International Journal of Stroke最新文献

{"title":"Stroke patterns, risk factors, management, and outcomes from hospital-based stroke registries in India.","authors":"Prashant Mathur, Deepadarshan Huliyappa, Prathyusha Pv, Vinay Urs, Rahul Rajendra Koli, Sureshkumar N, Kavyashree Seenappa","doi":"10.1177/17474930251393187","DOIUrl":"10.1177/17474930251393187","url":null,"abstract":"<p><strong>Background: </strong>India is facing a growing burden of stroke due to population aging, lifestyle changes, and increased exposure to risk factors. However, longitudinal data on stroke patterns and outcomes in India are limited.</p><p><strong>Objectives: </strong>This study assessed stroke patterns, risk factors, management practices, and outcomes using data from the Hospital-Based Stroke Registries (HBSRs) in India.</p><p><strong>Methods: </strong>This prospective hospital-based registry included 34,792 stroke cases from 30 centers across India, recorded between 2020 and 2022. Data on demographics, clinical features, risk factors, diagnostics, treatments, and outcomes were collected, with follow-up at 28 days and 3 months. Functional outcome was assessed using the modified Rankin Scale (mRS), along with data on recurrence.</p><p><strong>Results: </strong>The mean age was 59.4 years; 13.8% were aged under 45, 63.4% were male, and 72.1% were from rural areas. Hypertension (74.5%) was the most common risk factor, followed by smokeless tobacco use (28.5%) and diabetes mellitus (27.3%). Ischemic stroke accounted for 60% of cases. Only 20.1% were presented within 4.5 h of symptom onset, while 37.8% of cases presented after 24 h. Motor impairment (74.8%) followed by speech disturbance (51.2%) were the commonest symptoms at onset. Thrombolysis was given in 4.6%, and thrombectomy in 0.7%, of ischemic strokes. At 3 months, 27.8% had died, 29.7% had significant disability (mRS 3-5), and 1.1% had a recurrent stroke.</p><p><strong>Conclusion: </strong>In this study, one in 7 stroke were in the young, 2 in 5 patients arrived after 24 h of symptom onset, and thrombolysis and mechanical thrombectomy were underutilized. Over half had poor 3-month outcomes, highlighting the need for improving comprehensive stroke care across India.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"827-838"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917598","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":"Stroke and climate change: A World Stroke Organization scientific statement.","authors":"Ali Saad, Maria Khan, Conrado Estol, Mohammad Wasay, Tomoaki Kameda, Teresa Ullberg, Yannick Béjot, Serefnur Ozturk, Maria Epifania Collantes, Carol Zavaleta-Cortijo, Janice Kang, Alexandra Macmillan, Daniel G Kingston, Janet Stephenson, Jacques Reis, Anna Ranta","doi":"10.1177/17474930261436535","DOIUrl":"10.1177/17474930261436535","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Climate change poses an escalating threat to global brain health and is increasingly linked to stroke incidence, outcomes, and inequities in prevention and treatment. This World Stroke Organization scientific statement summarizes current evidence on the associations between stroke and the environmental variables exacerbated by climate change, with a focus on risk and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We systematically identified and reviewed published studies assessing associations between stroke and environmental variables, including extreme temperatures, temperature variability, humidity, barometric pressure, wildfires, dust and sandstorms, and compound weather events. Air pollution, unrelated to wildfire exposure, was excluded, as a subsequent statement will focus on this. Paired reviewers screened titles and abstracts. Full texts were evaluated for study design, sample size, geographic context, and strength of evidence, with attention to impacts on vulnerable populations where data were available. Study type, exposure assignment, and strength of evidence were further confirmed by a team member with Master's level qualification in epidemiology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Most of the included studies were based on ecological designs. Cold exposure, temperature variability, and extreme thermal events were most consistently associated with increased stroke risk. Although cold effects were generally stronger than heat effects, heat effects have been increasing over time. Increased stroke incidence was also associated with low or varying barometric pressure, rapid humidity shifts, and exposure to wildfire smoke, dust, and sandstorms, particularly among older adults and those in low- and middle-income countries. Compound weather events, such as concurrent heat and humidity extremes, showed additive or synergistic effects on stroke incidence and mortality. Despite heterogeneity in definitions and methods and most evidence supporting associations rather than proving causation, the overall direction of evidence across exposures was positive, coherent, and biologically plausible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Recommendations: &lt;/strong&gt;Advancing mitigation efforts that reduce greenhouse gas emissions is essential, since limiting further climate change directly decreases the environmental drivers of stroke risk and protects long-term population brain health, along with broader climate-related health risks. Stroke professionals and organizations can meaningfully contribute through local, regional, and global advocacy. Climate-related environmental variables already meaningfully increase stroke risk and exacerbate existing health inequities. To further counter these trends, stroke prevention and care systems should integrate climate risk awareness, patient education, and early-warning mechanisms into clinical practice and health system planning. Priority areas include targeted protection for vulnerable groups, standardized expos","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"742-758"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463310","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":"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}

{"title":"Rates and risk factors for major adverse cardiovascular and cerebrovascular events after stroke due to intracerebral hemorrhage: Systematic review and study-level meta-analysis.","authors":"Vega Pratiwi Putri, Neshika Samarasekera, Tom J Moullaali, Saketh Jampana, Joseph Aked, Signild Åsberg, Sam Schulman, Georgios Tsivgoulis, Maria Pikilidou, Hsin-Hsi Tsai, Li-Kai Tsai, Phyo Kyaw Myint, Tiberiu A Pana, Charlotte Cordonnier, Barbara Casolla, David Gaist, Alessandro Pezzini, Pol Camps-Renom, Catharina J M Klijn, Michele Romoli, Arnstein Tveiten, Ming Liu, Mangmang Xu, Bo Wu, David Werring, Philip S Nash, Gargi Banerjee, Linxin Li, Rustam Al-Shahi Salman","doi":"10.1177/17474930261416692","DOIUrl":"10.1177/17474930261416692","url":null,"abstract":"<p><strong>Background: </strong>Intracerebral hemorrhage (ICH) survivors are at increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared with population controls; however, little is known about the annual rates and risk factors for MACE.</p><p><strong>Methods: </strong>We searched Medline, Embase, and trial registries systematically in April 2024 for studies of adults with ICH, reporting either a MACE composite outcome or both ischemic and hemorrhagic outcomes, with at least one year of follow-up. We excluded studies limited to secondary ICH or isolated non-ICH intracranial hemorrhages. We used the QUIPS tool to assess studies' risk of bias. The primary outcome was the rate of MACE. We used a random-effects meta-analysis to estimate the annual event rate (per 100 person-years, expressed as %) for each outcome. We conducted subgroup analyses and meta-regression to explore heterogeneity.</p><p><strong>Results: </strong>We included 26 studies, involving 198,289 ICH survivors. Individual studies' reported annual rate of MACE ranged 4.2-14.6%. The pooled annual rate of recurrent ICH was 2.1% (95% confidence interval (CI) = 1.7-2.6; 26 studies; I² = 94%) and of ischemic stroke was 2.0% (95% CI = 1.5-2.7; 24 studies; I² = 95%). Meta-regression analyses identified one statistically significant association between a higher prevalence of atrial fibrillation and an increased risk of ischemic stroke.</p><p><strong>Discussion: </strong>The rates of recurrent ICH and ischemic stroke were comparable among ICH survivors, but evidence about other MACE outcomes remains limited. An individual participant data meta-analysis is needed to investigate the predictors of MACE outcomes, which may help inform risk stratification and prognosis among ICH survivors.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"778-787"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283597","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":"Safety and tolerability of Rinvecalinase Alfa (DM199) for acute ischemic stroke (ReMEDy1).","authors":"Bruce Cv Campbell, Scott E Kasner, Annette D Lista, John J Volpi, Timothy J Kleinig, Dennis Cordato, Helen M Dewey, Philip Mc Choi, Carlos Garcia-Esperon, Ramesh Sahathevan, Tissa Wijeratne, Andrew A Wong, Darshan Ghia, Geoffrey C Cloud, Michael Giuffre, Philip M Bath","doi":"10.1177/17474930251396480","DOIUrl":"10.1177/17474930251396480","url":null,"abstract":"<p><strong>Background: </strong>Rinvecalinase alfa (DM199), a recombinant form of human tissue kallikrein-1 (KLK1), aims to promote local vasodilation to ischemic brain and enhance collateral blood flow. The ReMEDy1 trial tested the safety and tolerability of rinvecalinase alfa in ischemic stroke.</p><p><strong>Methods: </strong>ReMEDy1 was a phase II, randomized, double-blind, placebo-controlled, study conducted at 13 Australian sites. Ninety-two patients with NIH Stroke Scale (NIHSS) 6-25 were enrolled within 24 h of ischemic stroke onset. Patients were randomized 1:1 to receive rinvecalinase alfa (1 µg/kg intravenous infusion followed by 3 µg/kg subcutaneously every 3 days for 22 days) or placebo. The primary outcome was safety, assessed by adverse events (AEs) and serious adverse events (SAEs). Secondary outcomes included changes in NIHSS, modified Rankin Scale (mRS), and Barthel Index (BI) at Days 22 and 90. Post hoc analyses excluded patients who underwent endovascular therapy (EVT).</p><p><strong>Results: </strong>The median age was 72, NIHSS 10, and onset-to-randomization was 19.5 h. SAEs were reported in 20/47 (43.5%) rinvecalinase alfa patients and 14/45 (31.1%) placebo patients. Most patients experienced at least one AE; the most common in the rinvecalinase alfa group were constipation (60.9%), oral candidiasis (23.9%), and nausea (17.4%). Stroke-in-evolution by Day 90 occurred in 0 (0%) rinvecalinase alfa patients versus 6 (13.3%) placebo patients; 4/6 (66.7%) placebo patients with stroke-in-evolution died. No significant differences were observed in secondary efficacy outcomes at Day 90. Post hoc analyses in patients not treated with EVT suggested a tendency toward improved excellent global outcomes with rinvecalinase alfa.</p><p><strong>Conclusions: </strong>Rinvecalinase alfa appeared to be safe and generally well-tolerated in ischemic stroke patients, with potential efficacy in reducing stroke progression. Further studies are needed to confirm efficacy and long-term benefits in patients without EVT.</p><p><strong>Registrations: </strong>https://www.</p><p><strong>Clinicaltrials: </strong>gov/study/NCT03290560.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"861-870"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451798","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":"Dyslipidemia management in stroke prevention: An individualized approach.","authors":"Maria-Ioanna Stefanou, Evangelos Panagiotopoulos, Evangelos Liberopoulos, Haralampos Milionis, Aikaterini Theodorou, Mira Katan, Diana Aguiar de Sousa, Lina Palaiodimou, Charalampos Vlachopoulos, Gerasimos Siasos, Sotirios Giannopoulos, Georgios Tsivgoulis","doi":"10.1177/17474930261418388","DOIUrl":"10.1177/17474930261418388","url":null,"abstract":"<p><p>Dyslipidemia remains a major, modifiable determinant of global stroke burden, accounting for more than one-fifth of ischemic strokes (IS) worldwide. Recent evidence has shifted emphasis from conventional lipid fractions to apolipoprotein B (ApoB)-containing lipoproteins, including lipoprotein(a) [Lp(a)], which more accurately reflect atherogenic particle burden than low-density lipoprotein cholesterol (LDL-C) alone and are increasingly used for stroke risk stratification. While the principle \"the faster and the lower, the better\" underpins dyslipidemia management, evidence-based, subtype-specific lipid strategies in stroke remain limited. Intensive LDL-C reduction significantly lowers recurrent IS risk; however, uniform lipid targets are often applied without accounting for stroke etiology. High-intensity statins remain first-line therapy, with pleiotropic benefits extending beyond LDL-C reduction. For statin intolerance or suboptimal response, ezetimibe and PCSK9 inhibitors provide potent, bleeding-neutral LDL-C lowering. Inclisiran and bempedoic acid broaden therapeutic options, although stroke-specific efficacy data are still pending. Lp(a)-lowering agents, including pelacarsen, olpasiran, and lepodisiran, are under active evaluation and may address residual cardiovascular risk. For triglyceride lowering, recent randomized evidence supports icosapent ethyl for reducing IS risk. In intracerebral hemorrhage (ICH), the optimal intensity and thresholds of lipid lowering remain uncertain, warranting individualized weighting of ischemic against hemorrhagic risk, particularly in patients with lobar ICH or suspected cerebral amyloid angiopathy (CAA). In such cases, hydrophilic statins, ezetimibe, or PCSK9 inhibitors may represent reasonable options. This review synthesizes current evidence and proposes a phenotype-guided, individualized framework for dyslipidemia management across stroke subtypes. Moving beyond uniform targets toward etiologic and genetically informed lipid modulation may improve post-stroke outcomes and refine individualized stroke prevention.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"759-777"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of causal pathways of socioeconomic inequalities in stroke.","authors":"Camila Pantoja-Ruiz, Lu Liu, Evelyn Lim, Marina Soley-Bori, Wasana Kalansooriya, Eva Emmett, Abdel Douiri, Yanzhong Wang, Ajay Bhalla, Amal R Khanolkar, Divya Parmar, Sabine Landau, Matthew Dl O'Connell, C D A Wolfe, Iain J Marshall","doi":"10.1177/17474930251399064","DOIUrl":"10.1177/17474930251399064","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status (SES), often measured by education, income, occupation, or area-level deprivation, impacts stroke incidence and outcomes, yet the underlying mechanisms remain unclear. This review synthesizes causal analyses quantifying drivers of these inequalities.</p><p><strong>Methods: </strong>We conducted a systematic review (PROSPERO CRD42024554285) and reported following the PRISMA-2020 guidelines. Observational studies applying causal mediation analysis between SES and stroke risk, disability, or mortality were included from PubMed, Embase, Scopus, and Google Scholar. SES indicators, outcomes, mediators, and decompositions into natural direct effect (NDE) and natural indirect effect (NIE) were extracted. Risk of bias and certainty of evidence were assessed using ROBINS-E and GRADE. A narrative synthesis was undertaken, and findings were illustrated in causal diagrams.</p><p><strong>Results: </strong>Of 12,034 records, 19 studies (15 in high-income countries) were included. Lower SES increased stroke incidence through hypertension (NIE 14-21% of the total effect, moderate certainty), although one study restricted to women reported smaller effects (2-4%). Smoking (6-19.9%, very low certainty). At 3 months post-stroke, the combined outcome of death or disability was higher due to severe strokes (38.5% for ischemic, 57-94% for hemorrhagic, moderate certainty). One study found that hypertension, atrial fibrillation, and smoking together mediated 28.5% of the SES effect on stroke severity (low certainty). Reduced access to thrombolysis and stroke units mediated 2.7% of 3-month disability/mortality (very low certainty), while greater distance to specialized centers explained 48% of inequalities in thrombectomy access (low certainty). Long-term mortality (⩾6 months) was mediated by comorbidities (18%) and healthcare coverage (24-55%), both with low certainty.</p><p><strong>Conclusions: </strong>Hypertension, smoking, and differential stroke severity at presentation are the main pathways through which low SES increases stroke risk and causes worse outcomes. Targeting these may reduce inequalities, though evidence from low-income settings and emerging mediators (e.g. early-life SES, environmental exposures, care quality) is lacking.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"801-814"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495562","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":"Polygenic risk scores improve stroke risk stratification in Chinese adults: Validation from the Chinese multi-provincial cohort study.","authors":"Zongwei Wang, Pingping Jia, Pan Zhou, Yue Qi, Jiayi Sun, Jun Liu, Miao Wang, Qiuju Deng, Yongchen Hao, Na Yang, Lizhen Han, Jing Liu, Jie Du, Zhao Yang","doi":"10.1177/17474930251396062","DOIUrl":"10.1177/17474930251396062","url":null,"abstract":"<p><strong>Objective: </strong>To validate whether incorporating existing polygenic risk scores (PRSs) derived from East Asian or trans-ancestry populations into clinical risk equations improves stroke risk stratification in Chinese adults.</p><p><strong>Methods: </strong>Participants from the Chinese Multi-provincial Cohort study with genotyped data (n = 2931) were included. Four well-established PRSs (i.e., PRS-GBMI, PRS-GIGA, PRS-ChinaPAR, and PRS-MEGA) from either the predominantly Chinese or trans-ancestry populations were constructed and evaluated by assessing their associations with stroke and its subtypes. We tested the incremental predictive capability of the four PRSs for the 10- and 20-year risk of stroke and its subtypes after adding PRSs to recalibrated China-PAR stroke risk equations, based on discrimination, calibration, and reclassification.</p><p><strong>Results: </strong>Over a median follow-up period of 28.2 years, 340 stroke events were recorded. Higher PRSs were generally associated with a higher stroke risk, though only the highest quantile group of PRS-GIGA showed statistical significance (hazard ratio (HR): 1.79, 95% confidence interval (CI): 1.05-3.07). Adding PRS-GIGA to the recalibrated China-PAR stroke risk equations (i.e., the base model) yielded a moderate improvement in 20-year stroke risk, with 17.2% (95% CI: 3.8%-30.6%) more participants correctly categorized into their corresponding risk groups. However, for ischemic stroke, adding PRS-GIGA, PRS-ChinaPAR, and PRS-MEGA to the base model could correctly categorize 18.7%-23.8% more participants into their corresponding 10-year risk groups and 27.8%-32.5% more participants into their corresponding 20-year risk groups. Adding PRSs did not improve prediction for hemorrhagic stroke.</p><p><strong>Conclusion: </strong>Adding existing PRSs, particularly PRS-GIGA, to clinical risk equations can improve all stroke and ischemic stroke risk stratification in Chinese adults.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"879-888"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421536","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":"Lost to follow-up in randomized clinical trials on long-term patient management following stroke: A cross-sectional survey.","authors":"Peipei Du, Mingzhen Qin, Yan Liu, Xu Pang, Sijin Wang, Yixuan Li, Jierong Gao, Ziwen Xu, Chi Zhang","doi":"10.1177/17474930251394853","DOIUrl":"10.1177/17474930251394853","url":null,"abstract":"<p><strong>Background: </strong>Although long-term stroke management is critically important, poor patient adherence to follow-up appointments threatens the validity of clinical trials. This cross-sectional survey aimed to identify contributing factors and potential consequences of lost to follow-up (LTFU) in long-term stroke management trials.</p><p><strong>Methods: </strong>We searched Medline, Embase, Web of Science, Cochrane library, and Scopus from inception to 20 August 2024 for randomized controlled trials of multimodal post-stroke care initiated within 1 year of stroke. Data on general trial and methodological characteristics were extracted. Univariable random-effects meta-regression analyses were performed to identify LTFU predictors. Furthermore, we assessed how assumptions about LTFU affected effect estimates for significant binary primary outcomes.</p><p><strong>Results: </strong>Among 58 eligible reports (27,575 patients and 3349 caregivers), six trials (10.3%) did not specify patient LTFU, while 8 of 17 caregiver-inclusive trials (47.1%) omitted LTFU reporting of caregivers. The median follow-up was 12 months (interquartile range (IQR): 6-12), with LTFU rates of 9.0% (IQR: 3.2-15.4%) for patients and 14.0% (IQR: 6.8-20.7%) for caregivers. Higher LTFU odds correlated with a higher proportion of females (odds ratio (OR): 2.93, 95% confidence interval (CI): 1.30-9.29) and older age (OR: 3.05, 95% CI: 1.38-9.07). Trials involving multidisciplinary rehabilitation teams showed lower LTFU (OR: 0.05, 95% CI: 0.01-0.26). When assuming different event rates for LTFU patients, 0-14.3% of significant results were no longer significant.</p><p><strong>Conclusion: </strong>Overall, approximately 10% of stroke trials on long-term patient management still did not report LTFU. Identified potential risk factors may provide targets to improve the continuity of stroke management within these trial settings. Attention to patient management is critical for ensuring valid trial conclusions.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"850-860"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel rendezvous approach between mobile stroke units and EMS improves timely thrombolysis in rural areas.","authors":"Xiao Wu, Jialu Li, Tao Fu, Hongyun Wang, Wenting Zhang, Pengkun Fan, Fang Wu, Lu Wang, Fuxia Yang, Xueqiao Jiao, Lulan Li, Fangfang Zhang, Shanbin Liu, Xunming Ji, Xiuhai Guo","doi":"10.1177/17474930251393555","DOIUrl":"10.1177/17474930251393555","url":null,"abstract":"<p><strong>Background: </strong>Mobile stroke units (MSUs) improve outcomes in acute ischemic stroke (AIS), but their effectiveness is constrained by limited service radii. Integrating a rendezvous strategy with emergency medical services (EMS) may extend the operational reach of MSUs in rural areas.</p><p><strong>Aim: </strong>We evaluated whether a novel rendezvous approach between MSUs and EMS could enhance thrombolysis efficiency for rural AIS patients in a larger service area.</p><p><strong>Methods: </strong>We conducted a single-center, pragmatic, non-randomized, operationally allocated comparative study in Suzhou, Anhui, from 1 January to 31 December 2024. When a suspected stroke call originated from a remote location, a nearby conventional ambulance was dispatched. Subsequently, the MSU was dispatched via an EMS call, met the EMS at a predetermined midway point en route to the stroke center, and treated the patient when MSU was available. Inclusion criteria were: age ⩾ 18 years; onset location ⩾ 20 km from the MSU center; and onset-to-call time ⩽ 4 h. Patients with a final diagnosis of cerebral ischemia were analyzed based on transport method (MSU rendezvous vs EMS only). The primary outcome was the thrombolysis rate; secondary outcomes included time metrics, 90-day functional prognosis, and incidence of symptomatic intracranial hemorrhage (sICH). Propensity score matching (PSM) was used to balance baseline characteristics.</p><p><strong>Results: </strong>A total of 307 patients with AIS were included; the median age was 72 years (IQR, 63-79), and 192 (62.50%) were male. One hundred ninety-three patients were transferred through rendezvous transport, and 114 patients were transferred through EMS-only. The median distance from onset location to hospital in the rendezvous transport group was 39.00 km (24.23 miles) (IQR 30.00-47.00 km), with a maximum of 68.00 km (42.25 miles). Compared with EMS-only transfers, patients transferred through rendezvous transport had a nearly 3-fold increase in thrombolysis rates (68.90% vs 17.50%, <i>p</i> < 0.001), reduced dispatch-to-door time by 12.5 min, door-to-needle time by 46 min, and onset-to-needle time by 60 min (all <i>p</i> < 0.001). In addition, in terms of clinical outcomes, patients in the rendezvous group had lower median 90-day modified Rankin Scale scores (2.0 (1.0-3.0) vs 3.0 (1.5-5.0), <i>p</i> < 0.001). These findings remained consistent after PSM.</p><p><strong>Conclusion: </strong>Our study demonstrates that the novel MSU-EMS rendezvous approach significantly improves thrombolysis rates and functional outcomes, serving as a viable strategy to expand acute stroke care to remote populations.Data access statement:Data collected for the study may be made available from the corresponding author to others upon reasonable request.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"839-849"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367946","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}