Stroke最新文献

{"title":"Diffusion MRI Identifies a Prolonged Pre-WMH Phase in Cerebral Small Vessel Disease.","authors":"Prashanthi Vemuri, Mingzhao Hu, Emily S Lundt, Michael G Kamykowski, Robert I Reid, Terry M Therneau, Sheelakumari Raghavan, Petrice M Cogswell, Michael E Griswold, B Gwen Windham, Clifford R Jack, Ronald C Petersen, Jonathan Graff-Radford","doi":"10.1161/STROKEAHA.126.055797","DOIUrl":"10.1161/STROKEAHA.126.055797","url":null,"abstract":"<p><strong>Background: </strong>White matter hyperintensities (WMH) are widely used to assess cerebral small vessel disease but reflect late-stage injury. Diffusion magnetic resonance imaging (MRI) biomarkers have been proposed to capture earlier small vessel disease-related microstructural damage but their temporal progression relative to WMH and risk factors associated with progression remain unexplored.</p><p><strong>Methods: </strong>We identified 2077 participants from the population-based cohort study of the Mayo Clinic Study of Aging in Olmsted County, Minnesota (aged 50-101 years) collected between 05/2005 and 09/2024 with longitudinal neuroimaging. Using multioutput nonlinear mixed-effects models in those with at least 2 fluid-attenuated inversion recovery-MRI and diffusion MRI scans, we characterized the temporal progression of WMH and 4 diffusion MRI biomarkers: fractional anisotropy of the genu of the corpus callosum, peak width of skeletonized mean diffusivity, free water, and Arteriolosclerosis-score, which were automatically estimated. Models incorporated participant-specific time shifts, correlations between biomarkers, and effects of risk factors (sex, education, <i>APOE ε4</i> status, cardiometabolic conditions).</p><p><strong>Results: </strong>The study population had a mean age of 78 years, 47% were women, 28% were <i>APOE ε4</i> allele carriers, and 80% were cognitively unimpaired, with an average follow-up of 5.2 years (SD, 4.3 years) for fluid-attenuated inversion recovery-MRI and 4.3 years (SD, 3.9 years) for diffusion MRI. Arteriolosclerosis-score, fractional anisotropy of the genu of the corpus callosum, free water, and peak width of skeletonized mean diffusivity became abnormal in 50% of the study population 16, 12, 10, and 7 years before WMH become abnormal (half-width of CI <1 year), respectively. Global markers (Arteriolosclerosis-score, free water, peak width of skeletonized mean diffusivity, and WMH) were correlated, indicating shared substrates of widespread white matter injury. Fractional anisotropy of the genu of the corpus callosum, a vascular risk microstructural injury biomarker, was weakly coupled with WMH and had an earlier but more linear worsening across adulthood. Cardiometabolic conditions predicted earlier worsening of all biomarkers. Female participants showed earlier WMH, fractional anisotropy of the genu of the corpus callosum, and Arteriolosclerosis-score abnormalities, whereas male participants exhibited earlier peak width of skeletonized mean diffusivity and free water abnormalities.</p><p><strong>Conclusions: </strong>Diffusion MRI biomarkers were abnormal at least a decade before WMH become abnormal in the population, revealing a prolonged phase of early small vessel disease and highlighting their potential for small vessel disease prevention.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2789-2800"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550406","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":"Advances in Stroke 2026: Health Policy and Health Services Delivery.","authors":"Dominique A Cadilhac, Janet Prvu Bettger","doi":"10.1161/STROKEAHA.126.054531","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.054531","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 9","pages":"2909-2912"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814081","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":"Balloon Angioplasty by Prior Stroke History in Intracranial Artery Stenosis: A Post Hoc Analysis of the BASIS Trial.","authors":"Fangguang Chen, Ming Yang, Dapeng Sun, Longhui Zhang, Yiyang Sun, Yuesong Pan, Hongyi Yan, Ziqian Xu, Feng Gao, Ning Ma, Dapeng Mo, Yilong Wang, Zhongrong Miao, Xuan Sun","doi":"10.1161/STROKEAHA.126.055945","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.055945","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 9","pages":"e468-e470"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814099","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":"Response to Request for Modification of the 2026 AHA/ASA Acute Ischemic Stroke Guidelines: Endovascular Thrombectomy Imaging Selection in the 6- to 24-Hour Window.","authors":"Nestor R Gonzalez, Shyam Prabhakaran, Kori S Zachrison, Enrique C Leira, Mona N Bahouth, Joseph P Broderick","doi":"10.1161/STROKEAHA.126.056726","DOIUrl":"10.1161/STROKEAHA.126.056726","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2939-2948"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631563","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":"Portable Low-Field MRI Across the Stroke Continuum: From Hyperacute Care to Brain Health.","authors":"W Taylor Kimberly, Kevin N Sheth","doi":"10.1161/STROKEAHA.126.056840","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056840","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 9","pages":"2574-2576"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814071","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":"Quantitative Relationship Between White Matter Hyperintensity Volume and Fazekas Score on Brain MRI.","authors":"Yu-Yuan Xu, Francesca M Chappell, Maria Valdes Hernandez, Carmen Arteaga Reyes, Una Clancy, Daniela Jaime Garcia, Stephen Makin, Michael Stringer, Michael Thrippleton, Stewart Wiseman, Yajun Cheng, Dillys Xiaodi Liu, Rosalind Brown, Fergus Doubal, Ian J Deary, Simon Cox, Danielle Kerkhofs, Julie Staals, Walter Backes, Robert van Oostenbrugge, Anna Kopczak, Marco Duering, Joanna M Wardlaw","doi":"10.1161/STROKEAHA.125.055101","DOIUrl":"10.1161/STROKEAHA.125.055101","url":null,"abstract":"<p><strong>Background: </strong>The Fazekas score is widely used to grade white matter hyperintensities (WMHs) in cerebral small vessel disease, yet the equivalent volume of each grade is unclear. We quantified the correspondence between Fazekas scores and WMH volume, normalized ratios, and derived conversion equations across populations.</p><p><strong>Methods: </strong>We analyzed 1220 participants from 4 mostly United Kingdom-based cohorts representing different cerebral small vessel disease severities: community-dwelling (LBC1936 [Lothian Birth Cohort 1936]), stroke (MSS2 [Mild Stroke Study 2] and MSS3 [Mild Stroke Study 3]), and a cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy-enriched cohort (INVESTIGATE [Imaging Neuro-Vascular, Endothelial and Structural Integrity in Preparation to Treat Small Vessel Diseases]). WMH burden was quantified as absolute WMH volume and as normalized ratios: WMH volume as a percentage of brain volume and WMH volume as a percentage of intracranial volume. Transition zones were defined as the overlap of WMH volume interquartile ranges between adjacent Fazekas scores. Linear, exponential (nonlinear least squares), and log-linear (ln WMH≈Fazekas score and zeros excluded) models were fitted; model fit was assessed using mean squared error, (pseudo-)R², and Vuong tests. Periventricular-versus-deep WMH patterns within each total Fazekas score were compared using the Kruskal-Wallis test.</p><p><strong>Results: </strong>The pooled cohort had a mean age of 69.4±8.9 years; 700 of 1227 records (57.1%) were male. WMH burden increased monotonically with a Fazekas score in all cohorts. Adjacent-grade separation was strongest in LBC1936 (all <i>P</i>≤0.002) but weaker at lower grades in MSS2, MSS3, and INVESTIGATE. The widest transition zones occurred between Fazekas grades of 3 to 4 and 4 to 5, whereas a clear WMH volume gap separated grades 5 and 6. Exponential models generally fit better than linear models, with lower mean squared error and supportive Vuong tests in most cohorts. Log-linear sensitivity analyses showed similar fitted trajectories after back-transformation. WMH burden did not differ consistently by periventricular-versus-deep distribution within Fazekas grades.</p><p><strong>Conclusions: </strong>WMH burden followed an exponential trajectory across Fazekas scores, with population-dependent progression. The resulting conversion equations enabled bidirectional translation between visual Fazekas score and quantitative WMH volume, facilitating cross-study comparison, large-scale epidemiology, and might facilitate clinical decision-making in cerebral small vessel disease.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2801-2812"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449575","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":"Tenecteplase Efficacy in Patients With Distal Occlusions: Secondary Analysis of the TASTE Randomized Clinical Trial.","authors":"Vignan Yogendrakumar, Justin Phung, Hannah T Johns, Leonid Churilov, Carlos Garcia-Esperon, Gagan Sharma, Niruta Dhimal, Chushuang Chen, Longting Lin, Beng Lim Chew, Felix C Ng, Akshay Deepak, Ferdinand Miteff, Philip M C Choi, Timothy J Kleinig, Dennis J Cordato, Teddy Y Wu, Henry Ma, Carlos A Molina, Chon-Haw Tsai, Jiunn-Tay Lee, Jiann-Shing Jeng, Daniel Strbian, Juan F Arenillas, Brian H Buck, Michael J Devlin, Kenneth S Butcher, Geoffrey A Donnan, Stephen M Davis, Neil J Spratt, Christopher R Levi, Bruce C V Campbell, Mark W Parsons","doi":"10.1161/STROKEAHA.126.056290","DOIUrl":"10.1161/STROKEAHA.126.056290","url":null,"abstract":"<p><strong>Background: </strong>Tenecteplase has been previously evaluated in large- and medium-sized vessel occlusion subgroups, but its effectiveness in more distal occlusions, particularly those involving the distal middle cerebral artery branches or the anterior cerebral artery and posterior cerebral artery territories, and across varying ischemic core and perfusion profiles, remains uncertain.</p><p><strong>Methods: </strong>We performed a secondary analysis of TASTE (Tenecteplase Versus Alteplase for Stroke Thrombolysis Evaluation), a randomized clinical trial comparing tenecteplase and alteplase in patients presenting within 4.5 hours of symptom onset with perfusion imaging-confirmed stroke and evidence of target mismatch (penumbra/core ratio >1.8 and an absolute difference >15 mL). The primary outcome was the modified Rankin Scale (mRS) score of 0 to 1 at 90 days. We compared the effect of tenecteplase versus alteplase in subgroups based on occlusion site (proximal M2, distal M2, M3 and beyond, anterior cerebral artery, and posterior cerebral artery), ischemic core, core growth rate, and penumbra. The treatment effect of tenecteplase and alteplase was compared stratifying by the subgroup of interest, adjusting for age, baseline National Institutes of Health Stroke Scale score, and premorbid mRS score in modified Poisson regression models.</p><p><strong>Results: </strong>Of the 680 patients enrolled, 492 were included in the primary analysis (median age, 73 [interquartile range, 63-82] years; male sex: 306/492 [62%]). Two hundred forty-two (49%) received tenecteplase, and 250 (51%) received alteplase. Tenecteplase was associated with a higher proportion of mRS score of 0 to 1 with distal (M3 and beyond) occlusions (tenecteplase: 62/81 [77%] versus alteplase: 59/93 [63%]; adjusted risk ratio, 1.23 [95% CI, 1.04-1.46]). Numerically higher rates of mRS score of 0 to 1 were observed with distal M2 (tenecteplase: 30/46 [65%] versus alteplase 28/48 [58%]; adjusted risk ratio, 1.14 [95% CI, 0.84-1.54]) and anterior cerebral artery occlusions (tenecteplase: 12/21 [57%] versus alteplase 5/13 [38%]; adjusted risk ratio, 1.46 [95% CI, 0.71-3.00]). No treatment differences were seen for proximal M2 or posterior cerebral artery occlusions (<i>P</i>_interaction across all occlusion sites: 0.89). Across ischemic core, penumbra, and core growth rate subgroups, no difference in treatment effect was observed.</p><p><strong>Conclusions: </strong>Patients with distal middle cerebral artery occlusions who are treated with tenecteplase are more likely to achieve an mRS score of 0 to 1 at 90 days than those treated with alteplase.</p><p><strong>Registration: </strong>URL: https://www.anzctr.org.au; Unique identifier: ACTRN12613000243718.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2643-2652"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550429","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":"PREVENT Equations: Implications for Stroke Prevention.","authors":"Taha Ahmed, Roy O Mathew, Mitchell S V Elkind, Ambar Kulshreshtha","doi":"10.1161/STROKEAHA.126.053362","DOIUrl":"10.1161/STROKEAHA.126.053362","url":null,"abstract":"<p><p>Stroke remains a leading cause of death and long-term disability. Yet, much of its burden is preventable through earlier and more intensive management of vascular and cardiovascular-kidney-metabolic risk factors. Primary prevention is challenging as the first clinical event is often unpredictable and may manifest as stroke, myocardial infarction, heart failure, or peripheral arterial disease. Contemporary tools, therefore, estimate overall cardiovascular risk rather than stroke risk in isolation. The goal of this review is to emphasize that effective stroke prevention requires a shift toward global cardiovascular risk assessment and to highlight the potential clinical utility of newer risk prediction tools. The predicting risk of cardiovascular disease events equations, developed by the American Heart Association, update absolute risk estimation by modeling overall cardiovascular disease risk using sex-specific, race-free equations that incorporate kidney function, account for competing noncardiovascular death, and optionally include neighborhood deprivation. External validations suggest improved calibration compared with pooled cohort equations, supporting a more reliable estimation of absolute treatment benefit. For clinicians managing patients at risk for stroke, predicting risk of cardiovascular disease events is most useful when the clinical question is how aggressively to optimize risk factors before the first event, including decisions about blood pressure, lipid-lowering therapy, cardiovascular-kidney-metabolic management, and patient communication using 10-year, 30-year, and risk age outputs. Key limitations include its focus on overall rather than cause-specific cardiovascular risk, lack of stroke mechanism-specific estimates, absence of major nonatherosclerotic stroke drivers such as atrial fibrillation, and lack of imaging-stratified treatment-effect estimates. Predicting the risk of cardiovascular disease events' ultimate clinical impact and equity will depend on implementation within electronic health record workflows, autopopulated inputs, treatment pathways tied to estimated risk, and complementary cause-specific evaluation when clinically indicated.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2913-2924"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406037","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":"Disseminated Cerebral Amyloid Angiopathy With Lobar Hemorrhage.","authors":"Sunil Munakomi","doi":"10.1161/STROKEAHA.126.056827","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056827","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 9","pages":"e475-e476"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814069","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":"Bilateral Hypertrophic Olivary Degeneration and Holmes Tremor Following Pontine Bleed.","authors":"Farsana Mustafa, Ayush Agarwal, Achal Kumar Srivastava, Savyasachi Jain, Divyani Garg","doi":"10.1161/STROKEAHA.126.056577","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056577","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 9","pages":"e473-e474"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814118","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}