac monitoring for detection of atrial fibrillation after TIA: An updated systematic review and meta-analysis.","authors":"Alexander W Veltkamp, Eleni Korompoki, Lucio D'Anna, Manuel C Olma, Karl Georg Haeusler, Matthias Endres, Roland Veltkamp","doi":"10.1177/17474930261449734","DOIUrl":"10.1177/17474930261449734","url":null,"abstract":"<p><strong>Background and aims: </strong>The optimal monitoring strategy for atrial fibrillation (AF) detection after transient ischemic attacks (TIAs) is uncertain, as existing evidence is largely derived from ischemic stroke or mixed stroke-TIA populations. This systematic review and meta-analysis aimed to determine the rate of newly diagnosed AF in TIA patients using different electrocardiographic monitoring modalities and durations.</p><p><strong>Methods: </strong>A literature search from 1966 through 31 May 2025 was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using a protocol registered on PROSPERO (CRD420251075716). Prospective observational studies and randomized controlled trials including TIA patients who underwent at least 12 h of cardiac monitoring were eligible. The primary outcome was newly detected AF lasting at least 30 s, with subgroup analyses by monitoring duration and modality.</p><p><strong>Results: </strong>Forty-two studies enrolling 3981 TIA patients were included. The pooled AF detection rate was 6.5% (95% confidence interval (CI): 4.5-9.3). AF detection rates increased with monitoring duration: 3.5% at 1 day, 6.3% at 7 days, 9.6% at 30 days, 13.1% at 90 days, and 19.1% at 12 months, respectively. Implantable cardiac monitors yielded statistically significantly higher AF detection rates than non-invasive cardiac monitoring (20.8% vs. 4.7%, <i>p</i> < 0.0001). AF detection appeared higher in selected cohorts (based on older age, undetermined cause, and more extensive cardiovascular work-up) than in unselected cohorts (9.0% vs. 4.5%, <i>p</i> = 0.031). However, stratified analysis of non-invasive monitoring showed no difference between selected and unselected TIA patients (5.0% (95% CI: 2.3-10.5) vs. 4.5% (95% CI: 3.1-6.5)). Substantial heterogeneity was observed among studies (<i>I</i>² = 81.9%).</p><p><strong>Conclusion: </strong>This meta-analysis found high rates of newly detected AF in TIA patients undergoing prolonged cardiac monitoring, which are similar to rates previously reported after ischemic stroke. Studies using implantable cardiac monitors specifically in TIA patients are scarce. Randomized trials are needed for a face-to-face comparison of different monitoring strategies and to determine whether prolonged cardiac monitoring improves clinical outcomes in TIA patients.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"933-945"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771302","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":"Early combined brain-cardiac CT imaging refines etiological classification of large vessel occlusion stroke.","authors":"Pierre-Antoine Garbuio, Cédric Fasolin, Angélique Bernard, Gauthier Duloquin, Thibault Leclercq, Soundous M'Rabet, Camil-Cassien Bamdé, Pierre-Olivier Comby, Frédéric Ricolfi, Yannick Béjot, Charles Guenancia","doi":"10.1177/17474930251398254","DOIUrl":"10.1177/17474930251398254","url":null,"abstract":"<p><strong>Background: </strong>Timely identification of stroke etiology is crucial in managing large vessel occlusion (LVO) strokes. However, a substantial proportion remains cryptogenic despite comprehensive workup, raising concern about underdiagnosed cardioembolic sources. This study assessed the diagnostic contribution of early combined brain-cardiac CT imaging in patients with LVO stroke and explored imaging markers associated with each etiological subtype.</p><p><strong>Methods: </strong>A total of 252 consecutive patients admitted for LVO stroke who underwent standardized acute-phase brain and cardiac CT imaging were included. Patients were classified as atheromatous, cardioembolic, or cryptogenic LVO stroke before and after consideration of cardiac CT results. Clinical and imaging characteristics of patients were compared according to final causes of stroke.</p><p><strong>Results: </strong>Cardiac CT led to etiological reclassification in 8 patients (3.2%), including 7 cryptogenic cases upgraded to cardioembolic due to detection of intracardiac thrombi in the absence of atrial fibrillation. Patients with cardioembolic LVO stroke (n = 137, 54%) were older, more frequently women, and had higher left atrial surface areas and volumes compared to atheromatous (n = 40, 16%) and cryptogenic cases (n = 75, 30%). Epicardial adipose tissue volume was highest in atheromatous strokes, while cryptogenic cases lacked markers of atrial cardiomyopathy. At follow-up, mortality was highest in the cardioembolic group.</p><p><strong>Conclusion: </strong>Early brain-cardiac CT imaging enhances etiological classification in LVO strokes by identifying intracardiac thrombi and other cardioembolic markers missed by standard workup. A substantial subset of cryptogenic LVO strokes may represent a distinct pathophysiological entity. Broader adoption of cardiac CT could inform targeted stroke prevention strategies.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1040-1048"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in mortality and functional outcomes across stroke subtype: A nationwide cohort study.","authors":"Tae Jung Kim, Ji Sung Lee, Jun Yup Kim, Do Yeon Kim, Yong Soo Kim, Dong-Wan Kang, Jihoon Kang, Beom Joon Kim, Seong-Eun Kim, Jong-Moo Park, Kyungbok Lee, Jeong-Yoon Lee, Yong-Jin Cho, Han-Yeong Jeong, Han-Gil Jeong, Byeolnim Ban, Mi Sun Oh, Soo Joo Lee, Juneyoung Lee, Yong Uk Kwon, Yu Ra Lee, Yu Jeong Lim, Philip B Gorelick, Hee-Joon Bae","doi":"10.1177/17474930261419672","DOIUrl":"10.1177/17474930261419672","url":null,"abstract":"<p><strong>Background: </strong>Sex disparities in stroke outcomes are well-recognized, but it remains unclear whether these disparities vary across stroke subtypes and how they relate to differences in acute care delivery.</p><p><strong>Aim: </strong>The aim of the study was to examine sex differences in long-term mortality, functional outcomes, and acute stroke management across stroke subtypes using a nationwide population-based cohort.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed linked clinical audit and claims data from 58,429 patients with acute stroke admitted to 269 hospitals in South Korea between 2018 and 2021. Clinical data were derived from the national Acute Stroke Quality Assessment Program and linked to claims. The primary outcome was all-cause mortality. The secondary outcome was poor functional outcome at discharge. Multivariable Cox and logistic regression models were used to assess associations between sex and outcomes, stratified by stroke subtype and adjusted for age, stroke severity, and comorbidities. Differences in acute stroke care were also analyzed.</p><p><strong>Results: </strong>Of 58,429 patients (mean [SD] age, 68.6 [13.8] years; 43.9% female), 76.1% had ischemic stroke (IS), 15.7% intracerebral hemorrhage (ICH), and 8.2% subarachnoid hemorrhage (SAH). Females were older than males across all subtypes and had different comorbidity profiles. After adjustment, females had significantly lower mortality in all subtypes (adjusted hazard ratios [95% CI]: IS, 0.77 [0.74-0.80]; ICH, 0.60 [0.56-0.64]; SAH, 0.60 [0.54-0.67]; all P < 0.001). Functional outcomes varied: females had worse outcomes in IS, better in ICH, and no difference in SAH. Males were more likely to receive reperfusion and surgical therapies; females were more likely to receive rehabilitation services. These care differences did not fully explain the observed disparities in outcomes.</p><p><strong>Conclusion: </strong>In this national cohort, sex disparities in stroke outcomes differed by subtype. Despite lower adjusted mortality in females, functional outcomes were not uniformly better. These findings underscore the importance of adopting sex- and subtype-specific approaches to stroke care, secondary prevention, and rehabilitation.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1030-1039"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018407","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 epidemiology of atrial fibrillation and atrial flutter: An increasing worldwide burden.","authors":"Fabian Sanchis-Gomar, Carl J Lavie, Giuseppe Lippi","doi":"10.1177/17474930261464877","DOIUrl":"10.1177/17474930261464877","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation and atrial flutter (AF/AFL) are major contributors to ischemic stroke, heart failure, disability, and mortality worldwide.</p><p><strong>Objective: </strong>To provide a descriptive global analysis of AF/AFL burden using Global Burden of Disease (GBD) 2023 estimates, with emphasis on incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their distribution by sex, age, and socio-demographic index (SDI).</p><p><strong>Methods: </strong>We performed a descriptive epidemiological analysis using direct extractions from the Institute for Health Metrics and Evaluation Global Burden of Disease 2023 Results Tool for the cause category \"atrial fibrillation and atrial flutter.\" We assessed incidence, prevalence, deaths, DALYs, and selected rates globally and according to sex, quinquennial age group, and SDI. Temporal trends were examined using available historical series, and the 2023 burden was summarized across major demographic and SDI strata.</p><p><strong>Results: </strong>In 2023, AF/AFL accounted globally for 5,021,980 incident cases, 59,045,058 prevalent cases, 9,265,726 DALYs, and 377,258 deaths. Compared with 1990, the global burden increased substantially in absolute terms. It was substantially higher in older adults, with the highest observed counts of incident and prevalent cases in the 70- to 74-year age group, the highest DALY counts in the 80- to 84-year age group, and the highest death counts in the 85- to 89-year age group. Men accounted for more incident and prevalent cases in absolute terms, whereas women accounted for more deaths and DALYs; age-standardized rates indicated higher male incidence, prevalence, and DALYs, but essentially equivalent mortality between sexes. High-SDI settings carried the largest absolute burden and the highest rates across all major metrics. Overall, the findings indicate a marked expansion in the global AF/AFL burden, with important heterogeneity by age, sex, and socio-demographic development.</p><p><strong>Conclusion: </strong>AF/AFL remains a major and growing global public health challenge. The burden is increasingly concentrated in older populations, shows persistent sex differences, and remains greater in high-SDI settings. These findings reinforce the relevance of AF/AFL to stroke prevention, health-system planning, and long-term cardiovascular care worldwide.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"902-909"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301688","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":"Atrial fibrillation detection after embolic stroke of undetermined source: Development and validation of the CATCH-AF score.","authors":"Lucio D'Anna, Francesco Favruzzo, Claudio Baracchini, Alessandra Pes, Fionn Mag Uidhir, Diletta Rosin, Mariarosaria Valente, Gian Luigi Gigli, Liqun Zhang, Nathan Leung, Manav Sohal, Simona Sacco, Raffaele Ornello, Federico De Santis, Ubaldo Coppola, Gabriele Prandin, Michele Romoli, Valentina Tudisco, Federica Nicoletta Sepe, Jianqun Guan, Asha Barnard, Lydia Jeffrey, Jake Dagan, Tsering Dolkar, Irtiza Syed, Soma Banerjee, Selina Edwards, Ceylan Safak, Roberto Avila, Joan Cruz, Ashley Laurie, Gaurav Desai, Maryam Haneef, Anne Idian, Arvind Chandratheva, Phang Boon Lim, Giovanni Merlino, Matteo Foschi, Robert Simister","doi":"10.1177/17474930261428118","DOIUrl":"10.1177/17474930261428118","url":null,"abstract":"<p><strong>Background: </strong>Embolic stroke of undetermined source (ESUS) accounts for up to one quarter of ischemic strokes, with occult atrial fibrillation (AF) as a key underlying cause. Implantable cardiac monitors (ICMs) markedly improve AF detection but are limited by cost and resource demands. Existing AF-prediction models show modest accuracy and lack longitudinal validation. We developed and validated the CATCH-AF score to provide a simple, clinically applicable tool for stratifying early and long-term AF risk after ESUS.</p><p><strong>Methods: </strong>We analyzed 543 consecutive ESUS patients systematically monitored with ICMs. Variable selection used LASSO-penalized Cox regression. Model performance was assessed with time-dependent ROC curves, restricted mean survival time (RMST) analysis, and 10-fold cross-validation. To evaluate geographic generalizability, internal-external cross-validation was performed across seven participating centers, estimating discrimination and calibration for each held-out cohort. Based on the final multivariable model, a point-based score was derived including age, coronary artery disease, heart failure, and prior transient ischemic attack or ischemic stroke.</p><p><strong>Results: </strong>During 1558.5 patient-years of follow-up, 118 patients (22%) developed new AF. The CATCH-AF score showed excellent discrimination (AUC 0.85, 95% CI 0.82-0.89), stable over 4.5 years (0.84-0.87). Compared with low-risk patients (0-2 points), those at high risk (⩾5 points) had a 19-fold higher hazard of AF detection (HR 19.2, 95% CI 9.4-39.4; <i>p</i> < 0.001) and 918 fewer AF-free days (95% CI -1080 to -757).</p><p><strong>Conclusions: </strong>The CATCH-AF score provides a robust, interpretable, and easily applicable tool for predicting AF after ESUS, supporting targeted and cost-effective rhythm monitoring.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"946-955"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258078","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}