International Journal of Stroke最新文献

{"title":"Cognitive impairment in acute ischemic stroke patients with early versus delayed antihypertensive treatment: A prespecified analysis of CATIS-2 trial.","authors":"Minghua Wang, Yufei Wei, Xuewei Xie, Yuesong Pan, Mengxing Wang, Aili Wang, Dacheng Liu, Zilin Zhao, Ximing Nie, Wanying Duan, Xin Liu, Zhe Zhang, Jingyi Liu, Lina Zheng, Suwen Shen, Chongke Zhong, Tan Xu, Yong Jiang, Jing Jing, Xia Meng, Katherine Obst, Chung-Shiuan Chen, Hao Li, Yilong Wang, Yonghong Zhang, Jiang He, Yongjun Wang, Liping Liu","doi":"10.1177/17474930251401203","DOIUrl":"10.1177/17474930251401203","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing for initiating antihypertensive therapy after acute ischemic stroke (AIS), particularly regarding cognitive outcomes, remains uncertain. This study investigated the association between treatment timing and 3-month cognitive function.</p><p><strong>Methods: </strong>This prespecified analysis of the China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2) included patients completing 3-month Montreal Cognitive Assessment (MoCA). Participants were randomized to early (immediate) or delayed (day 8) antihypertensive treatment, with MoCA score as primary outcome.</p><p><strong>Results: </strong>A total of 1682 patients completed the cognitive assessment; 823 received early antihypertensive treatment and 859 received delayed treatment. Baseline characteristics were comparable between the two groups. The median MoCA score was 23 in both groups (β, -0.06; 95% CI, -0.16 to 0.03; <i>P</i> = .19). In addition, the proportion of individuals with MoCA scores < 25 was similar between the two groups (62% vs 59%; OR, 1.15; 95% CI, 0.95 to 1.40; <i>P</i> = 0.16). Exploratory subgroup analyses suggested a potential interaction by prior antihypertensive use, whereby early antihypertensive treatment was associated with worse cognitive outcomes in patients with prior antihypertensive use (OR, 1.34; 95% CI, 1.01-1.77; <i>p</i> = 0.03; <i>P</i> for interaction = 0.04).</p><p><strong>Conclusions: </strong>Early antihypertensive initiation did not improve 3-month cognitive outcomes in AIS patients, highlighting the importance of individualized therapy, especially for high-risk PSCI subgroups.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"999-1008"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540679","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":"Prevalence and predictors of atrial fibrillation detected after stroke or transient ischemic attack: A comprehensive meta-analysis.","authors":"Ghassab E Ababneh, Ahmed Yassin, Malik Allahham, Khaled Alawneh, Suhyb Hamed, Sohaib A Alomari, Mohammad B Jaradat, Abdallah Alkhawaldeh, Abdallah Almbaidin","doi":"10.1177/17474930251398615","DOIUrl":"10.1177/17474930251398615","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) detected after stroke or transient ischemic attack (AFDAS) is a critical but often underdiagnosed condition with implications for secondary stroke prevention. This distinctive type of AF is increasingly studied to provide a more comprehensive understanding of its complex pathophysiology, which may involve both cardiogenic mechanisms and stroke-induced autonomic dysfunction, a concept known as the neurogenic hypothesis. This study aims to identify the prevalence and predictors of AFDAS to help refine monitoring strategies and improve patient outcomes.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We included English-language retrospective and prospective cohort studies published from January 1999 to January 2025, analyzing data from 91 studies for prevalence and 54 studies for predictors. We categorized AF detection by different monitoring methods, including electrocardiogram (ECG), Holter monitoring, external loop recorders, and implantable cardiac monitors (ICM). Predictors were grouped into demographic, cardiogenic, neurogenic, and laboratory factors.</p><p><strong>Results: </strong>The overall prevalence of AFDAS varied significantly based on monitoring technique. The pooled prevalence was 7% (95% CI 4.6-10.5) by emergency room ECG, 12.7% (95% CI 9-17.8) by inpatient ECG, 11.9% (95% CI 7.8-17.9) by continuous ECG monitoring, 11.5% (95% CI 8-16.1) by external loop recording, 5.1% (95% CI 2.6-9.7) by Holter monitor, 21.3% (95% CI 18.3-24.7) by ICM, and 17.2% (95% CI 10-28.1) by multiple monitoring methods. Key predictors of AFDAS included older age, female sex, hypertension, chronic kidney disease, left atrial enlargement, advanced interatrial block, and higher NIHSS scores. Insular involvement and major strokes were strongly associated with AF detection, supporting the neurogenic hypothesis. Elevated N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and B-type Natriuretic Peptide (BNP) levels were also linked to a higher AF risk.</p><p><strong>Conclusion: </strong>AFDAS is a frequent but variably detected condition, with its prevalence strongly dependent on monitoring duration and modality. Identifying high-risk patients using a combination of clinical, cardiogenic, neurogenic, and laboratory markers can optimize screening strategies and early anticoagulation initiation, potentially reducing stroke recurrence. Future research should focus on refining risk scores integrating neurogenic and cardiogenic markers to guide personalized monitoring approaches and to define the distinct characteristics of AFDAS from known atrial fibrillation (KAF).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"910-922"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458707","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":"Ticagrelor plus aspirin versus cilostazol plus aspirin in the acute-phase treatment of large-vessel minor stroke or TIA: A randomized controlled multi-center trial, the TACTIS trial.","authors":"Mohamed Ismaiel, Sherihan Rezk Ahmed, Mohamed Fouad Elsayed Khalil, Ahmad Galal Elmesallami, Ahmed Ahmed Mohamed Kamal Ebied, Ahmed Zaki Omar Akl, Youssry Salah Shafiq Kerolos, Mohamed Elshafei, Enji Hamdy Elsawy Khalil, Ahmed Mohamed Ali Daabis, Romany Adly Yousef, Dalia Maher Samy, Hamada Zehry, Ashraf Ali Soliman, Ghada Abd Elwahab Khalil Ibrahim, Mohamed G Zeinhom","doi":"10.1177/17474930251406865","DOIUrl":"10.1177/17474930251406865","url":null,"abstract":"<p><strong>Introduction: </strong>More intensive antiplatelet agents may reduce recurrent stroke risk in minor stroke and TIA, particularly those with non-cardioembolic stroke. The SOCRATES trial showed that ticagrelor was not superior to aspirin in decreasing the risk of stroke, heart attack, or death at 90 days in patients with minor ischemic stroke or TIA. Cilostazol has been shown to have similar effects on platelet reactivity and aggregation to those produced by ticlopidine and aspirin, but may be associated with fewer hemorrhagic side effects. It is also cheaper than ticagrelor; for example, it is approximately half that of ticagrelor, making it a potentially cost-effective antiplatelet agent, especially in low and middle-income countries.</p><p><strong>Aim: </strong>To evaluate the benefits or hazards of adding cilostazol or ticagrelor to aspirin in patients with minor ischemic stroke or TIA.</p><p><strong>Methods: </strong>We randomized 900 first-ever, large-vessel occlusion minor ischemic stroke or TIA patients in a one-to-one ratio to receive either a 200 mg loading dose of cilostazol within 24 h after acute stroke symptoms, then 100 mg twice daily until day 90 post-stroke, or a 180 mg loading dose of ticagrelor during the first 24 h, followed by 90 mg twice daily from day 2 to day 90. Both groups received an open-label 300 mg loading dose of aspirin during the first 24 h, then 75 mg once daily. We followed up with our patients for 3 months.</p><p><strong>Results: </strong>857 patients completed the 3-month follow-up study 34 (7.6%) patients in the cilostazol group and 29 (6.4%) patients in the ticagrelor group experienced a new stroke (either hemorrhagic or ischemic) (HR 1.37; 95% CI, 0.84-2.26; <i>p</i>-value = 0.21), and 44 (9.8%) patients in the cilostazol group and 40 (8.9%) patients in the ticagrelor group experienced a composite of a new stroke, myocardial infarction (MI), or death due to vascular insults (HR 1.11; 95% CI, 0.64-1.93; <i>p</i>-value = 0.30). Fifteen (3.3%) patients in the cilostazol arm and 30 (6.7%) patients in the ticagrelor arm experienced drug-related hemorrhagic complications (HR 0.32; 95% CI, 0.19-0.68; <i>p</i>-value = 0.01).</p><p><strong>Conclusion: </strong>Combining cilostazol with aspirin in large-vessel occlusion minor ischemic stroke or TIA was as effective as ticagrelor and aspirin in preventing recurrent stroke, MI, and death due to vascular events, but resulted in significantly lower rates of hemorrhagic complications.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1019-1029"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653333","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 and advances in secondary prevention.","authors":"Hugh S Markus","doi":"10.1177/17474930261466442","DOIUrl":"https://doi.org/10.1177/17474930261466442","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"21 7","pages":"892-894"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148561875","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":"Safety and efficacy of intravenous thrombolytics among patients with emergent intracranial stenting after thrombectomy: Subanalysis of the RESISTANT registry.","authors":"Adnan Mujanovic, Marta Olivé-Gadea, Francesco Diana, Greta Charlotte Sökeland, David J Seiffge, Serdar Geyik, Songul Senadim, Amedeo Cervo, Andrea Salcuni, Mariangela Piano, Manuel Moreu, Alfonso López-Frías, Ameer E Hassan, Samantha Miller, Elena Zapata, Asier de Albóniga-Chindurza, Mauro Bergui, Stefano Molinaro, João André Sousa, Fábio Gomes, João Sargento, Andrea Alexandre, Alessandro Pedicelli, Jeremy Hofmeister, Paolo Machi, Luca Scarcia, Erwah Kalsoum, Fabiano Cavalcante, Fouzi Bala, Jose Amorim, Torcato Meira, Santiago Ortega-Gutierrez, Aaron Rodriguez-Calienes, Leonardo Renieri, Francesco Capasso, Daniele G Romano, Eduardo Barcena, David Seoane, Mohamad Abdalkader, Piers Klein, Thanh N Nguyen, Catarina Perry-da-Câmara, Isabel Fragata, Dileep Yavagal, Jude Hassan Charles, José Rodríguez, Pedro Vega, Atilla Özcan Özdemir, Zehra Uysal Kocabas, Stanislas Smajda, Sadiq Al Salman, Jane Khalife, Tudor Jovin, Francesco Biraschi, Francesca Ricchetti, Pedro Castro, Luis Albuquerque, Adnan Siddiqui, Vinay Jaikumar, Pedro Navia, Nikolaos Ntoulias, Marios Psychogios, Mariano Velo, Joaquín Zamarro, Gonzalo de Paco, Osama Zaidat, Yazan Ashouri, Mohammad AlMajali, Juan F Arenillas, Alicia Sierra, Michele Romoli, João Pedro Marto, Shadi Yaghi, Tomas Dobrocky, Jan Gralla, Urs Fischer, Marc Ribo, Alejandro Tomasello, Manuel Requena, Johannes Kaesmacher","doi":"10.1177/17474930251400088","DOIUrl":"10.1177/17474930251400088","url":null,"abstract":"<p><strong>Background: </strong>The value of intravenous thrombolysis (IVT) prior to endovascular therapy (EVT) with emergent stenting for intracranial atherosclerotic disease (ICAD)-large vessel occlusion (LVO) is unknown. We aimed to investigate the safety and efficacy of IVT among patients with adjuvant intracranial stenting after EVT.</p><p><strong>Methods: </strong>RESISTANT is a study of consecutive acute ischemic stroke patients who underwent EVT and intracranial stenting from 36 comprehensive stroke centers in 7 countries across 3 continents. The primary outcome of interest was ordinal shift of the modified Rankin Scale (mRS) score at 90 days after the intervention. Secondary outcomes were excellent outcome (mRS 0-1) and functional independence (mRS 0-2) at 90 days. Safety outcomes were rates of symptomatic intracranial hemorrhage (sICH) at 24-hour and 90-day mortality. Adjusted multivariate ordinal and logistic regressions were performed for all outcomes.</p><p><strong>Results: </strong>Of 828 patients (median age 67 years, interquartile range (IQR) 59-77; 65% male), 23% have received IVT. In the adjusted analysis, receiving IVT was not associated with mRS ordinal shift (aOR 0.8, 95% CI 0.6 -1.1), nor with functional independence (aOR 1.1, 95% 0.7-1.7). However, there was a positive association with excellent outcome (aOR 1.6, 95% CI 1.0-2.7). There were no differences in sICH rates at 24-h (aOR 1.5, 95% CI 0.8-2.9), nor 90-day mortality (aOR 0.8, 95% 0.5-1.3).</p><p><strong>Conclusion: </strong>In this multi-center study of patients who underwent EVT with emergent intracranial stenting, IVT was associated with excellent clinical outcome, possibly due to indication bias, and there were no safety concerns. Receiving IVT should not be a criterion for deferring acute stenting among patients with ICAD-associated LVO and IVT should not be routinely withheld in suspected ICAD cases.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"989-998"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512673","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 detected after stroke: Recent advances and future directions.","authors":"Lussiana Folleco-Insuasty, Luis Fernando Roa-Wandurraga, Federico Liberman, Diana Ayan, Rodrigo Bagur, Luciano A Sposato","doi":"10.1177/17474930261465951","DOIUrl":"10.1177/17474930261465951","url":null,"abstract":"<p><p>Prolonged cardiac monitoring has made atrial fibrillation (AF) an increasingly common diagnosis after ischemic stroke. Applied to all patients with ischemic stroke, prolonged cardiac monitoring would result in over a million new AF diagnoses per year worldwide. Almost 10 years after the conceptual inception of AF detected after stroke (AFDAS), several patterns are now consistent across studies. AFDAS is a distinct, mechanistically heterogeneous entity that differs from AF known before stroke in its risk-factor profile, cardiac comorbidity, and its lower rate of ischemic stroke recurrence. Its detection is determined primarily by the monitoring method and increases with earlier and longer-duration monitoring. AF identified on a standard electrocardiogram behaves as a high-burden arrhythmia, resembling AF known before stroke, and should be distinguished from the low-burden AF detected by prolonged monitoring. Important questions remain unresolved. It is unproven that detecting more AF, or detecting it earlier, reduces recurrent ischemic stroke. The low-burden arrhythmia that monitoring increasingly identifies appears to carry a lower embolic risk than the high-burden AF for which anticoagulation was established. Whether patients with low-burden, monitor-detected AFDAS derive net benefit from anticoagulation, the contribution of neurogenic mechanisms, and the thresholds of AF burden that should guide treatment are undefined. Future trials should be powered for recurrent stroke as the primary endpoint.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"895-901"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390765","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":"Single versus dual antiplatelet therapy for stroke prevention in patients with first-ever embolic stroke of undetermined source.","authors":"Minwoo Lee, Chulho Kim, Jong-Hee Sohn, Joo Hye Sung, Yerim Kim, Hee-Jin Im, Sang-Hwa Lee","doi":"10.1177/17474930251398257","DOIUrl":"10.1177/17474930251398257","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate the efficacy and safety of dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) for patients with a first-ever embolic stroke of undetermined source (ESUS).</p><p><strong>Methods: </strong>We assembled a multicenter cohort and a propensity score-matched (PSM) subset to compare DAPT with SAPT. The primary outcome was a composite of recurrent ischemic stroke, myocardial infarction, or all-cause death, and the safety outcome was major bleeding. Follow-up extended to 3 years (median, 2.6 years). We used Cox proportional hazards models to complement time-stratified (piecewise) analyses and restricted mean survival time (RMST).</p><p><strong>Results: </strong>In the total cohort (n = 1675), DAPT was associated with a lower hazard of the composite outcome (adjusted hazard ratio (HR) = 0.56, 95% confidence interval (CI) = 0.44-0.70). Stroke recurrence and mortality were likewise reduced, while myocardial infarction events were infrequent. There was no significant difference in major bleeding between groups (e.g. incidence-rate ratio ≈1.0; p > 0.05). The annual incidence rate for the composite was 5.5%/year with DAPT versus 10.1%/year with SAPT. Time-stratified analyses revealed that the ischemic benefit was most pronounced between 6 and 12 months and appeared to persist thereafter. Bleeding, however, showed only a numerical increase beyond 1 year without statistical significance. RMST differences favored DAPT from 1 year onward and increased over 1000 days.</p><p><strong>Conclusion: </strong>In this ESUS cohort, DAPT was associated with fewer ischemic events and no increased major bleeding. The benefit was most evident at 6-12 months and was sustained over a longer follow-up period.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"979-988"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451770","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":"Effect of colchicine for secondary prevention according to stroke subtype: A secondary analysis of the CONVINCE randomized trial.","authors":"Louise Maes, Cathal Walsh, Christian Weimar, Francisco Purroy, Christopher Price, Brian Clarke, Pedro Castro, Anna Czlonkowska, Elisa Cuadrado-Godia, Urs Fischer, Ana Catarina Fonseca, Michael D Hill, Dalius Jatuzis, Janika Kõrv, Christina Kruuse, Robert Mikulik, Paul J Nederkoorn, Laszlo Sztriha, Marcus Thieme, Peter Kelly, Robin Lemmens","doi":"10.1177/17474930251406818","DOIUrl":"10.1177/17474930251406818","url":null,"abstract":"<p><strong>Background: </strong>The Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) trial evaluated long-term treatment with colchicine for the prevention of major adverse cardiovascular events (MACE) in a stroke population. Although the intention-to-treat analysis did not demonstrate a significant reduction in the primary endpoint, fewer outcome events were observed in the colchicine-treated group. It is unknown if a potential treatment effect is modified by ischemic stroke etiology.</p><p><strong>Aims: </strong>In this pre-specified secondary analysis, we aimed to evaluate the efficacy of colchicine for prevention of MACE in patients with minor stroke or high-risk transient ischemic attack (TIA) according to index event stroke etiology.</p><p><strong>Methods: </strong>A total of 3154 patients with recent non-cardioembolic stroke or TIA were randomly assigned to receive colchicine, 0.5 mg daily in addition to guideline-based usual care or usual care alone. The primary endpoint was a composite of first fatal or non-fatal recurrent ischemic stroke, myocardial infarction, cardiac arrest, or hospitalization for unstable angina. Subgroups of patients with large-artery atherosclerosis, small-vessel disease, and cryptogenic stroke were evaluated.</p><p><strong>Results: </strong>A total of 3100 patients were included in the current analysis. The treatment effect did not vary across stroke subtype subgroups (p = 0.64 for interaction). In patients allocated to colchicine versus usual care alone, the primary endpoint occurred in 32 of 260 (12.3%) versus 42 of 263 (16%) patients with large-artery atherosclerosis (hazard ratio (HR), 0.77 (95% CI, 0.48-1.22)); 39 of 419 (9.3%) versus 47 of 435 (10.8%) patients with small-vessel occlusion (HR, 0.87 (95% CI, 0.57-1.34)); and 82 of 877 (9.4%) versus 92 of 846 (10.5%) patients with cryptogenic stroke (HR, 0.89 (95% CI, 0.66-1.12)).</p><p><strong>Conclusions: </strong>The direction of effect for prevention of recurrent MACE favored colchicine, consistent with randomized trials in coronary disease, regardless of stroke subtype. Future stroke trials should consider selecting patients with evidence of atherosclerosis irrespective of stroke subtype.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02898610.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1009-1018"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653017","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 insertable cardiac monitor implantation after ESUS stroke and the yield of atrial fibrillation detection: A systematic review and meta-analysis.","authors":"Lucio D'Anna, Gabriele Prandin, Matteo Foschi, Samir Abu-Rumeileh, Francesco Favruzzo, Renato Simonetti, Lorenzo Barba, Giovanni Merlino, Francesco Bax, Arsalan Faiz, Markus Otto, Jianqun Guan, Asha Barnard, Lydia Jeffrey, Jake Dagan, Tsering Dolkar, Jonathan Hayton, Mariarosaria Valente, Gian Luigi Gigli, Simona Sacco, Maurizio Paciaroni, Arvind Chandratheva, Robert Simister, Soma Banerjee, Phang Boon Lim","doi":"10.1177/17474930251404336","DOIUrl":"10.1177/17474930251404336","url":null,"abstract":"<p><strong>Background: </strong>The clinical utility of implantable cardiac monitors (ICMs) for atrial fibrillation (AF) detection following cryptogenic stroke or embolic stroke of undetermined source (ESUS) is well established. However, the optimal timing for ICM implantation to maximize diagnostic yield remains uncertain.</p><p><strong>Aims: </strong>To systematically review the literature and conduct a meta-analysis to determine whether earlier ICM implantation after cryptogenic stroke or ESUS ischemic stroke improves detection rates and reduces the time to AF diagnosis.</p><p><strong>Summary of review: </strong>A comprehensive search of PubMed, Embase, and Cochrane CENTRAL was conducted from inception to June 2025, without language restrictions. References of retrieved articles and relevant reviews were manually searched. We included observational studies or randomized trials reporting ICM use in patients with ESUS or cryptogenic stroke/transient ischemic attack (TIA), providing data on AF detection rates and/or timing metrics (stroke-to-ICM interval, ICM-to-AF interval). Two reviewers independently screened studies and extracted data. Disagreements were resolved by consensus or third-party adjudication. Data were extracted following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Study-level AF detection rates were modeled using logit-transformed proportions and pooled using random-effects models (REML). Mixed-effects meta-regressions assessed the effect of timing (stroke-to-ICM interval) on AF detection and diagnostic delay, adjusting for ICM monitoring duration. The primary outcomes were pooled AF detection rate and mean time from ICM implantation to AF diagnosis. Timing of implantation was assessed as a continuous and categorical (early, intermediate, delayed) variable. Forty-seven studies (<i>N</i> = 6918 patients) were included. The pooled AF detection rate was 27.3% (95% CI: 24.6-30.2), with substantial heterogeneity (<i>I</i>² = 80.8%). Early ICM implantation (<31.5 days from index event) was associated with a higher AF detection rate compared with delayed implantation (30.0% vs 23.7%; <i>p</i> = 0.0017), independent of monitoring duration. Stratified meta-regression confirmed that delayed implantation was associated with lower AF detection even after adjusting for ICM duration. For each additional day of delay in ICM implantation, the time from AF diagnosis increased by an additional 0.32 days on average, even after accounting for monitoring duration (<i>p</i> = 0.0007).</p><p><strong>Conclusion: </strong>These findings suggest that earlier ICM implantation enhances AF detection after ESUS or cryptogenic stroke and shortens diagnostic delay. Optimizing timing of post-stroke monitoring may improve patient selection for anticoagulation and reduce recurrent stroke risk.CRD 420251064227.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"923-932"},"PeriodicalIF":6.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604010","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":"Practical guidance for Win Statistics and Tournament Methods for multifaceted outcomes in stroke research: Review and recommendations.","authors":"Hannah Johns, Vignan Yogendrakumar, Nathalie H Launder, Kathryn S Hayward, Lucy Vivash, Terence J O'Brien, Anna H Balabanski, Tolulope Sajobi, Michael D Hill, Guillaume Turc, Bruce C V Campbell, Leonid Churilov","doi":"10.1177/17474930261475853","DOIUrl":"10.1177/17474930261475853","url":null,"abstract":"<p><strong>Background: </strong>Most stroke trials conventionally use outcome measures that reflect a single point of concern, such as functional outcomes or neurological improvement. Such a focus has a limited capacity to reflect the holistic nature of clinical reality, where multiple facets of health are of importance. Other clinical areas are increasingly embracing alternative approaches that better reflect the multifaceted nature of health outcomes, driven by the development of Win Statistics methodology.</p><p><strong>Methods: </strong>Win Statistics compare the outcomes for all possible pairs of patients from the treatment versus control group and summarize the treatment effect as a combination of proportions of such comparisons where the person from the treatment group has a better/worse outcome when compared to the person in the control group. In this context, \"better outcome\" is defined holistically, based on information collected across multiple health facets (e.g. mortality, symptom reduction, and quality of life). Such approaches are highly applicable to stroke research. They are a direct extension of \"Tournament Methods\" that are already used to analyze modified Rankin Scale data, and several stroke trials have already adopted this new approach to better reflect the multifaceted nature of stroke. Despite this, there is little guidance available to stroke researchers who wish to make use of the approach.</p><p><strong>Results: </strong>This article provides a review of how to effectively use Tournament Methods to reflect the multifaceted nature of stroke. We review how Tournament Methods may be used to estimate treatment effects that simultaneously consider multiple clinical outcomes. We describe methods that have been used within stroke to combine multiple clinical outcomes for Tournament Methods analysis, provide an overview of the effect size measure estimates commonly used to summarize treatment effects, and discuss both available statistical methods and software for the analysis, visualization, and reporting of Win Statistics. We provide practical recommendations for conducting and reporting statistical analyses under the Tournament Methods approach using published stroke trials as illustrative examples. We further present newly developed point-and-click software that provides easy access to statistical codes for conducting Tournament Methods analyses and facilitates the use of our recommendations. This software can be downloaded from https://github.com/HannahJohns/compare-wins.</p><p><strong>Conclusion: </strong>Tournament Methods are flexible and increasingly used within stroke research. We advocate for a principled approach to their use in the design and analysis of stroke trials to better reflect the multifaceted nature of health care.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261475853"},"PeriodicalIF":6.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591065","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}