International Journal of Stroke最新文献

{"title":"Non-motor Outcomes After Stroke: Updated Systematic Review and Meta-Analysis.","authors":"Hatice Ozkan, Taniya Esmail, Gareth Ambler, Avril Drummond, Alex P Leff, Robert Simister, David Werring","doi":"10.1177/17474930261475966","DOIUrl":"https://doi.org/10.1177/17474930261475966","url":null,"abstract":"<p><strong>Background: </strong>Adverse non-motor outcomes are common after stroke, yet their true prevalence and prognosis remain uncertain, partly due to substantial methodological heterogeneity across studies. We aim to undertake a comprehensive synthesis of the available evidence on adverse non-motor outcomes after stroke. First, we aim to examine prevalence across study settings (hospital-based versus population-based cohorts) and to evaluate the influence of outcome definitions, measurement instruments (validated versus non-validated), stroke type (ischaemic stroke, intracerebral haemorrhage, or mixed), and duration of follow-up. Second, we aim to identify study-level characteristics associated with adverse outcomes.</p><p><strong>Methods: </strong>We searched PubMed, MEDLINE, EMBASE, Scopus, Web of Science, and PsycINFO via Ovid (1st January 1999 - 30th November 2025) for prospective cohorts reporting 11 non-motor outcomes: anxiety, depression, apathy, fatigue, sleep disturbance, social participation, pain, bladder, bowel, and sexual dysfunction. Pooled prevalence according to study setting (hospital versus population) was estimated using random-effects models; outcome definitions and measures were synthesised using descriptive statistics, and meta-regression analysis was used to identify associated factors. The quality of all included studies was assessed with the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>A total of 357 prospective cohort studies, (247 541 participants; mean age 64 years; 247 male-predominant studies) were included, with a follow-up between 30 days to 10 years after stroke with median follow-up 6 months [IQR 3-12]. Half of the studies were hospital based 181/352 (51%). Of the included studies, 195 (55%) included participants with ischaemic stroke, 148 (42%) included participants with ischaemic stroke or intracerebral haemorrhage, while only 10 (3%) included participants with intracerebral haemorrhage. Across all analysis heterogeneity ranged I2 41%-99%. We found no significant differences in the prevalence of adverse non-motor outcomes between hospital versus population settings, except, bowel dysfunction was more frequently reported in population-based studies (61%, 95% Cl 54%-67% vs 47%, 95% Cl 37%-58%, p=0.005). Non-validated outcome measures were used in 156/352 studies (44.3%). Studies using non-validated outcome measures showed higher pooled prevalence of anxiety (34%, 95% Cl 29%-40%, vs 25%, 95% Cl 20%-33%, p<0.001), apathy (32%, 95% Cl 27%-36, vs 22%, 95% 13%-41%, p=0.005), sleep disturbance (62%, 95% Cl 54%-73%, vs 51%, 95% Cl 44%-58%, p<0.001), and bowel dysfunction (56%, 95% Cl 43%-69% vs. 49%, 95% Cl 38%-60%, p=0.027). Majority of studies 207/352 (59%), were conducted within 30 days to 6 months after stroke, whereas only 41/352 (12%) examined non-motor outcomes beyond 2 years post-stroke. Older age (>60 years), stroke due to ICH, and use of non-validated outcome measures were significantly associ","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261475966"},"PeriodicalIF":6.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591060","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":"Dual antiplatelet therapy in stroke without stenotic atherosclerosis: A meta-analysis with trial sequential analysis.","authors":"Mateus K Ibiapino, Marwa Ibrahim, Vanisha Kumar, Diana L Mamani-Sucari, Sofia Zs Mantovani, Igor Haitovich, Leonardo C Borgomanero, Gisele S Silva","doi":"10.1177/17474930261475466","DOIUrl":"10.1177/17474930261475466","url":null,"abstract":"<p><strong>Background and aim: </strong>Individuals without stenotic large-artery atherosclerosis (LAA) are an important subgroup of the patients who suffer transient ischemic attack (TIA) or ischemic stroke (IS), and they are commonly treated with dual antiplatelet therapy (DAPT). Stenotic LAA is a marker of higher vascular risk, and current guideline-defining trials did not prospectively evaluate if negative LAA status modifies the effect of DAPT. Moreover, platelet activation may not contribute as much toward future stroke risk after excluding stenotic LAA, leaving uncertainty regarding the applicability of this treatment among populations without this marker. We aimed to evaluate the efficacy and safety of DAPT compared with monotherapy for patients who suffered a TIA or IS without stenosis of 50% or more on vessel imaging.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to November 2025 for publications in English. We included randomized controlled trials comparing short-term (up to 90 days) DAPT to single antiplatelet therapy after a TIA or IS with outcome data available for the groups without 50% or more stenosis on vessel imaging. Data were pooled using random-effects for non-rare outcomes and Bayesian models for rare outcomes. The primary outcome was a new ischemic or hemorrhagic stroke. We also analyzed ischemic and hemorrhagic stroke individually, moderate and severe bleeding, any bleeding, all-cause death, functionality and a composite vascular outcome.</p><p><strong>Results: </strong>Eight publications met the eligibility criteria. DAPT was associated with a reduction in new stroke, with a relative risk of 0.80 (95% CI 0.65 to 0.98; p = 0.04, I² = 25.5%). Trial sequential analysis showed a substantial risk of type I error, and a sensitivity analysis restricted to studies that included only high-risk TIA or mild IS found no significant benefit. There was an increase in moderate and severe bleeding (odds ratio of 2.70, 95% Bayesian Credible Interval 1.28 to 4.85) and no differences in functionality and mortality. Heterogeneity in trial methodology and populations may limit interpretation of our findings, but sensitivity analyses evaluating the impacts of DAPT duration and region of trial conduction on new stroke did not show significant effects, although they are hindered by the small number of studies.</p><p><strong>Conclusion: </strong>In patients with TIA or IS with a negative assessment of stenotic atherosclerosis on any vessel imaging, the benefit of DAPT is unclear, particularly for individuals with high-risk TIA and mild IS, while there is an increased risk of bleeding. Further trials are required to clarify if DAPT is truly beneficial for these patients.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261475466"},"PeriodicalIF":6.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591762","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":"AI-based synthetic CT angiography from non-contrast CT for cerebrovascular disease screening.","authors":"Jiahao Liao, Bin Xu, Qianwen Zhang, Xin Wang, Xi Qiao, Kefei Chen, Jian Zhou, Jiansong Fan, Chuhan Xu, Hongxiang Wang, Yuhai Wang, Junsheng Chu, Jinxu Zhou","doi":"10.1177/17474930261473812","DOIUrl":"10.1177/17474930261473812","url":null,"abstract":"<p><strong>Background: </strong>CT angiography (CTA) is a key investigation in cerebrovascular disease. However, CTA is not always available and it also requires intravenous injection of iodinated contrast agents. It is increasingly possible to derive additional information from standard imaging sequences using artificial intelligence techniques. We investigated whether CTA maps could be derived from non-contrast CT (NCCT).</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter study across five Chinese hospitals, enrolling 3709 patients who underwent head NCCT paired with CTA. The dataset encompassed three cerebrovascular conditions: intracranial aneurysms (IA), intracranial atherosclerotic stenosis (IAS), and normal intracranial arteries. We developed the Cerebrovascular CTA Generative Artificial Intelligence Model (CTA-GAI) to synthesize CTA images directly from NCCT head scans. Synthetic outputs were evaluated against five typical models using quantitative metrics and visual assessment by clinicians. We also assessed the potential clinical utility of synthetic CTA for preliminary screening and triage by evaluating its ability to distinguish diseased from normal intracranial arteries and to classify common cerebrovascular subtypes.</p><p><strong>Results: </strong>CTA-GAI demonstrated consistent and robust performance across both the validation and test sets. In internal validation, synthetic CTA images achieved a mean absolute error (MAE) of 0.0416, mean squared error (MSE) of 0.0178, peak signal-to-noise ratio (PSNR) of 25.59 dB, and structural similarity index measure (SSIM) of 85.41%. Clinicians assigned an average visual quality score of 4.45 out of 5. These metrics reflect close approximation to real CTA images. Performance remained consistent across four external validation sets. In a test set of 110 patients, clinicians achieved an overall accuracy, precision, sensitivity, specificity, and F1 score of 92.7%, 97.7%, 86.0%, 98.3%, and 91.5%, in distinguishing diseased intracranial arteries. Differentiation between IA and IAS within diseased arteries reached 90.7% accuracy.</p><p><strong>Conclusion: </strong>CTA-GAI can synthesize CTA-like images from NCCT that show promising utility for preliminary assessment in clinical practice. These results support its potential role as a rapid, low-cost, and non-invasive tool for large-scale screening or triage of cerebrovascular diseases.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261473812"},"PeriodicalIF":6.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549061","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":"Radiological thrombus characteristics and the effect of tenecteplase versus alteplase on outcomes in acute ischemic stroke.","authors":"Fouzi Bala, Katrina Ignacio, Nishita Singh, Ibrahim Alhabli, Faysal Benali, Houman Khosravani, Aravind Ganesh, Aleksander Tkach, Luciana Catanese, Dar Dowlatshahi, Thalia S Field, Gary Hunter, Michael D Hill, Tolulope T Sajobi, Brian Buck, Richard Swartz, Bijoy K Menon, Mohammed Almekhlafi","doi":"10.1177/17474930261473813","DOIUrl":"10.1177/17474930261473813","url":null,"abstract":"<p><strong>Background: </strong>To determine whether computed tomography (CT) thrombus characteristics modify the effect of intravenous (IV) thrombolysis type (tenecteplase vs alteplase) on outcomes.</p><p><strong>Methods: </strong>This is a secondary analysis of the Alteplase compared to Tenecteplase (AcT) trial. Patients with visible intracranial occlusions on thin-slice baseline imaging were included. Key thrombus characteristics assessed by CT imaging were hyperdense artery sign, thrombus length, residual flow, clot burden score, and occlusion site. Multivariable analyses were performed to test for interactions between thrombolysis type and thrombus characteristics on clinical and angiographic outcomes.</p><p><strong>Results: </strong>Of 1577 patients, 939 met inclusion criteria; 479 (51.0%) received tenecteplase and 460 (49.0%) alteplase. Among the 498 patients (53.0%) treated with endovascular thrombectomy (EVT), angiographic outcomes were comparable between treatment groups. A significant interaction was observed between thrombolysis type and thrombus length; longer thrombi were associated with reduced likelihood of modified Rankin Scale (mRS) 0-1 with alteplase (adjusted odds ratio (aOR) per 1 mm increase, 0.97 (95% confidence interval (CI): 0.95-1.00)), but not with tenecteplase (aOR: 1.00 (95% CI: 0.98-1.02); interaction p = 0.04). Similarly, the presence of residual flow within the thrombus was associated with higher odds of mRS 0-2 in the alteplase group (aOR: 2.00 (95% CI: 1.25-3.20)), but had no significant effect in the tenecteplase group (aOR: 0.93 (95% CI: 0.62-1.41); interaction p = 0.01). No other significant interactions between thrombus characteristics and thrombolysis type were identified.</p><p><strong>Conclusion: </strong>In the AcT trial, alteplase appeared less effective with longer thrombi and those lacking residual flow, whereas IV tenecteplase showed more consistent effectiveness across thrombus characteristics. These findings require confirmation in future prospective studies.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261473813"},"PeriodicalIF":6.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549085","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":"Venous Thrombotic and Thromboembolic Considerations in Stroke: An Expert Meeting Report on Future Directions for Clinical Trials.","authors":"Diana N Vikulova, Vanessa Dizonno, Lily Zhou, Johnathon Gorman, Ronda Lun, Katrina Hd Ignacio, Cheryl D Bushnell, Aravind Ganesh, Aristedis H Katsanos, Luciano A Sposato, Sara Db Rosa, Alejandro Fuerte-Hortigon, Diana Aguiar de Sousa, Cheryl Carcel, Nishita Singh, Tony Wan, Bethany T Samuelson Bannow, Hetao Bian, Chen Chen, Jonathan M Coutinho, Andrew M Demchuk, Darshan Doshi, Mehdi Farhoudi, Ana Catarina Fonseca, Vivian Fu, Mirjam R Heldner, Menglu Ouyang, Emily R Ramage, Ivy Sebastian, Ronen R Leker, Craig S Anderson, Bijoy K Menon, Thalia S Field","doi":"10.1177/17474930261473348","DOIUrl":"10.1177/17474930261473348","url":null,"abstract":"<p><strong>Background: </strong>Venous thrombosis and venous thromboembolism (VTE) are important causes and complications of stroke. They may complicate acute stroke as deep venous thrombosis or pulmonary embolism (DVT/PE), contribute causally to ischemic stroke through paradoxical embolism from a patent foramen ovale (PFO), or present directly as cerebral venous thrombosis (CVT). Despite shared pathophysiological features and overlapping antithrombotic strategies, these conditions are typically considered separately, fragmenting evidence and limiting the exchange of concepts.</p><p><strong>Purpose: </strong>We therefore convened experts across both stroke neurology and thrombosis medicine fields to examine these conditions under a unifying venous theme and define priorities for future clinical trials.</p><p><strong>Methods: </strong>Thirty-two stroke and thrombosis clinicians and researchers identified research priorities across three domains: prevention of VTE after stroke, secondary prevention after PFO-related stroke, and acute and long-term management of CVT. Structured discussions were guided by the PICO (Population, Intervention, Comparison, Outcome) framework, followed by a Delphi survey to establish consensus. Priority questions centered on the balance between thrombosis prevention and bleeding risk and the optimal timing, duration, and choice of DVT/PE prophylaxis after stroke; the optimal antithrombotic strategy for patients awaiting or forgoing PFO closure; and, for CVT, the role of endovascular therapy in severe disease and the optimal duration of secondary prevention (Graphical Abstract). Across domains, the group prioritized pragmatic and platform trial designs, integration with international registries to address the rarity of CVT, and patient-oriented outcomes that extend beyond functional recovery.</p><p><strong>Conclusions: </strong>By considering these venous conditions together and bridging stroke and thrombosis disciplines, this work defines priority questions to address persistent evidence gaps, harmonize practice, and improve patient-centered outcomes.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261473348"},"PeriodicalIF":6.9,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520408","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":"Device-detected atrial high-rate episodes and risk of ischemic stroke and progression to atrial fibrillation: A systematic review and meta-analysis.","authors":"Jessica Dlima, Ann-Marie Beaudoin, Han S Lim, Jan Ho, Vincent Thijs","doi":"10.1177/17474930261472691","DOIUrl":"10.1177/17474930261472691","url":null,"abstract":"<p><strong>Background: </strong>There is a well-established association between atrial fibrillation (AF) and an increased risk of ischemic stroke; new evidence, however, suggests that atrial high-rate episodes (AHREs), a subset of atrial tachycardia (AT), may also contribute to this risk. Through cardiac remodeling pathways and physiological changes, a multi-faceted risk of stroke exists. Our review suggests there is an increased risk of ischemic stroke in the presence of AHREs and, additionally, a greater risk of developing overt AF after these events. There are, however, many inconsistencies within the studies including ambiguity surrounding AHRE definitions and control for anticoagulation and concurrent AF episodes that are not often reported. Further research is warranted to better define atrial high-rate episodes and to further characterize this relationship. While there is clinical direction for anticoagulation in patients with AF, there are no standardized indications for intermediate durations of AHREs and oral anticoagulation is largely determined on an individual basis. Given this gap within clinical practice, we performed a review of the literature to explore if a relationship between episodes of AHREs and ischemic stroke exists, excluding those with a history of prior AF.</p><p><strong>Aims: </strong>To systematically review and meta-analyze the association between device-detected AT/AHREs and (1) risk of ischemic stroke and (2) progression to clinical AF, excluding patients with a prior history of AF.</p><p><strong>Summary of review: </strong>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (PROSPERO CRD42022337209). MEDLINE, EMBASE, and Cochrane databases were searched up to 10 March 2025. Nine studies (n = 5099 patients) met inclusion criteria. Overall, 33.7% experienced at least one AHRE, and 2.5% developed a thromboembolic event during follow-up. A meta-analysis of six studies demonstrated a 2.6-fold increased risk of ischemic stroke in patients with AHREs (pooled hazard ratio (HR) = 2.59, 95% confidence interval (CI) = 1.54-3.64; I² = 0%). A second meta-analysis demonstrated a 4.5-fold increased risk of progression to AF (pooled effect size = 4.51, 95% CI = 1.50-7.51; I² = 73.1%). Among the reviewed studies, definitions of AHRE duration and rate varied substantially.</p><p><strong>Conclusions: </strong>Device-detected AHREs are associated with a significantly increased risk of ischemic stroke and progression to clinical AF in patients without prior AF. While the magnitude of stroke risk is lower than that reported for overt AF, AHREs represent a clinically meaningful risk marker. Standardized definitions and burden thresholds are required to guide anticoagulation strategies and optimize stroke prevention.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261472691"},"PeriodicalIF":6.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470587","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":"Randomization of endovascular treatment with stent-retriever and/or thromboaspiration versus best medical therapy in acute ischemic stroke due to large vessel occlusion in the extended time window trial (RESILIENT-Extend): Rationale and design.","authors":"Sheila O Martins, Gisele S Silva, Francisco J Montalverne, Leticia Costa Rebello, Fabricio O Lima, Mario W Wagner, Daniel G Abud, Leonardo A Carbonera, Ana C Souza, Jamary Oliveira-Filho, Daniel C Bezerra, Octávio M Pontes-Neto, Raul G Nogueira","doi":"10.1177/17474930261472689","DOIUrl":"10.1177/17474930261472689","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials have demonstrated substantial benefit of mechanical thrombectomy (MT) in selected patients treated 6-24 h after stroke onset. However, these trials relied on advanced imaging not typically available in resource-constrained settings. The RESILIENT-Extend trial aims to evaluate the efficacy and safety of MT in the 8- to 24-h window using a pragmatic imaging selection based on non-contrast computed tomography (CT) and CT angiography alone.</p><p><strong>Methods: </strong>RESILIENT-Extend is a multicenter, randomized, controlled, open-label, blinded-endpoint, phase 3 trial conducted in Brazil. The planned sample size is 376 participants. Patients presenting with anterior-circulation large vessel occlusion within 8-24 h from time last known well will be randomized 1:1 to receive either MT plus best medical management (BMM) or BMM alone. The trial uses a minimization algorithm to balance prognostic variables including age, National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), occlusion site, time window, and clinical site. The primary outcome is the distribution of 90-day modified Rankin Scale scores assessed by blinded central adjudication.</p><p><strong>Discussion: </strong>RESILIENT-Extend is one of the first randomized trials to evaluate MT in the extended window using a pragmatic selection strategy based exclusively on widely available imaging modalities (non-contrast CT and CT angiography), with a focus on scalability in real-world and resource-constrained settings.</p><p><strong>Trial registration: </strong>clinicaltrials.govNCT04256096.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261472689"},"PeriodicalIF":6.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470620","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":"Recovery-focused community support to avoid readmissions and improve participation after stroke: A multicenter randomized controlled trial.","authors":"Dominique A Cadilhac, Janette Cameron, Monique F Kilkenny, Nadine E Andrew, Olivia Brancatisano, Geoffrey C Cloud, Ian Kneebone, Amanda G Thrift, Maree Hackett, Rohan Grimley, Sandy Middleton, Avril Drummond, Muideen Olaiya, Vincent Thijs, Henry Ma, Rajesh Khanna, Darshan Ghia, Kylie Tastula, Natasha A Lannin","doi":"10.1177/17474930261472686","DOIUrl":"10.1177/17474930261472686","url":null,"abstract":"<p><strong>Background: </strong>Evidence is lacking on whether support and education programs, facilitated by mobile technology, benefit people with stroke.</p><p><strong>Aims: </strong>The primary aim was to determine the effectiveness of a co-designed, eHealth self-management intervention for reducing unplanned hospital presentations.</p><p><strong>Methods: </strong>Prospective, multicenter randomized controlled trial with blinded outcome assessment and intention-to-treat analysis. Randomization (1:1, stratified by age and level of disability at baseline) within 2 weeks of hospital discharge. Participants aged ⩾18 years with modified Rankin Scale (mRS) score 0-4 were recruited from 11 Australian hospitals. To maintain blinding, all participants co-developed three to five self-management goals with a trained clinician-researcher, using a standardized approach. Following randomization, participants were allocated to receive personalized, goal-centered electronic messages (intervention) or administrative messages (active control) over 12 weeks via text or email. The groups were not informed about the number of messages they would receive and were unaware that only the intervention group had their messages tailored to their goals. The primary outcome was unplanned hospital presentations (emergency department/admission) within 90 days post-randomization. Secondary outcomes included goal attainment, self-efficacy, and various health outcomes. We used generalized mixed-effects regression model with a logistic link for categorical outcomes and Cohen's d (0.2 considered small effect, 0.5 moderate-1.0 large) to assess within-group change.</p><p><strong>Results: </strong>The trial was impacted by COVID-19 and ceased with 556/890 planned participants; 465 were randomized (n = 234 control, n = 231 experimental), a median of 10 days post-discharge (median age 67.2 years, 67.1% male, median 3 goals/participant). Primary outcome assessments for 222 control and 218 experimental participants showed no between-group differences for unplanned hospital presentations (odds ratio (OR): 1.32; 95% confidence interval (CI): 0.52-3.34). Compared to controls at 90 days, a larger proportion of the experimental group had >3 unmet needs and slight to severe disability (both <8% difference). Both groups showed non-significant improvements in goal attainment at 90 days post-randomization; overall attainment was stronger among intervention participants (within-group change Cohen's d intervention 0.76 vs 0.61).</p><p><strong>Conclusion: </strong>We found no evidence that tailored, electronic messaging over 12 weeks, in addition to structured goal-setting reduced unplanned hospital presentations. Future research is needed to understand the role of disability and unmet needs, and factors that influence goal attainment.</p><p><strong>Trial registration: </strong>ACTRN12618001468213, U1111-1206-7237.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261472686"},"PeriodicalIF":6.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470625","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":"World Stroke Organization (WSO) rehabilitation certification program.","authors":"Jessica Nolan, Kwah Li Khim, Dorcas Bc Gandhi, Jussara A Oliveira Baggio, Shamala Thilarajah, Marina Charalambous, Emily A Stevens, Fiona J Rowe, Marie-Louise Bird, Nevine El Nahas, Sanjana Gururaj, Patricia Meier, Sharon D Ignacio, Jeyaraj D Pandian, Rachel C Stockley, Julie Bernhardt, Sheila Martins, Gillian Mead, Simiao Wu, Norhayati Hussein, Thoshenthri Kandasamy, Sean I Savitz, Elizabeth A Lynch","doi":"10.1177/17474930261463019","DOIUrl":"10.1177/17474930261463019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Rehabilitation has been identified by the World Stroke Organization (WSO) as a key priority to reduce the global burden of stroke. Global access to rehabilitation is inconsistent and is particularly limited in low-and-middle-income countries. Progress in rehabilitation has not been as well evidenced as progress in acute care. The WSO certification program, which commenced in 2021, focuses on acute interventions. A rehabilitation certification program, applicable in both inpatient and outpatient rehabilitation settings, has been developed to complement the acute certification program to address global implementation of evidence-based stroke care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To develop globally applicable, evidence-based, stroke rehabilitation recommendations and performance metrics for use in a stroke rehabilitation certification program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Strong recommendations were extracted from high-quality stroke rehabilitation Clinical Practice Guidelines, systematic reviews and syntheses of clinical practice guidelines, and from the defining criteria of the International Stroke Recovery and Rehabilitation Alliance (ISRRA) Centers of Clinical Excellence. The WSO Rehabilitation Implementation Committee led the development of the recommendations and invited input from three international, multidisciplinary consultation groups. Group 1 compared strong recommendations from the Australia/New Zealand Living Guidelines with other international guidelines to identify consistent, high-quality recommendations. Group 2 mapped recommendations from global guideline syntheses against the Australia/New Zealand Living Guidelines. Group 3 reviewed and adapted the ISRRA Center of Clinical Excellence recommendations. Recommendations were consolidated through consensus meetings involving representatives from each workgroup, including people from high, upper-middle, and lower-middle-income countries. Strong recommendations that were consistent across teams, alongside additional recommendations based on certainty of evidence, anticipated risk versus benefit, and relevance across settings, were included as patient-level recommendations in the implementation certification program. Service-level recommendations were generated through consensus or derived from existing guidelines. An implementation manual, outlining \"what,\" \"who,\" and \"how,\" as well as indicators to demonstrate performance of each recommendation, was developed to support clinical implementation and to facilitate assessment for certification. The criteria were piloted between November 2024 and September 2025 at 15 centers in six upper- and lower-middle-income countries (three continents) and subsequently refined. Expectations (mandatory or recommended) for each level of certification (Minimal, Essential and Advanced) were set post-pilot through rating strength of evidence, a series of group discussions and review of pilot data.ResultsFifty-five recommendat","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261463019"},"PeriodicalIF":6.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375683","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":"First World Health Organization resolution on stroke at the Seventy-ninth World Health Assembly: A turning point for global stroke prevention, care, and health-system readiness.","authors":"Kouamivi Agboyibor, Seyyed-Hadi Ghamari, Sok Cin Tye, Nicoline Schiess, Tarun Dua, Jeyaraj Durai Pandian, Maria Fredin Grupper, Sheila Ouriques Martins, Bo Norrving, Alarcos Cieza","doi":"10.1177/17474930261452532","DOIUrl":"10.1177/17474930261452532","url":null,"abstract":"<p><strong>Background: </strong>Stroke is the second leading cause of death and the third leading cause of disability worldwide, with global economic costs exceeding US $890 billion annually and a projected 50% rise in deaths between 2020 and 2050. So far, stroke has been addressed within the World Health Organization (WHO) Global Noncommunicable Disease (NCD) Action Plan 2023-2030 and the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031, but until now, no World Health Assembly resolution has been specifically dedicated to stroke.</p><p><strong>Objectives: </strong>To present the first WHO Resolution specifically dedicated to stroke (EB158/CONF./9), describe its content and significance, and analyze its implications for global public health.</p><p><strong>Methods: </strong>This article presents and analyzes resolution EB158/CONF./9-\"<i>Reducing the burden of stroke: strengthening prevention, acute care, rehabilitation and health-system readiness</i>\", as advanced by the WHO Executive Board at its 158th session on 3 February 2026 and adopted by the Member States in the Seventy-ninth World Health Assembly.Key content of the resolution:In February 2026, the 158th session of the WHO Executive Board advanced the first WHO resolution dedicated to stroke, proposed by Egypt and co-sponsored by Chile, Georgia, Palestine, Paraguay, and Tunisia, and adopted by Member States at the Seventy-ninth World Health Assembly. The resolution frames stroke as a continuum of care and sets out 16 operative actions for Member States (OP1), organized under three categories: (1) primary interventions across the prevention spectrum; (2) acute care and rehabilitation; and (3) surveillance and data; all underpinned by a health-system strengthening approach. A further eight requests to the Director-General (OP2) provide WHO's mandate to act, covering normative guidance, technical support, monitoring, research, medicine access, regional cooperation, and progress reporting.Public health implication:The resolution establishes a comprehensive stroke action plan across the full continuum of care. Its legacy will depend not on its adoption in Geneva but on whether political commitment is matched by sustained implementation, investment, robust monitoring, and accountability grounded in stroke-specific indicators.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"735-741"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837590","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}