Journal of Stroke最新文献

{"title":"Direct Transport to a Comprehensive Stroke Center May Offer Outcome Benefits in Metropolitan Thrombectomy Networks.","authors":"Péter Orosz, Zoltán Kővári, Henriette Mészáros, Álmos Hunor Bata, Balázs Kis, Máté Pásztor, Péter Pál Böjti, Loránd Erőss, István Szikora, Béla Merkely, Zsolt Berentei, Ákos Kornfeld, Máté Kondor, Sándor Nardai","doi":"10.5853/jos.2025.06758","DOIUrl":"10.5853/jos.2025.06758","url":null,"abstract":"<p><strong>Background and purpose: </strong>The optimal prehospital transport strategy for patients eligible for mechanical thrombectomy remains debated. We evaluated how direct versus secondary transfer to a comprehensive stroke center (CSC) influences outcomes in a large metropolitan stroke network.</p><p><strong>Methods: </strong>This prospective registry-based cohort study included all patients undergoing thrombectomy between 2015 and 2022 in a city of 1.7 million inhabitants. The network comprised 11 primary stroke centers (PSCs) referring to a single CSC, all reachable within 60 minutes. Among 2,017 patients, 242 (12.0%) were transported directly to the CSC, whereas 1,775 (88.0%) were secondarily transferred after initial assessment at a PSC. Functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Multivariable logistic and Cox regression models were used to identify independent predictors of good functional outcome and survival.</p><p><strong>Results: </strong>The median onset-to-CSC admission time was shorter after direct versus secondary transfer (101 [7-1,071] vs. 240 [40-1,411] min, P<0.001). A good functional outcome (mRS 0-2) was more frequent after direct transport (50.3% vs. 40.5%, P=0.015). After adjustment for age, National Institutes of Health Stroke Scale score, thrombolysis, posterior circulation stroke, and comorbidities, direct transport independently predicted good functional outcome (odds ratio: 1.74; 95% confidence interval [CI] 1.25-2.42; P=0.001). Among patients receiving combined thrombolysis and thrombectomy (n=1,110), direct transport was associated with improved long-term survival (log-rank P=0.026; adjusted hazard ratio: 0.67; 95% CI 0.47-0.95; P=0.026).</p><p><strong>Conclusions: </strong>Even within a metropolitan network with 1-hour access, direct transport to a CSC shortens treatment delays, improves functional recovery, and enhances survival among patients undergoing combined reperfusion therapy.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":"415-424"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends in the Distribution of Extracranial Carotid and Intracranial Artery Disease Among South Korean Stroke Patients.","authors":"Kyusik Kang, Nam Oh Kim, Michelle Sojung Youn, Jong-Moo Park, Jae Guk Kim, Soo Joo Lee, Dae-Hyun Kim, Jae-Kwan Cha, Tai Hwan Park, Jeong-Yoon Lee, Kyungbok Lee, Jun Lee, Hong-Kyun Park, Yong-Jin Cho, Keun-Sik Hong, Mi-Sun Oh, Kyung-Ho Yu, Byung-Chul Lee, Dong-Wan Kang, Beom Joon Kim, Jihoon Kang, Hee-Joon Bae","doi":"10.5853/jos.2025.06737","DOIUrl":"10.5853/jos.2025.06737","url":null,"abstract":"<p><strong>Background and purpose: </strong>To examine 16-year temporal trends in the distribution of symptomatic extracranial carotid artery disease (ECAD) versus intracranial artery disease (IAD) among South Korean patients with anterior-circulation steno-occlusive ischemic stroke, and to explore how evolving vascular risk profiles and their management may have influenced these patterns.</p><p><strong>Methods: </strong>Using the CRCS-K-NIH (Clinical Research Collaboration for Stroke in Korea-National Institute of Health) registry, we retrospectively included first-ever ischemic stroke patients admitted to 9 South Korean hospitals from April 2008 to December 2023. Patients with symptomatic ≥50% stenosis or occlusion in the anterior circulation were selected, while those with high-risk cardioembolic sources or rare stroke etiologies were excluded. Temporal trends in the proportions of symptomatic ECAD and IAD were evaluated across four time periods (2008-2011, 2012-2015, 2016-2019, and 2020-2023), and logistic regression was used to assess associations of periods and risk factors with ECAD and IAD.</p><p><strong>Results: </strong>Among 7,978 eligible patients, the unadjusted proportion with ECAD decreased linearly, whereas the unadjusted proportion with IAD remained stably predominant. Over the same period, age, diabetes and obesity prevalence, and pre-stroke use of antihypertensive, antidiabetic medications, and statins increased, while current smoking declined. Temporal trends in ECAD persisted after adjustment for baseline factors. Use of antihypertensive and antidiabetic medications and current smoking was not associated with the presence of ECAD, while statin use was associated with the presence of ECAD after adjusting for possible confounders.</p><p><strong>Conclusions: </strong>In South Korean patients with anterior-circulation steno-occlusive ischemic stroke, symptomatic ECAD has declined over 16 years, contrasting with the persistently high burden of IAD. Further research is needed to clarify what caused these trends.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"405-414"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Decade of Transformation in Stroke Care in South Korea (2013-2023): Increasing Ambulance Use but Persistent Prehospital Delay and Reversing Mortality Trends.","authors":"Jun Yup Kim, Seong-Eun Kim, Do Yeon Kim, Jihoon Kang, Beom Joon Kim, Yong Soo Kim, Dong-Wan Kang, Han-Gil Jeong, Tae Jung Kim, Hong-Kyun Park, Yong-Jin Cho, Jong-Moo Park, Kyungbok Lee, Soo Joo Lee, Ji Sung Lee, Juneyoung Lee, Yong Uk Kwon, Yu Ra Lee, Yu Jeong Lim, Hee-Joon Bae","doi":"10.5853/jos.2026.00360","DOIUrl":"10.5853/jos.2026.00360","url":null,"abstract":"<p><strong>Background and purpose: </strong>While stroke management has evolved rapidly, comprehensive nationwide evidence covering all stroke subtypes remains limited. We evaluated 10-year secular trends in acute stroke care and outcomes in South Korea using a mandatory national quality audit dataset.</p><p><strong>Methods: </strong>Data from the Acute Stroke Quality Assessment Program, covering nearly all general and tertiary hospitals in Korea, were linked with national insurance claims and mortality records. We analyzed 136,191 episodes of ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) from 2013 to 2023.</p><p><strong>Results: </strong>Over the decade, mean patient age increased (67.1 to 69.6 years), with the ≥85-year population doubling (7.2% to 13.4%). An unexplained discrepancy between ambulance use and arrival time emerged: ambulance use rose (55.4% to 61.8%), but median onset-to-arrival time remained stagnant (4.0 hours), with only 36.6% of IS patients arriving within 3 hours. While intravenous thrombolysis utilization remained stable at approximately 6.0% after 2014, endovascular thrombectomy rates more than doubled (5.3% to 11.6%), reaching 41.1% in severe cases. Statin (92.1%), non-vitamin K antagonist oral anticoagulant (78.4%), and dual antiplatelet therapy (67.2%) use increased markedly. In SAH, treatment shifted from clipping (36.7% to 12.2%) to coiling (36.0% to 63.4%). Notably, adjusted mortality exhibited a non-linear U-shaped trend, reaching a nadir in 2018 followed by an uptick after 2020.</p><p><strong>Conclusions: </strong>Despite substantial improvements in inpatient stroke care, the discrepancy between ambulance use and arrival time highlights structural challenges. Furthermore, the U-shaped mortality reversal underscores the vulnerability of healthcare resilience in a super-aging society, particularly under the strain of the COVID-19 pandemic.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":"425-436"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Patent Foramen Ovale-Associated Stroke: A Population-Based Study.","authors":"Romain Schneckenburger, Fabien Labombarda, Sarah Tragin, Estelle La Porte, Jean Bouchart, Marion Boulanger, Gwendoline Le Du, Marguerite Watrin, Emmanuel Touzé, Ahmad Nehme","doi":"10.5853/jos.2026.01186","DOIUrl":"10.5853/jos.2026.01186","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"481-484"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study.","authors":"Eung-Joon Lee, Matthew Chung, Han-Yeong Jeong, Jayoun Kim, Nan Hee Park, Min Kyoung Kang, Dongwhane Lee, Jinkwon Kim, Yo Han Jung, Sungwook Yu, Wook-Joo Kim, Han-Jin Cho, Kyungbok Lee, Tai Hwan Park, Mi Sun Oh, Ji Sung Lee, Joon-Tae Kim, Byung-Woo Yoon, Jong-Moo Park, Hee-Joon Bae, Keun-Hwa Jung","doi":"10.5853/jos.2026.02761","DOIUrl":"10.5853/jos.2026.02761","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recurrent ischemic stroke is a sentinel audit point for secondary prevention delivery. We quantified attainment of prevention indicators, sex- and age-related heterogeneity, and projected prevention gains.</p><p><strong>Methods: </strong>We analyzed 24,183 recurrent ischemic stroke admissions from 81 Korean Stroke Registry hospitals (2018-2023). Annual attainment of antithrombotic therapy, low-density lipoprotein cholesterol (LDL-C) <70 mg/dL, glycated hemoglobin (HbA1c) <7.0% in diabetes, non-current smoking, and normal weight (body mass index [BMI] 18.5-24.9 kg/m²) was age-standardized descriptively; temporal trends were assessed with hospital-clustered generalized estimating equation models. Projections combined observed implementation gaps with trial-derived relative risk reductions.</p><p><strong>Results: </strong>Antithrombotic use increased from 74.6% to 79.4% (odds ratio [OR]/year 1.05, 95% confidence interval 1.01-1.09), but plateaued after 2019, leaving 20.6% untreated in 2023. Among 4,441 patients with known atrial fibrillation (AF), oral anticoagulant use rose from 65.3% to 73.3% (OR/year 1.08; P=0.005), and 26.7% remained untreated. LDL-C <70 mg/dL improved from 32.6% to 41.9% (OR/year 1.08; P<0.001), whereas HbA1c, smoking, and weight indicators showed limited overall progress. Heterogeneity emerged: non-current smoking improved in men but not women (already near ceiling, approximately 95%); LDL-C control did not improve in adults aged 19-49 years; and BMI ≥25 kg/m² rose from 36.2% to 56.2% in this age group. Upper-bound projections estimated approximately 183, 126, and 201 potentially preventable recurrent strokes per year within the registry (not national estimates) from antithrombotic non-use, anticoagulant non-use in AF, and LDL-C gaps in large-artery atherosclerosis, respectively.</p><p><strong>Conclusions: </strong>Recurrent-stroke admission revealed persistent, unevenly distributed prevention gaps. Medication reconciliation, AF detection and anticoagulation, lipid intensification, and tailored behavioral pathways should be prioritized.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"437-450"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Predicted 10-Year Atherosclerotic Cardiovascular Disease Risk and Magnetic Resonance Imaging-Defined Covert Brain Infarction.","authors":"Peiyuan Gao, Xuan Wang, Lijie Ren, Mengyuan Zhou, Ruinan Zhang, Xueli Cai, Yingying Yang, Jingping Sun, Yongjun Wang, Yilong Wang, Yuesong Pan","doi":"10.5853/jos.2026.00766","DOIUrl":"10.5853/jos.2026.00766","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"475-480"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic Insights Into Cryptogenic Stroke: From Etiologic Heterogeneity to Clinical Translation.","authors":"Lanxin Li, Zihan Sun, Huihui Wang, Jie Zhang, Si Cheng","doi":"10.5853/jos.2026.03923","DOIUrl":"10.5853/jos.2026.03923","url":null,"abstract":"<p><p>Cryptogenic stroke remains challenging because its complex etiology and limited diagnostic tools hinder precise secondary prevention. Growing genetic evidence suggests that cryptogenic stroke may have identifiable genetic architectures that provide additional insights into etiologic classification. In recent years, large-scale genome-wide association studies, multi-omics integration, and other genetic investigations have begun to reveal signals linked to several potential causes, including occult atrial fibrillation and atrial cardiopathy, nonstenotic carotid artery plaque, patent foramen ovale-related paradoxical embolism, monogenic disorders, clonal hematopoiesis of indeterminate potential, and cancer-related thrombosis. These findings suggest a possible shift from exclusion-based diagnosis toward a more mechanism-driven approach. Recent genetic discoveries have enabled preliminary work on predictive models for risk stratification. Emerging genetic tools may also offer promising approaches for etiologic stratification and mechanistic investigation. However, current research in this area remains limited by heterogeneous definitions, modest sample sizes, limited ancestral diversity, and gaps in mechanistic and prognostic evidence. Consequently, clinical translation remains at an early stage. Future research should establish larger and more diverse genomic cohorts with longitudinal phenotyping and advance multidimensional data integration. These efforts may refine etiologic classification and support precision treatment in cryptogenic stroke.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"372-392"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Discharge Ambient Sulfur Dioxide Exposure and Stroke Recurrence After Acute Ischemic Stroke.","authors":"Keon-Joo Lee, Jeongeun Hwang, Seong-Eun Kim, Beom Joon Kim, Moon-Ku Han, Hyunsoo Kim, Joon-Tae Kim, Kang-Ho Choi, Kyu Sun Yum, Dong-Ick Shin, Jae-Kwan Cha, Dae-Hyun Kim, Dong-Seok Gwak, Dong-Eog Kim, Jong-Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Minwoo Lee, Mi-Sun Oh, Kyung-Ho Yu, Hong-Kyun Park, Keun-Sik Hong, Yong-Jin Cho, Joong-Goo Kim, Jay Chol Choi, Tai Hwan Park, Sang-Soon Park, Jee-Hyun Kwon, Wook-Joo Kim, Doo Hyuk Kwon, Jun Lee, Kyungbok Lee, Jeong-Yoon Lee, Sung Il Sohn, Jeong-Ho Hong, Kwang-Yeol Park, Hae-Bong Jeong, Chulho Kim, Sang-Hwa Lee, Juneyoung Lee, Hee-Joon Bae","doi":"10.5853/jos.2026.03265","DOIUrl":"https://doi.org/10.5853/jos.2026.03265","url":null,"abstract":"<p><strong>Background and purpose: </strong>Ambient air pollution is an established risk factor for incident stroke, but whether post-discharge pollutant exposure influences stroke recurrence remains unclear. We investigated the association between post-discharge exposure to six ambient air pollutants and stroke recurrence after acute ischemic stroke.</p><p><strong>Methods: </strong>We analyzed 27,340 patients in the Clinical Research Collaboration for Stroke in Korea-National Institutes of Health nationwide multicenter registry (2014-2021). The 3-month post-discharge district-level mean concentrations of particulate matter ≤10 μm (PM10), ≤2.5 μm (PM2.5), nitrogen dioxide, sulfur dioxide (SO2), carbon monoxide, and ozone were estimated by inverse-distance-weighted interpolation. The primary outcome was stroke recurrence from 3 to 15 months post-discharge. Cause-specific Cox models with cluster-robust standard errors were used, treating death as a competing risk; non-linear dose-response was assessed by restricted cubic splines.</p><p><strong>Results: </strong>During follow-up (median 364.8 days), 764 patients had recurrence and 542 died. Only SO2 showed a significant association with recurrence (P for overall association in the spline model= 0.024), with a graded dose-response; the non-linear (J-shaped) pattern did not reach significance (P for non-linearity=0.095), and quartile contrasts were individually non-significant (Q4 vs. Q1: hazard ratio 1.19, 95% confidence interval 0.94-1.50). The association was numerically stronger among older adults (≥75 years; P for interaction=0.051) and women (P for interaction=0.062). The highest SO2 concentrations were observed in harbor cities (Incheon, Ulsan, Busan). No significant associations were observed for the other five pollutants.</p><p><strong>Conclusions: </strong>Elevated post-discharge SO2 exposure was associated with increased stroke recurrence, with a graded dose-response, supporting consideration of ambient air quality in secondary stroke prevention.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"451-461"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Day Glycemic Patterns and 3-Month Functional Outcomes After Endovascular Thrombectomy.","authors":"Kwanju Song, Ji Sung Lee, Hyun Goo Kang, Seong Hwan Ahn, Tae-Jin Song, Dong-Ick Shin, Hee-Joon Bae, Chang Hun Kim, Sung Hyuk Heo, Jin Soo Lee, Jae-Kwan Cha, Yeong Bae Lee, Eung Gyu Kim, Man Seok Park, Hee-Kwon Park, Jinkwon Kim, Sungwook Yu, Heejung Mo, Sung Il Sohn, Jee Hyun Kwon, Jae Guk Kim, Young Seo Kim, Jay Chol Choi, Yang-Ha Hwang, Keun Hwa Jung, Soo-Kyoung Kim, Woo Keun Seo, Jung Hwa Seo, Joonsang Yoo, Jun Young Chang, Mooseok Park, Wookjin Yang, Bum Joon Kim, Sun U Kwon","doi":"10.5853/jos.2026.03867","DOIUrl":"10.5853/jos.2026.03867","url":null,"abstract":"<p><strong>Background and purpose: </strong>Admission hyperglycemia is associated with poor outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke, but whether post-EVT glycemic pattern determines functional outcome remains unknown.</p><p><strong>Methods: </strong>A Retrospective Study for the Prediction of Clinical Outcomes in Acute Ischemic Stroke Patients with Thrombectomy study was a hybrid prospective-retrospective multicenter cohort study nested within the Rescue on Reperfusion Damage in Cerebral Infarction by Nelonemdaz trial (NCT05041010) across 24 tertiary stroke centers in South Korea. Patients with ≥80% measurements within 80-140 mg/dL and no value ≥200 mg/dL were classified as normoglycemic (Group 1); the remainder were classified by group-based trajectory modeling into persistently elevated (Group 2) and variable hyperglycemia (Group 3). The primary outcome was 3-month modified Rankin Scale (mRS) distribution.</p><p><strong>Results: </strong>Among 457 patients, 319 were included (mean age 73.6±12.2 years; 53.6% male): 97 (30.4%) in Group 1, 159 (49.8%) in Group 2, and 63 (19.7%) in Group 3. Groups 2 and 3 had more diabetes and higher hemoglobin A1c; stroke severity, Alberta Stroke Program Early Computed Tomography Scores, and reperfusion status were comparable. Both hyperglycemic groups had lower odds of a favorable mRS shift than Group 1 (adjusted common odds ratio [OR] 0.35, 95% confidence interval [CI] 0.20-0.61 and 0.49, 0.25-0.94). Functional independence (mRS 0-2) was achieved in 63.9% of Group 1 versus 36.5% and 38.1% in Groups 2 and 3 (adjusted OR 0.26, 95% CI 0.13-0.53 and 0.31, 0.13-0.73). No significant difference was observed between Groups 2 and 3.</p><p><strong>Conclusions: </strong>Five-day post-EVT hyperglycemic status was independently associated with worse 3-month functional outcomes beyond chronic glycemic burden, supporting re-evaluation of targeted glycemic interventions during this vulnerable window.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"462-474"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Oxygen Modulation in the Reperfusion Era: Conditioning and Therapeutic Strategies in Ischemic Stroke.","authors":"Weilin Liu, Zihan Li, Zhou Sun, Jia Liu, Xunming Ji","doi":"10.5853/jos.2026.02747","DOIUrl":"10.5853/jos.2026.02747","url":null,"abstract":"<p><p>Endovascular thrombectomy (EVT) and advanced perfusion imaging have transformed acute ischemic stroke (AIS) treatment, yet tissue hypoxia may persist because of delayed presentation, incomplete reperfusion, microvascular no-reflow, and secondary injury. Oxygen is an essential substrate for cerebral metabolism and a modifiable therapeutic exposure; however, clinical studies of oxygen-based interventions have yielded inconsistent results because of heterogeneity in timing, dose, delivery, and patient selection. Here we propose precision oxygen modulation (POM) as a stage-, phenotype-, and tissue-informed framework for the reperfusion era-treating oxygen exposure as a dose-titrated therapy that must be matched to the right patient, time window, physiological target, and safety boundary. POM integrates oxygen conditioning strategies that may prime neurovascular resilience before or around ischemia, time-limited therapeutic oxygen strategies deployed around reperfusion to support tissue at risk, and recovery-stage strategies paired with rehabilitation. We synthesize clinical and preclinical evidence linking oxygen tension to excitotoxicity, oxidative stress, inflammation, endothelial dysfunction, blood-brain barrier (BBB) integrity, and repair, while emphasizing the context-dependent risks of hyperoxia. We outline an operational decision framework and translational roadmap based on phenotype- and imaging-guided selection, biomarker validation, protocolized dosing, predefined safety boundaries, and phenotype-enriched randomized trials. POM is presented as a testable translational framework for organizing heterogeneous evidence and guiding the prospective validation of stage-specific oxygen modulation in modern stroke care.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"339-356"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}