Stroke最新文献

{"title":"Longitudinal Degeneration of Microstructural and Structural Connectivity Patterns Following Stroke.","authors":"Lorenzo Pini, Mohammad Hadi Aarabi, Alessandro Salvalaggio, Angela M Colletta, Nicholas V Metcalf, Joseph C Griffis, Alexandre R Carter, Gordon L Shulman, Maurizio Corbetta","doi":"10.1161/STROKEAHA.125.054736","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.054736","url":null,"abstract":"<p><strong>Background: </strong>Stroke causes neurological impairment through local plasticity mechanisms, such as synaptic sprouting, and large-scale network reorganization. Although poststroke Wallerian degeneration is well established, whether white matter (WM) tracts' remodel over time to support behavioral recovery remains controversial. We investigated whether longitudinal changes in WM microstructure and structural connectivity are coupled to poststroke behavior, and how structural connectivity reorganization relates to local disconnection microstructure.</p><p><strong>Methods: </strong>In this prospective cohort study (Washington University, St. Louis; 2016-2018), patients with first-time stroke underwent diffusion-weighted magnetic resonance imaging and behavioral assessments at 2 weeks and 3 months poststroke; healthy controls were assessed twice. Latent factorial analysis was applied to behavioral and microstructural data from diffusion tensor imaging and neurite orientation dispersion and density imaging. Primary measures were whole-brain structural connectivity gradient divergences computed from tractography, microstructural diffusion parameters extracted from both WM and cortical regions disconnected by the lesion, and behavioral factors. Linear mixed models (adjusted for sociodemographic values) assessed longitudinal changes, linear regression assessed brain-behavior associations, and machine learning algorithms assessed differences between healthy controls and stroke.</p><p><strong>Results: </strong>Seventy-nine patients (age, 60±12 years; 43% female; diffusion-weighted magnetic resonance imaging: 48 at 2 weeks and 26 at 3 months) and 33 age-matched healthy controls were included. At 2 weeks, patients with stroke exhibited diffuse whole-brain alterations in WM organization. These widespread changes were closely linked to microstructural abnormalities in WM pathways disconnected by the lesion. Notably, WM degeneration progressed between 2 weeks and 3 months poststroke. Whole-brain structural connectivity alterations were associated with cognitive deficits acutely but not at 3 months, whereas microstructural parameters in disconnected tracts were primarily related to motor impairment.</p><p><strong>Conclusions: </strong>In patients with predominantly mild-severity stroke, we observed widespread and progressive alterations in WM microstructure that persists beyond the lesion and continues to evolve over time. Although acute structural disconnection relates to behavioral deficits, chronic WM degeneration appears largely uncoupled from functional recovery.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843099","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":"Polygenic Risk Identifies Older Adults Who May Benefit From Aspirin for the Primary Prevention of Ischemic Stroke.","authors":"Chenglong Yu, Sultana Monira Hussain, Peter D Fransquet, Cammie Tran, Andrew M Tonkin, Mark R Nelson, Christopher M Reid, Johannes T Neumann, Jeff D Williamson, Charles B Eaton, Peter Hand, Geoffrey A Donnan, Amy Brodtmann, Geoffrey C Cloud, John J McNeil, Paul Lacaze","doi":"10.1161/STROKEAHA.125.054979","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.054979","url":null,"abstract":"<p><strong>Background: </strong>Low-dose aspirin is no longer recommended for routine primary prevention in older adults due to bleeding risks outweighing vascular benefits. We hypothesized that an integrative polygenic score (iPGS) could identify a subgroup of older individuals who derive net benefit from aspirin for the primary prevention of ischemic stroke.</p><p><strong>Methods: </strong>We performed post hoc analysis of the ASPREE randomized, placebo-controlled trial (Aspirin in Reducing Events in the Elderly) of daily 100-mg aspirin, in 12 031 genotyped participants of European ancestry aged >70 years without prior cardiovascular disease. The iPGS was derived from >1.2 million variants and evaluated both continuously and by quintiles. Cox models assessed associations between polygenic risk, ischemic stroke, and major bleeding events, and tested the interaction between the iPGS and treatment allocation, with adjustment for baseline lifestyle and clinical covariates.</p><p><strong>Results: </strong>The mean age of participants was 75.1 years, and 54.9% were women. Over a median of 4.6 years, 187 ischemic strokes and 373 major bleeds occurred, including 101 intracranial bleeds (46 hemorrhagic strokes). Each 1-SD increase in the iPGS was associated with higher incident ischemic stroke risk (hazard ratio, 1.39 [95% CI, 1.20-1.62]). An interaction between the continuous iPGS and aspirin allocation was observed for ischemic stroke (<i>P</i>=0.04) but not major bleeding. In the highest iPGS quintile, aspirin reduced ischemic stroke by 51% (hazard ratio, 0.49 [95% CI, 0.28-0.85]) without significantly increasing major bleeding (hazard ratio, 1.15 [95% CI, 0.71-1.88]). No benefit was observed in the overall cohort or in lower-risk quintiles.</p><p><strong>Conclusions: </strong>Among older adults, high polygenic risk identifies individuals who may experience substantial stroke reduction with aspirin, with no excess bleeding. These findings raise the possibility that genomic risk stratification may enable targeted aspirin use for the primary prevention of ischemic stroke.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843086","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":"Minimal Sufficient Balance Randomization and Site-Specific Covariate and Group Size Imbalance in Multicenter Acute Stroke Trials.","authors":"Timofei Biziaev, Michael D Hill, Hannah Johns, Michael Tymianski, Corey Adams, Leonid Churilov, Bijoy K Menon, Tolulope T Sajobi","doi":"10.1161/STROKEAHA.126.055315","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.055315","url":null,"abstract":"<p><strong>Background: </strong>Preservation of treatment allocation randomness, achievement of treatment group size balance, and balance on prognostic baseline covariates are desirable properties of optimal randomization schemes. Previous studies have demonstrated the accuracy of covariate-adaptive randomizations, such as minimal sufficient balance (MSB) randomization, for achieving covariate balance in acute stroke trials at the end of the trial. This study evaluates the performance of covariate-adaptive randomization techniques against simple and block randomization in minimizing site-specific treatment group imbalance in multicenter acute stroke trials.</p><p><strong>Methods: </strong>Monte Carlo simulations were used to evaluate the performance of stratified and unstratified versions of MSB, common scale MSB, and common scale group-size MSB (CSSize-MSB), against permuted block and simple randomization designs, for achieving balance across baseline covariates and sites. Simulation conditions investigated include the number of sites (3, 6, or 20 sites), enrollment per site (equal or unequal enrollment across sites), number and distribution of baseline covariates (sex, age, National Institutes of Health Stroke Scale score, large vessel occlusion status), and sample size (n=250, 600, 1000, 3000). The probability of observing statistically significant imbalance on any baseline covariate, proportion of biased allocations, and overall and site-specific group allocation ratio at interims and end of enrollment were used to evaluate the performance of the randomization schemes.</p><p><strong>Results: </strong>The average probability of observing imbalance on any of the baseline covariates for the simple randomization, permuted block, common scale MSB, common scale group-size MSB, and MSB were 21%, 21%, 0%, 2%, and 2%, respectively, at n=600 with 20 study sites. Although site-specific treatment allocation imbalance was improved under MSB algorithms, imbalance at low-enrolling sites persisted, regardless of the randomization scheme. Treatment allocation randomness and treatment-control group balance were preserved in high-volume sites under MSB.</p><p><strong>Conclusions: </strong>Although site-specific treatment group imbalance persisted in low-enrolling sites, regardless of the randomization technique adopted, the overall randomness of treatment allocation and balance of covariates were preserved with MSB algorithms. Logistical considerations and oversight to minimize low enrollment across sites are recommended before onboarding sites in multicenter acute stroke trials.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843075","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":"Redefining the Cerebral Ischemic Core-Penumbra-Oligemia Continuum.","authors":"Umberto Pensato, Johanna M Ospel, Aravind Ganesh, Nishita Singh, Mohammed Almekhlafi, Gabriel Broocks, Giorgio Busto, Enrico Fainardi, Diego Gutierrez Vasquez, Tyler Henry, Maarten G Lansberg, Felix Ng, Thanh N Nguyen, Jean-Marc Olivot, Mark W Parsons, Vignan Yogendrakumar, Andrea Zini, Beom Joon Kim, Vivek Yedavalli, Gregory W Albers, Bruce C V Campbell, Michael D Hill, Bijoy K Menon, Andrew M Demchuk","doi":"10.1161/STROKEAHA.126.055331","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.055331","url":null,"abstract":"<p><p>During acute ischemic stroke, cerebral tissue undergoes different stages of ischemic damage and evolves towards irreversible injury at a varying pace depending on local perfusion and metabolic factors. This complex ischemic pathological process represents a dynamic continuum that has been historically conceptualized as a binary ischemic core-penumbra model. Although this simplification has proven useful for explaining the evolution of tissue damage in acute stroke, important nuances with clinical implications might be underappreciated. In this review, we critically appraise the pathophysiology and conventional clinical concepts adopted to explain infarct evolution in the early phases of ischemic stroke. We discuss recent mounting evidence that challenges the traditional compartmentalization of the ischemic core, penumbra, and oligemia, calling for more nuanced pathophysiological tissue concepts. For example, clinical benefits and the harmful hemorrhagic transformation associated with reperfusion therapies are observed across a spectrum of core volumes, challenging the deterministic assumptions of the core-penumbra hypothesis. Automated image processing systems reinforce this simplification of stroke pathophysiology, leading to misinterpretation of the range of truth in human imaging. We propose a modified definition of the core-penumbra-oligemia continuum that includes 6 levels of ischemic progression and their corresponding clinical implications: (1) benign oligemia, (2) vulnerable oligemia, (3) durable penumbra, (4) critical penumbra, (5) nonleaky core, and (6) leaky core. This more granular classification could better reflect the continuum of pathological ischemic changes and vulnerability. The proposed 6 levels can provide a framework for future neuroimaging efforts to better understand tissue fate and infarct evolution in ischemic stroke, ultimately informing treatment decision-making and refining targeting for new therapeutic approaches.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843202","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":"Transcranial Direct Current Stimulation for Stroke Motor Recovery What the TRANSPORT2 Trial Taught Us.","authors":"Christy Cassarly, Salman Ikramuddin, Gottfried Schlaug, Ahlam Salameh, Steven L Wolf, Joseph P Broderick, Jody A Feld, Stacy Fritz, Veronica T Rowe, Wuwei Feng","doi":"10.1161/STROKEAHA.126.051391","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.051391","url":null,"abstract":"<p><p>Over the past 2 decades, transcranial direct current stimulation has attracted substantial interest as an adjunctive strategy to enhance poststroke motor recovery. In addition to its potential neuromodulatory effects on motor cortical networks, transcranial direct current stimulation devices are low-cost, easy to use, and compatible with concurrent rehabilitation. Yet, despite its promise, several barriers hinder translation into routine clinical practice, including neutral results from several recently completed multicenter trials, such as TRANSPORT2 (Transcranial Direct Current Stimulation for Post-Stroke Motor Recovery). Moving forward, progress will depend on addressing issues in 3 broad domains: device-related (stimulation parameters and montage), disease-related (patient characteristics and timing), and trial design (outcomes, analytical approaches, adjunctive therapy, and trial infrastructure). In this topical review, we critically examine these challenges and outline strategies to refine transcranial direct current stimulation application, with the goal of more effectively leveraging its neuromodulation properties to promote neuroplasticity and enhance motor recovery after stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842702","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":"Sarcopenia, Grip Strength, Walking Pace, and New-Onset Stroke Risk: A UK Biobank Study.","authors":"Li-Li Tang, Yu-Hui Huang, Yu-Jia Jin, Kai-Cheng Yang, Qing Lin, Zien Zhou, Feng Gao, Bing Xiong, Changzheng Yuan, Lu-Sha Tong","doi":"10.1161/STROKEAHA.125.052311","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052311","url":null,"abstract":"<p><strong>Background: </strong>Novel stroke risk factors have received widespread attention. This study examined the association between sarcopenia status, grip strength, and walking pace with incident stroke (any stroke, ischemic stroke, and hemorrhagic stroke) and poststroke mortality.</p><p><strong>Methods: </strong>This prospective study included 482 699 participants from the UK Biobank, a large-scale, population-based cohort. Sarcopenia status was assessed according to the EWGSOP2 criteria (European Working Group on Sarcopenia in Older People 2). Incident strokes were ascertained based on health records. Stroke risk was assessed using multivariable-adjusted Cox proportional hazards models, whereas poststroke mortality was compared using the Kaplan-Meier analysis with log-rank tests. A 2-sample Mendelian randomization analysis, utilizing genetic instruments from public genome-wide association studies, was conducted to infer causal associations.</p><p><strong>Results: </strong>The cohort (mean age±SD: 56.4±8.1 years; 45.37% were men; n=219 015) had a probable sarcopenia prevalence of 4.7% and a confirmed sarcopenia prevalence of 0.4%. Participants with probable sarcopenia had a higher risk of any stroke (adjusted hazard ratio [aHR], 1.30 [95% CI, 1.21-1.39]), ischemic stroke (aHR, 1.31 [95% CI, 1.22-1.42]), and hemorrhagic stroke (aHR, 1.41 [95% CI, 1.20-1.67]) than those without. Among those who had a stroke, probable or confirmed sarcopenia was associated with increased all-cause mortality. Higher risk of any stroke was associated with lower grip strength (absolute: aHR, 1.07 [95% CI, 1.06-1.09] per 5 kg; relative: aHR, 1.36 [95% CI, 1.28-1.44] per 1 kg/[kg/m²]) and a slow walking pace (aHR, 1.64 [95% CI, 1.54-1.75]; compared with brisk pace). Mendelian randomization analysis demonstrated that a faster walking pace was associated with a lower risk of any stroke (odds ratio, 0.94 [95% CI, 0.90-0.97] per-SD increase) and ischemic stroke (odds ratio, 0.95 [95% CI, 0.91-0.98] per-SD increase).</p><p><strong>Conclusions: </strong>Sarcopenia status, lower grip strength, and slower walking pace were associated with an increased risk of incident stroke and all-cause poststroke mortality.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843237","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":"Sex-Based Efficacy of Endovascular Thrombectomy Techniques in LVO Stroke: A Multicenter Registry Analysis.","authors":"Joseph N Samaha, Ngoc Mai Le, Ritesh Bajaj, Ananya S Iyyangar, Hussain Azeem, Bruna Kfoury, Javier Gomez Farias, Freya Kanakhara, Mahnoor Khalid, Micah Kan, Syed Shams, Jack Li, Connor Nguyen, Eunyoung Lee, Michael I Nahhas, Robert Regenhardt, Louise D McCullough, Sunil A Sheth","doi":"10.1161/STROKEAHA.125.054591","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.054591","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in stroke cause, vessel anatomy, and thrombus composition are well established, yet whether these factors influence the efficacy of specific endovascular thrombectomy (EVT) techniques remains unknown. Here, we investigate sex-based differences in reperfusion outcomes across EVT techniques.</p><p><strong>Methods: </strong>Consecutive patients with anterior circulation large vessel occlusion including intracranial internal carotid artery and the M1 and M2 segments of the middle cerebral artery treated with EVT across 4 comprehensive stroke centers in the Greater Houston area (January 2021 to June 2024) were included from a prospectively maintained registry. EVT techniques were categorized as stent retriever, contact aspiration, or combined technique. The primary outcome was the first-pass effect (modified Thrombolysis in Cerebral Infarction 2c/3 after 1 pass). Secondary outcomes included achieving modified Thrombolysis in Cerebral Infarction 2c/3 within 2 passes, 90-day modified Rankin Scale score (0-2), intracerebral hemorrhage, symptomatic intracerebral hemorrhage, and mortality. Multivariable logistic regressions were used for binary outcomes adjusted for age, National Institutes of Health Stroke Scale score, atrial fibrillation, smoking, and prior thrombolysis. Linear regression was used for the number of thrombectomy passes.</p><p><strong>Results: </strong>Among 724 patients that met inclusion criteria, 47% were female, the median age was 68 (interquartile range, 54-78) years, and the National Institutes of Health Stroke Scale score was 16 (interquartile range, 11-21). Presentation characteristics were balanced except for a greater rate of atrial fibrillation in females (23.0% versus 16.6%; <i>P</i><0.05) and lower rates of intravenous thrombolysis in females (31% versus 40%; <i>P</i><0.05). EVT techniques were comparable between sexes. The first-pass effect across the cohort was similar (female versus male, 37.9% versus 36.3%). In females, contact aspiration yielded higher odds of first-pass effect (adjusted odds ratio, 2.17 [1.07-4.35]) and modified Thrombolysis in Cerebral Infarction 2c/3 within 2 passes (adjusted odds ratio, 2.63 [1.32-5.26]) versus stent retriever, with fewer passes overall (β, 0.28; <i>P</i><0.05). No difference in reperfusion outcomes was seen between EVT techniques in the male subgroup. Among patients receiving stent retriever as their first pass, female sex was associated with lower odds of achieving reperfusion within 2 passes (adjusted odds ratio, 0.43 [0.19-0.99]).</p><p><strong>Conclusions: </strong>This multicenter analysis provides the first evidence that EVT technique performance differs by sex. In females, contact aspiration achieved superior reperfusion with fewer passes compared with stent retrievers. These findings highlight the importance of sex-stratified EVT trials and support individualized, precision-based device selection in acute ischemic stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842408","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":"Predictors of Hematoma Expansion and Response to Andexanet in Patients With Intracerebral Hemorrhage: Secondary Analyses of the ANNEXA-I Randomized Clinical Trial.","authors":"Ashkan Shoamanesh, Stuart J Connolly, Andrew M Demchuk, David J Seiffge, Else Charlotte Sandset, Carlos A Molina, Georgios Tsivgoulis, Hanne Christensen, Jan Beyer-Westendorf, Jonathan M Coutinho, Pierre Amarenco, Robin Lemmens, Roland Veltkamp, Saskia Middeldorp, Andrea Zini, Anders Himmelmann, Per Ladenvall, Mikael Knutsson, Lizhen Xu, Mark Crowther, Mukul Sharma","doi":"10.1161/STROKEAHA.124.050418","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050418","url":null,"abstract":"<p><strong>Background: </strong>Andexanet improves hemostatic efficacy in FXa (factor Xa) inhibitor-associated intracranial hemorrhage but carries a risk of thrombotic events. These secondary analyses of the ANNEXA-I trial examined determinants of hematoma expansion (HE) and the corresponding response to andexanet.</p><p><strong>Methods: </strong>ANNEXA-I enrolled patients aged ≥18 years with acute FXa inhibitor-associated intracranial hemorrhage within 6 hours of onset between June 6, 2019, and May 27, 2023, at 131 sites in 23 countries. Participants were randomized (1:1) to andexanet or usual care. Among 530 participants, 459 (87%) had a qualifying intracerebral hemorrhage and adequate brain imaging for these analyses. The primary outcome was HE (≥12.5-mL or ≥35% increase in baseline volume) at 12 hours. We report differences in the proportion of HE between treatment groups stratified by variables significantly associated with HE in regression models.</p><p><strong>Results: </strong>HE occurred in 149 of 459 participants (32.5%). Symptom onset-to-treatment time (adjusted odds ratio per hour, 0.73 [95% CI, 0.63-0.85]), baseline hematoma volume (adjusted odds ratio per 10 mL, 1.11 [95% CI, 1.01-1.23]), and diastolic blood pressure (adjusted odds ratio per 10 mm Hg, 1.15 [95% CI, 1.02-1.29]) were associated with HE but not thrombotic events. In a separate multivariable model replacing volume and onset-to-treatment time with prescan hematoma growth rate, growth rate was also associated with HE (adjusted odds ratio per mL/h, 1.02 [95% CI, 1.01-1.04]). Patients in the highest risk quartiles (baseline volume >22.4 mL, growth rate >11.4 mL/h, diastolic blood pressure >95.0 mm Hg, and onset-to-treatment time ≤3.3 hours) had ≈50% to 60% absolute risk of HE with usual care. Numerically greater absolute risk reductions with andexanet (≈25%; number needed to treat: 4) were observed in the highest quartiles of baseline volume and growth rate.</p><p><strong>Conclusions: </strong>Shorter onset-to-treatment time, larger baseline hematoma volume, higher diastolic blood pressure, and higher prescan hematoma growth rate predict HE but not thrombotic events in FXa inhibitor-associated intracerebral hemorrhage. Andexanet benefit is observed across these ranges and may be amplified through patient selection using these metrics.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03661528.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843170","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":"Retraction of: Synergetic Neuroprotection of Normobaric Oxygenation and Ethanol in Ischemic Stroke Through Improved Oxidative Mechanism.","authors":"Xiaokun Geng, Paul Fu, Xunming Ji, Changya Peng, Vance Fredrickson, Christopher Sy, Ran Meng, Feng Ling, Huishan Du, Xiaomu Tan, Maik Hüttemann, Murali Guthikonda, Yuchuan Ding","doi":"10.1161/STR.0000000000000526","DOIUrl":"https://doi.org/10.1161/STR.0000000000000526","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843214","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":"National Evaluation of Racial, Ethnic, and Insurance-Based Disparities in Interhospital Transfer of Patients With Ischemic Stroke.","authors":"Ashby Clay Turner, Shen Li, Feras Wahab, Juan Zhao, Kathie Thomas, Remy Poudel, Mathew Reeves, Eric E Smith, Steven R Messé, Gregg C Fonarow, Lee H Schwamm, Kori S Zachrison","doi":"10.1161/STROKEAHA.125.054333","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.054333","url":null,"abstract":"<p><strong>Background: </strong>Disparities in interfacility transfer of patients with acute ischemic stroke have been identified at the regional level, but a national analysis has not been conducted. This study aims to evaluate patient-level trends and disparities in transfer rates based on sex, race, ethnicity, and insurance status using the Get With The Guidelines-Stroke registry.</p><p><strong>Methods: </strong>The Get With The Guidelines-Stroke registry was used to identify patients admitted with acute ischemic stroke between January 2016 and December 2021. We examined patient transfer rate by race/ethnicity groups and by patient insurance status. Odds of transferring out among each demographic group were calculated using a multivariable generalized linear mixed-effect model accounting for patient- and hospital-level confounders. Models were stratified by sex to test for any potential interaction between sex and race/ethnicity or insurance status.</p><p><strong>Results: </strong>Among 776 556 patients transferred out of 1333 sites, Hispanic and Black patients had lower odds of being transferred compared with non-Hispanic Whites among both males and females after adjustment for stroke severity and hospital characteristics (odds ratio [OR], 0.79 [95% CI, 0.74-0.84] for Hispanic females; OR, 0.88 [95% CI, 0.83-0.93] for Hispanic males; OR, 0.80 [95% CI, 0.76-0.83] for Black females; and OR, 0.84 [95% CI, 0.81-0.88] for Black males). Differences in transfer frequency were also noted based on insurance status. In the unadjusted model and model adjusted for stroke severity, patients of all non-Medicare payment groups had higher odds of being transferred out compared with Medicare patients. However, after also adjusting for hospital characteristics, patients with Medicaid had a lower frequency of transfer compared with patients with Medicare among males and females (OR, 0.75 [95% CI, 0.71-0.78] for females with Medicaid; OR, 0.78 [95% CI, 0.75-0.82] for males with Medicaid).</p><p><strong>Conclusions: </strong>In this large, nationwide cohort of patients with acute ischemic stroke, Black and Hispanic patients were less likely to be transferred than non-Hispanic White patients, and patients with Medicaid were less likely to be transferred than patients with Medicare. Further work is needed to understand the contributors to this disparity and the impact on access to high-quality stroke care.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843089","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}