Stroke最新文献

{"title":"Racial Disparities in Longitudinal Functional Outcome After Ischemic Stroke.","authors":"David J Robinson, Heidi Sucharew, Lili Ding, Rob Stanton, Yasmin Aziz, Paul Wechsler, Lisa Nobel, Brian Stamm, Shea Wright, Joseph Laporta, Emily R Fisher, Sabreena Slavin, Daniel Woo, Lauren Menzies, Suzanne E Judd, Tracy E Madsen, Kyle Walsh, Felipe De Los Rios La Rosa, Dawn Kleindorfer, Brett Kissela","doi":"10.1161/STROKEAHA.126.057341","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.057341","url":null,"abstract":"<p><strong>Background: </strong>The burden of stroke is unequally distributed in the United States, with Black individuals experiencing more incident stroke. It remains unclear whether Black individuals also experience worse stroke recovery. We sought to study disparities in longitudinal functional outcome after acute ischemic stroke in a population-based study.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study in the Greater Cincinnati Northern Kentucky region over an 18-month period (July 2019 to December 2020). All acute ischemic stroke events were captured. The modified Rankin Scale scores were determined at discharge, 3, 6, and 12 months for patients who survived the index event. We studied the association between Black race and longitudinal modified Rankin Scale (across all time points) with mixed-effects ordinal regression, initially adjusting for age, sex, and time since stroke. Hierarchical regression was used to sequentially adjust for stroke severity and management, premorbid health, and social determinants.</p><p><strong>Results: </strong>Among 2796 patients with acute ischemic stroke (mean age, 69.0; 31% Black; 52% female), 2537 survived and were included (mean age, 68.4; 32% Black; 52% female). Black race was associated with a worse longitudinal modified Rankin Scale score (cOR, 2.61 [95% CI, 1.89-3.60]). Excluding patients with recurrent events did not change this association (cOR, 2.69 [95% CI, 1.92-3.78]). Adding variables reflecting initial stroke severity and management partly attenuated the association (cOR, 1.92 [95% CI, 1.43-2.60]). Adding variables reflecting premorbid health further attenuated the association (cOR decreased to 1.43 [95% CI, 1.09-1.87]). The remaining association between Black race and the modified Rankin Scale score was fully attenuated by social determinants, with cOR, 1.09 (95% CI, 0.80-1.47). There was no interaction between race and time since stroke.</p><p><strong>Conclusions: </strong>Starting at discharge and persisting out to 12 months, acute ischemic stroke functional outcomes are worse among Black individuals. These disparities are significantly attenuated by clinical factors and social determinants; future studies should explore whether the social determinants can be intervened upon in the recovery period.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220697","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":"Initial Direct Oral Anticoagulants Versus Warfarin After Cerebral Venous Thrombosis: A Target Trial Emulation.","authors":"Jinghui Zhong, Jelle Vellema, Mingming Yu, Yiran Dong, Yingjie Xu, Wanqiu Zhang, Min Li, Xianjun Huang, Ping Chen, Mengmeng Gu, Zhixin Huang, Yongjun Jiang, Jonathan M Coutinho, Xinfeng Liu, Wen Sun","doi":"10.1161/STROKEAHA.126.057578","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.057578","url":null,"abstract":"<p><strong>Background: </strong>Vitamin K antagonists have traditionally been used after cerebral venous thrombosis, whereas direct oral anticoagulants (DOACs) are increasingly prescribed. Whether DOACs are noninferior to warfarin for preventing 1-year symptomatic recurrent venous thromboembolism (VTE) remains uncertain.</p><p><strong>Methods: </strong>We conducted a registry-based target trial emulation in a bidirectional multicenter Chinese cerebral venous thrombosis registry (retrospective phase, 2015-2022; prospective phase, 2023-2025). Eligible patients were adults with imaging-confirmed cerebral venous thrombosis who initiated either a DOAC or warfarin within 30 days after diagnosis. Time zero was the date of the first oral anticoagulant prescription. The primary efficacy outcome was symptomatic recurrent VTE within 1 year. Propensity score overlap weighting was used, and weighted Fine-Gray models treated death as a competing event. The clinically acceptable noninferiority margin was defined as an absolute increase of 1.5 percentage points in 1-year recurrent VTE risk, corresponding approximately to a relative margin of 1.50 for the primary Fine-Gray analysis.</p><p><strong>Results: </strong>Among 2476 eligible patients, 942 initiated a DOAC (rivaroxaban, n=701; dabigatran, n=121; apixaban, n=113; edoxaban, n=7) and 1534 initiated warfarin. Within 1 year, symptomatic recurrent VTE occurred in 36 and 73 patients, respectively. The overlap-weighted 1-year recurrence risks were 3.74% and 5.47%, corresponding to a risk difference of -1.73 percentage points (95% CI, -3.76 to 0.30). DOAC treatment was associated with a lower subdistribution hazard ratio of 0.67 compared with that of warfarin ([95% CI, 0.37-1.21]; <i>P</i>=0.184), meeting the prespecified noninferiority criterion (<i>P</i> for noninferiority=0.004). Major bleeding was rare within 1 year (0 versus 1 patient). Clinical nonmajor bleeding occurred in 18 versus 34 patients, and any bleeding occurred in 48 versus 75 patients.</p><p><strong>Conclusions: </strong>Among patients with cerebral venous thrombosis selected for oral anticoagulation, initial treatment with a DOAC met the noninferiority criterion relative to warfarin for the prevention of symptomatic recurrent VTE at 1 year. Findings regarding bleeding outcomes were exploratory and do not permit conclusions regarding comparative safety or equivalence.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220672","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":"Multiomics Profiling Supports Cathepsin B as a Protective Factor in White Matter Hyperintensities and Cognition.","authors":"Cyprien A Rivier, Sebastian Diaz-Perez, Gael Bories, Shufan Huo, Santiago Clocchiatti-Tuozzo, Adam de Havenon, Stéphanie Debette, Kevin N Sheth, Lauren H Sansing, Guido J Falcone","doi":"10.1161/STROKEAHA.126.056508","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056508","url":null,"abstract":"<p><strong>Background: </strong>White matter hyperintensities (WMH) are a common brain magnetic resonance imaging marker of cerebral small vessel disease and a major risk factor for stroke and dementia, yet the molecular mechanisms governing lesion formation remain incompletely understood. We sought to identify circulating proteins that lie upstream of WMH and influence related clinical manifestations.</p><p><strong>Methods: </strong>We conducted a 4-stage proteogenomic study. Stage 1 tested a WMH polygenic risk score against 2923 plasma proteins in 52 560 UK Biobank participants (mean age, 56.8 years, 53.9% female, 94.0% White), and candidate proteins against WMH volume in the neuroimaging subset (n=5443; mean age 54.2 years, 53.5% female). Stage 2 applied bidirectional Mendelian randomization, colocalization, and local genetic correlation using cis protein quantitative trait locus and cis expression quantitative trait locus instruments from plasma, vascular, and brain tissue. Stage 3 analyzed single-nucleus RNA sequencing of 8 postmortem periventricular white matter samples (4 WMH lesions, 4 controls; mean age, 81 years; 50% female). Stage 4 tested circulating and genetically predicted protein levels against general cognitive ability.</p><p><strong>Results: </strong>Stages 1 and 2 converged on CTSB (cathepsin B) and ECHDC3 (enoyl-coenzyme A hydratase domain-containing 3). Higher plasma CTSB was associated with lower WMH volume (β=-0.09 [95% CI, -0.13 to -0.05]; n=5260), and Mendelian randomization estimates were directionally consistent across all 5 instrument sets (plasma protein quantitative trait locus β=-0.052 [95% CI, -0.064 to -0.040]), with concordant effects on white matter microstructure, perivascular spaces, and lacunar stroke. Single-nucleus RNA sequencing showed CTSB downregulation within lesions, predominantly in astrocytes (log₂ fold change=-1.70) and oligodendrocytes (log₂ fold change=-0.48; both false discovery rate <i>P</i><1×10^-20). Higher plasma CTSB (β=0.061 [95% CI, 0.010-0.112]; n=5193) and a cis protein quantitative trait locus polygenic score (β=0.031 [95% CI, 0.009-0.054]; n=8884) predicted better cognitive performance. ECHDC3 showed no consistent association beyond stage 1.</p><p><strong>Conclusions: </strong>Multimodal proteogenomic evidence nominates CTSB as a lesion-suppressed protein associated with lower WMH burden and better cognition, and a candidate therapeutic target for cerebral small vessel disease.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196716","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":"Health Literacy and Communication in Stroke Prevention, Management, and Recovery: A Scientific Statement From the American Heart Association.","authors":"Mulubrhan F Mogos, Susan Maynard, Stacy Perrin, Mai Nguyen-Huynh, Mona N Bahouth, Catherine Torrington Eaton, Iris Feinberg, Joyce Sampson, Jared W Magnani, Kiffon Keigher","doi":"10.1161/STR.0000000000000537","DOIUrl":"https://doi.org/10.1161/STR.0000000000000537","url":null,"abstract":"<p><p>Health literacy is a critical component of high-quality stroke care. Across the continuum from prevention through recovery, health literacy is strongly associated with functional outcomes and stroke-related morbidity. Despite its importance, it is often overlooked, leaving patients and caregivers overwhelmed by communication demands that exceed their capacity. These mismatches are especially pronounced among individuals with stroke-related cognitive or language impairments, limited English proficiency, socioeconomic disadvantage, or limited digital literacy. This scientific statement synthesizes current evidence on the role of health literacy and communication within stroke systems of care and identifies nurse-led opportunities to advance equity and patient-centered outcomes while recognizing this as a shared interprofessional responsibility. Nurse-led interventions, including teach-back-based education, dyadic psychoeducational programs, and tailored digital support, have demonstrated improvements in stroke knowledge, self-efficacy, quality of life, and caregiver preparedness. However, the literature is marked by methodological heterogeneity. Many studies are underpowered and infrequently use validated health literacy or communication measures. Future directions include standardized assessment of health literacy; literacy-sensitive, nurse-led, and interprofessional care models; workforce training in plain-language and culturally responsive communication; and organizational health literacy principles. Emerging technologies, including telehealth and artificial intelligence, offer promise for improving communication and personalization but require rigorous evaluation to minimize bias and ensure equity and usability.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196724","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":"Clinical Outcome Differences in Asia Versus Non-Asia Intracerebral Hemorrhage: IPD Analysis From BP-Lowering Clinical Trials.","authors":"Shoujiang You, Menglu Ouyang, Tom J Moullaali, Else Charlotte Sandset, Lisa J Woodhouse, Qiang Li, Lili Song, Zhe Kang Law, Xinwen Ren, Qiao Han, Chen Chen, Hisatomi Arima, Ken Butcher, Candice Delcourt, Yongjun Cao, Kailash Krishnan, Leon Edwards, Salil Gupta, Wen Jiang, Sebastian Koch, John Potter, Adnan I Qureshi, Thompson G Robinson, Rustam Al-Shahi Salman, Jeffrey L Saver, Nikola Sprigg, Joanna Wardlaw, Craig S Anderson, Philip M Bath, John Chalmers, Xia Wang","doi":"10.1161/STROKEAHA.126.055677","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.055677","url":null,"abstract":"<p><strong>Background: </strong>Evidence of regional differences in clinical outcomes after intracerebral hemorrhage (ICH) is still scarce. We quantified differential outcomes and response to early intensive blood pressure lowering treatment by region in the Blood pressure in Acute Stroke Collaboration ICH data set.</p><p><strong>Methods: </strong>This was an observational analysis of pooled individual participant data from 16 completed randomized controlled trials of blood pressure-lowering treatment in acute ICH, based on the Blood pressure in Acute Stroke Collaboration data set. Generalized linear mixed models with inverse probability of treatment weighting (IPTW) were used to determine the association between regions (Asia [primarily East and South Asia] versus non-Asia) and clinical outcomes including neurological deterioration within 7 days, hematoma expansion at 24 hours (absolute ≥6 mL or relative ≥33%), and death or dependency (modified Rankin Scale scores, 3-6), major disability(modified Rankin Scale score, 3-5), death alone at 90 days.</p><p><strong>Results: </strong>Among 6221 patients (age, 63.3±13.0 years; female 36.4%), 3494 (56.2%) were from Asia. ICH participants from Asia had a significantly reduced risk of death or dependency (unadjusted odds ratio [OR], 0.44 [95% CI, 0.39-0.51]; IPTW-weighted OR, 0.67 [95% CI, 0.58-0.77]); and major disability (unadjusted OR, 0.49 [95% CI, 0.42-0.56]; IPTW-weighted OR, 0.67 [95% CI, 0.57-0.78]) at 90 days, neurological deterioration (unadjusted OR, 0.63 [95% CI, 0.52-0.77]; IPTW-weighted OR, 0.70 [95% CI, 0.56-0.89]) within 7 days, in comparison to those from non-Asia regions. However, there were no differences for hematoma expansion (<i>P</i>=0.97) at 24 hours or death (<i>P</i>=0.23) at 90 days using IPTW. Additionally, there were no significant interactions between blood pressure-lowering treatment and region (Asia versus non-Asia) for either outcome using IPTW.</p><p><strong>Conclusions: </strong>Participants from East and South Asia had a favorable functional recovery and a lower risk of neurological deterioration compared with those from non-Asian regions after adjustment for confounders, with no differences in hematoma expansion at 24 hours after ICH. These findings suggest that future ICH studies on clinical outcomes should consider regional differences.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184346","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":"Thrombolysis in the Delayed Treatment Window for Acute Ischemic Stroke: Updated Systematic Review and Meta-Analysis.","authors":"Praveen Nandha Kumar Pitchan Velammal, Thirumalaivasan Dhasakeerthi, Devin Manzoori, Sai Sreehith Mummareddy, Joshua Duzan, Cheran Elangovan, Balaji Krishnaiah","doi":"10.1161/STROKEAHA.126.058069","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.058069","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis is a standard treatment for acute ischemic stroke but has traditionally been limited to 4.5 hours after symptom onset. This time-based restriction may exclude patients with salvageable brain tissue, especially those with wake-up or unknown-onset strokes. Multimodal imaging allows for the identification of viable penumbra beyond traditional treatment windows. This study compiles randomized evidence evaluating intravenous thrombolysis in imaging-selected patients treated after 4.5 hours.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Cochrane Central were searched through February 2026 for randomized trials comparing intravenous thrombolysis (alteplase or tenecteplase) with best medical therapy in patients presenting beyond 4.5 hours or with wake-up/unknown-onset stroke selected by imaging. The primary outcome was excellent functional outcome at 90 days (modified Rankin Scale score 0-1). Secondary outcomes included functional independence (modified Rankin Scale score 0-2), symptomatic intracranial hemorrhage, and 90-day mortality.</p><p><strong>Results: </strong>Fourteen trials involving 4192 participants were analyzed. Intravenous thrombolysis improved excellent functional outcomes (modified Rankin Scale score 0-1; risk ratio, 1.22 [95% CI, 1.16-1.29]) and functional independence (modified Rankin Scale score 0-2; risk ratio, 1.12 [95% CI, 1.06-1.18]). Both alteplase and tenecteplase contributed to these benefits. Thrombolysis increased the risk of symptomatic intracranial hemorrhage (risk ratio, 2.58 [95% CI, 1.58-4.22]) but did not significantly affect 90-day mortality (risk ratio, 1.15 [95% CI, 0.97-1.35]).</p><p><strong>Conclusions: </strong>In patients selected using advanced imaging, intravenous thrombolysis performed after 4.5 hours improves functional outcomes without increasing mortality, supporting a tissue-based rather than strictly time-based approach to treating acute ischemic stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184349","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":"Adjuvant Systemic Hypothermia During Mechanical Thrombectomy (ReCCLAIM II): A Multicenter, Randomized, Controlled Trial.","authors":"Tareq Kass-Hout, Christopher Horn, Chung-Huan J Sun, Albert Yoo, Osama O Zaidat, Akash C Gupta, Syed F Zaidi, Alex Bou Chebl, Eugene Lin, Alhamza Al-Bayati, Neeraj Badjatia, David Liebeskind, Ying Zhang, Paul Wilburn, Rishi Gupta","doi":"10.1161/STROKEAHA.126.056651","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056651","url":null,"abstract":"<p><strong>Background: </strong>Hypothermia reduces ischemic injury in preclinical stroke models, yet translation into the clinical setting remains challenging. We aimed to assess the feasibility of inducing adjuvant systemic hypothermia among patients with large-vessel occlusion stroke during mechanical thrombectomy.</p><p><strong>Methods: </strong>This was a phase II randomized feasibility-controlled trial involving 10 sites in the United States, conducted between May 2019 and May 2024. All eligible patients had confirmed proximal middle cerebral artery or internal carotid artery occlusions, an Alberta Stroke Program Early Computed Tomography Score of 6 to 10, and symptom onset within 24 hours. Patients underwent mechanical thrombectomy and were randomly assigned to either treatment with adjuvant hypothermia using a novel intravascular cooling catheter or standard of care. The primary feasibility end points were the ability to achieve a target temperature of <34 °C within 1 hour of arterial puncture and overall door-to-reperfusion times. The primary safety end point was core-laboratory-adjudicated hemorrhagic conversion within 36 hours, and secondary end points included final infarct volume and serious adverse events.</p><p><strong>Results: </strong>A total of 95 patients were enrolled (29 in the roll-in phase and 66 randomized). The mean age of the randomized cohort was 65±12 years, with a median National Institutes of Health Stroke Scale score of 15. Among patients in the treatment arm, 30 of 33 (91%) achieved hypothermia within 1 hour of arterial puncture during thrombectomy, and 23 of 33 (70%) patients were at target temperature (<34 °C) before reperfusion. The median time to hypothermia was 10 minutes (interquartile range [IQR], 7-22) from arterial puncture. There were no significant differences in door-to-reperfusion times (hypothermia: 95 minutes [IQR, 54-116] versus control: 94 minutes [IQR, 77-121]; <i>P</i>=0.70). Final infarct volumes were numerically lower in the hypothermia treatment arm (hypothermia: 11 cm³ [IQR, 5-42] versus control: 30 cm³ [IQR, 6-80]; <i>P</i>=0.13), with no significant differences in the rates of hemorrhagic conversion or pneumonia. There was a higher number of serious adverse events in the hypothermia arm (45.5% versus 24.2%; <i>P</i>=0.12), although the trial was not powered for differences in serious adverse events or clinical efficacy.</p><p><strong>Conclusions: </strong>This is the first clinical trial to demonstrate the feasibility of early and rapid systemic hypothermia as an adjunct therapy during mechanical thrombectomy without delaying time to reperfusion. The potential impact on infarct volumes and serious adverse events, however, warrants further investigation.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03804060.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137569","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":"Parent Perspectives on I-ACQUIRE Therapy.","authors":"Mara M Yale, Kimberly A Hindery, Jennifer F Murray, Amy R Darragh, Craig T Ramey, Stephanie C DeLuca, Qi Pauls, Jill C Heathcock, Warren D Lo, Renee H Martin, Mary Rebekah Trucks, Sharon Landesman Ramey","doi":"10.1161/STROKEAHA.126.055913","DOIUrl":"10.1161/STROKEAHA.126.055913","url":null,"abstract":"<p><strong>Background: </strong>Although Constraint-Induced Movement Therapy is increasingly recommended as an evidence-based, intensive treatment for children with hemiparesis, parent perspectives are lacking. I-ACQUIRE, a multicomponent form of Constraint-Induced Movement Therapy, involves substantial parent participation. Child outcomes from the United States 15-site I-ACQUIRE phase 3 clinical trial (2019-2025), partnered with a Parent Council, are presented elsewhere. Here, we examine complementary lived-experience parent data.</p><p><strong>Methods: </strong>All parents (167) of infants/toddlers with perinatal arterial ischemic stroke and hemiparesis consented to child random assignment to usual treatment (UT), moderate-dose I-ACQUIRE (3 h/d, 5 d/wk over 4 weeks), or high-dose I-ACQUIRE (6 h/d). Parents completed assessments about life- and therapy-related stress, treatment concerns, observations of child progress, and perceived therapy-related responsibilities.</p><p><strong>Results: </strong>Parents of children in the I-ACQUIRE moderate-dose (56) and high-dose group (58), compared with UT (53), reported lower rates of concerns or problems that therapy did not produce clear benefits (≤4% versus 18%), child-therapist interactions (≤2% versus 24%), and parent-therapist interactions (≤2% versus 6%). I-ACQUIRE versus UT parents had higher proportions of positive feelings that therapy was useful (94%-98% versus 83%); interesting (96%-98% versus 79%), important (94%-98% versus 85%), and fun (78%-84% versus 53%); and provided comforting (72%-83% versus 47%) and relaxing benefits (28%-31% versus 17%). In all groups, similar proportions reported their role was stressful (I-ACQUIRE 26%-28%, UT 32%), difficult (I-ACQUIRE 35%-48%, UT 38%), and tiring (I-ACQUIRE 48%-52%, UT 43%). General life stress scores were mostly in the moderate-range category, similar across groups.</p><p><strong>Conclusions: </strong>Parents of I-ACQUIRE children reported higher positive feelings and notably fewer concerns about lack of benefits compared with UT. Across all groups, some parents (<52%) reported treatment-related stress, difficulty, and fatigue. These findings provide new perspectives from parents' lived experiences to help families and clinicians in treatment decision-making.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03910075.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137640","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":"Neural Repair Therapies After Stroke: II. Principles for Clinical Trials.","authors":"David J Lin, Steven C Cramer","doi":"10.1161/STROKEAHA.126.056133","DOIUrl":"10.1161/STROKEAHA.126.056133","url":null,"abstract":"<p><p>Stroke remains a leading cause of human disability worldwide. Additional approaches beyond acute stroke therapies are needed to improve patient outcomes. Neural repair therapies focus on promoting neural plasticity in surviving tissue rather than modifying the acute injury; examples include behavioral training, drugs, biological therapies, and neural stimulation. This review discusses principles related to patient selection, control group design, intervention timing, choice of outcome measures, experience-dependent plasticity, use of biomarkers, and statistical considerations, each of which emerges from a review of key stroke recovery trials. Patient selection strategies may benefit from incorporating neuroimaging and neurophysiology biomarkers to ensure viability of treatment targets. Modality-specific outcome measures offer advantages over global disability scales for repair-based trials. The timing of intervention is critical given evolving poststroke biology and the existence of critical periods for plasticity. Repair-based therapies benefit from pairing with concomitant experience of sufficient intensity and appropriate type to shape and reinforce brain circuits. Consideration of these key principles is expected to improve the design of trials that aim to promote neural repair and improve function after stroke. Researchers and clinicians should attend to these factors when designing and interpreting clinical trials to maximize the likelihood that neural repair therapies will improve disability after stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neural Repair Therapies After Stroke: I. Therapeutic Advances.","authors":"David J Lin, Steven C Cramer","doi":"10.1161/STROKEAHA.126.056092","DOIUrl":"10.1161/STROKEAHA.126.056092","url":null,"abstract":"<p><p>Stroke is a leading cause of disability worldwide. Neural repair therapies, distinct from acute stroke therapies, target surviving neural elements to promote plasticity after the acute injury has occurred. Repair therapies encompass a broad and rapidly evolving therapeutic landscape, ranging from behavioral training, drugs, and biological agents to neural stimulation. In this review, we highlight major advances across these therapeutic categories, focusing on the evidence base and readiness for clinical adoption. Intensive behavioral interventions, including constraint-induced movement therapy and telerehabilitation, result in meaningful gains even in chronic stroke. Biological therapies-growth factors, monoclonal antibodies, and stem cell approaches-show promise but face translational challenges. Pharmacological strategies targeting serotonergic and dopaminergic systems have yielded mixed results. Neural stimulation approaches span a spectrum of invasiveness, with vagus nerve stimulation now Food and Drug Administration-approved and emerging candidates including cerebellar deep brain stimulation and spinal cord epidural stimulation showing early promise. These studies have provided important lessons for neural repair trial design. Synthesizing evidence across modalities, we highlight how therapeutic advances are reshaping the landscape of poststroke recovery and identify the most promising opportunities for clinical translation. Emerging neural repair strategies stand to substantially improve function after stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}