Stroke最新文献

{"title":"Beyond the Threshold: Continuous Creatinine Change and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke.","authors":"Ghil Schwarz, Angelo Cascio Rizzo, Gareth Ambler, Pawel Wrona, Agnieszka Slowik, Aleksandra Bodzioch, Mohamed F Doheim, Alhamza R Al-Bayati, Raul G Nogueira, Ana Paiva Nunes, Patricia Ferreira, Matteo Paolucci, Andrea Zini, Luigi Simonetti, Norbert Leško, Jakub Fedorko, Zuzana Gdovinová, Luca Scarcia, Erwah Kalsoum, Firas Farhat, Morin Beyeler, Adnan Mujanovic, Marcel Arnold, Torcato Meira, Marta Morais, Leonor Francisco, Marcin Wiącek, Paulina Pudło, Halina Bartosik-Psujek, Patricia Calleja, Fernando Ostos, David Seoane, Negrila Anca, Razvan Alexandru Radu, Cristina Tiu, Sami Al Kasab, Ahmad Abu Qdais, Imad Samman Tahhan, Oscar Ayo-Martin, Francisco Hernández-Fernández, Maria Paya, Juan David Molina-Nevo, Beata Maria Labuz-Roszak, Danilo Toni, Karolina Moszko, Mateusz Łukasz Roszak, Manuela De Michele, Elena Barrile, Prasanna Eswaradass, Margaret L Houghton, Tiffany Barkley, Amir Ali, Jelle Demeestere, Wayne Martin Bauknight, Sunil Anil Sheth, Louise Maes, Anke Wouters, João Pedro Marto, José Blazer Costa, Nicola Davide Loizzo, Andrea Romi, Carmelo Tiberio Currò, Piotr Luchowski, Maksymilian Seweryn, Konrad Rejdak, Piers Klein, Mohamad Abdalkader, Valentina Saia, Antioco Sanna, Tiziana Tassinari, Maurizio Acampa, Francesca Rosini, Rossana Tassi, Marta Ewa Bilik, Anna Maria Bandzarewicz-Samcik, Jiangyong Min, Naser HajAissa, Marilena Mangiardi, Sabrina Anticoli, Enrico Pampana, Carlos Hervás-Testal, Ricardo Rigual, Blanca Fuentes, Davide Strambo, Carl Manuata Tetaria, Guillaume Saliou, Andrea Salvatore Caramma, Davide Maimone, Pier Andrea Rizzo, Marco Moci, Irene Scala, Antonio Cruz-Culebras, Rocío Vera Lechuga, Sebastian Garcia Madrona, Giovanni Merlino, Mariarosaria Valente, Arianna Todesco, Manuel Bolognese, Lehel-Barna Lakatos, Grzegorz Marek Karwacki, Paolo Candelaresi, Vincenzo Andreone, Carlo Maurea, Roberto Tarletti, Angelica Mele, Antonio Ciacciarelli, Michele Alessiani, Gabriella Monteforte, David Pakizer, Martin Roubec, David Školoudík, Fenne Vandervorst, Sylvie De Raedt, Martijn Verdam, Josef Bartoš, Martin Šrámek, Valentina Mazzoleni, Luca Quilici, Dario Alimonti, Jessica Moller, Ilaria Maestrini, Marina Diomedi, Giordano Lacidogna, Osama O Zaidat, Eugene Lin, Mohammad AlMajali, Claudio Baracchini, Matteo Zaccagnino, Federica Viaro, Alessandro Pezzini, Giulia Avola, Chiara Ferraro, Milena Świtońska, Paulina Sobieszak-Skura, Grzegorz Meder, Lukas Mayer-Suess, Michael Knoflach, Elke Ruth Gizewski, Matthew R Common, Patrick Nicholson, Sarah Power, Marta Małgorzata Nowakowska-Kotas, Michał Pula, Maciej Guzinski, Soledad Pérez Sánchez, Joan Montaner, Alexandra Sevilla Bravo, Simona Marcheselli, Francesca Vodret, Costanza Rapillo, Liliana Pereira, Miguel Rodrigues, Adam Jaros, Martin Kovar, Jan Vojik, Gloria Valcamonica, Serena Gallo Cassarino, Alessandra Cardillo, Marco Petruzzellis, Silvia Grimaldi, Nicola Marrone, Ameer E Hassan, Samantha Miller, Mohammad W Khasawneh, Valentina Poretto, Simone Tonello, Saverio Tollot, Aleksander Dębiec, Jacek Staszewski, Adam Stepien, Francisco Bernardo, Jorge Ferrao, Marialuisa Zedde, Rosario Pascarella, Alessandra Sanna, Rossella Meloni, Kati Delibas, Simona Sacco, Maria Grazia Vittorini, Raffaele Ornello, Marina Mannino, Valeria Terruso, Marco Filizzolo, Emily Hall, Christine Roffe, Małgorzata Dorobek, Justyna Zielinska-Turek, Giuseppe Scopelliti, Leonardo Pantoni, Guglielmo Carlo Pero, Antonio Macera, Amedeo Cervo, Simone Bellavia, Marco Longoni, Mine Sezgin, Yavuz Dilmen, Esme Ekizoglu, Georgios Tsivgoulis, Aikaterini Theodorou, Vlad Eugen Tiu, Cristina Aura Panea, Simona Petrescu, Mariangela Piano, Thanh N Nguyen, Maria Sessa","doi":"10.1161/STROKEAHA.126.056847","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056847","url":null,"abstract":"<p><strong>Background: </strong>Contrast-associated acute kidney injury (CA-AKI) after endovascular thrombectomy (EVT) worsens outcomes in acute ischemic stroke, but threshold-based definitions do not capture prognostic information from subthreshold changes. We tested whether early creatinine change within 48 hours of EVT conveys graded prognostic information beyond dichotomous CA-AKI.</p><p><strong>Methods: </strong>We performed a secondary analysis of the CAN-REST (Contrast-Associated Nephropathy After Endovascular Stroke Treatment; REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06596603) registry, a retrospective multicenter observational cohort study of 6638 EVT-treated adults with acute ischemic stroke enrolled at 73 centers in 16 countries between January 1 and December 31, 2023. Early creatinine change was quantified as the natural logarithm ratio of 48-hour creatinine to baseline creatinine (ln[48-hour/baseline creatinine]), with CA-AKI defined per Kidney Disease: Improving Global Outcomes criteria (≥0.3 mg/dL or ≥1.5× baseline rise within 48 hours). Multivariable logistic regression adjusted for prespecified baseline and periprocedural covariates examined associations with 90-day modified Rankin Scale shift and in-hospital mortality; linear versus restricted cubic spline specification was selected by likelihood ratio testing, and contrasts were estimated at ±10%, ±25%, and ±50%.</p><p><strong>Results: </strong>Greater creatinine worsening within 48 hours of EVT was independently associated with an unfavorable 90-day modified Rankin Scale shift (adjusted common odds ratio per 1-unit log-ratio increase, 1.48 [95% CI, 1.07-2.04]; linear) and in-hospital mortality (nonlinear dose-response, of larger magnitude). A 10% increase in creatinine at 48 hours-well below Kidney Disease: Improving Global Outcomes threshold-was associated with worse functional outcome (adjusted common odds ratio, 1.04 [95% CI, 1.01-1.07]) and death (adjusted odds ratio, 1.22 [95% CI, 1.13-1.32]); a 10% decrease in creatinine at 48 hours was associated with lower odds of both outcomes (adjusted common odds ratio, 0.96 [95% CI, 0.93-0.99] and 0.74 [95% CI, 0.65-0.86]). The functional-outcome association concentrated at upper modified Rankin Scale cut-points (severe disability, death); effect modification by baseline renal function was not significant.</p><p><strong>Conclusions: </strong>Early creatinine change after EVT conveys graded, outcome-specific prognostic information extending below formal CA-AKI thresholds, with a dose-response detectable at changes as modest as ±10%, complementing binary CA-AKI as a framework for post-EVT renal risk assessment.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT06596603.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114935","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 Recent Mechanical Risk Factors for Venous Thrombosis and Young-Onset Cryptogenic Ischemic Stroke.","authors":"Julija Valančienė, Pauli Ylikotila, Riikka Lautamäki, Marialuisa Zedde, Teresa Grimaldi, Tomi Sarkanen, Essi Ryödi, Dalius Jatužis, Kristina Ryliškienė, Diana Zakarkaitė, Bettina von Sarnowski, Raila Busch, Lauri Tulkki, Jani Pirinen, Nicolas Martinez-Majander, Radim Licenik, Phillip Ferdinand, Cheryl Oxley, Janika Kõrv, Piibe Muda, Tuukka A Helin, Lotta Joutsi-Korhonen, Tímea Szántó, Alessandro Pezzini, Carlo Mario Lombardi, Georgios Tsivgoulis, Satu Suihko, Heli Tolppanen, Ana Catarina Fonseca, Patricia Martínez-Sánchez, Laura Amaya-Pascasio, Sofie Abels, Frank-Erik de Leeuw, Nilufer Yesilot, Mine Sezgin, Ulrike Waje-Andreassen, Sahrai Saeed, Petra Redfors, Odd Bech-Hanssen, Juha Huhtakangas, Marja Hedman, Pekka Jäkälä, Hugo Ten Cate, Eva Gerdts, Mika Lehto, Juha Sinisalo, Jukka Putaala","doi":"10.1161/STROKEAHA.125.054299","DOIUrl":"10.1161/STROKEAHA.125.054299","url":null,"abstract":"<p><strong>Background: </strong>In young adults, the risk factors (RFs) for cryptogenic ischemic stroke (CIS) remain unclear. We aimed to investigate the association between recent mechanical venous thrombosis RFs (VTRFs) and young-onset CIS in this multicenter sex- and age-matched case-control study.</p><p><strong>Methods: </strong>Five hundred forty-six patients aged 18 to 49 years (median age, 41 [34-46] years; 47.3% women) with a recent CIS and 546 stroke-free community-based controls were included in the study across 19 European centers between October 2013 and November 2022. Mechanical VTRFs, including surgical treatment, nonsurgical intervention, injury, and immobilization occurring within 90 days prestroke, were assessed using standardized, structured interviews. Conditional logistic regression was used to assess the association of mechanical VTRFs with CIS. Age, sex, level of education, and traditional and nontraditional stroke RFs were included as confounders.</p><p><strong>Results: </strong>Mechanical VTRFs within 14 days prestroke were more prevalent in cases than controls (15.4% versus 9.6%) and independently associated with CIS after adjustment for demographics and traditional stroke RFs (odds ratio [OR], 1.67 [95% CI, 1.05-2.67]). In age-stratified analysis, this association remained significant after additional adjustment for nontraditional RFs in 18- to 39-year-olds (OR, 2.36 [95% CI, 1.02-5.46]) but was not significant in the 40- to 49-year age group (OR, 1.50 [95% CI, 0.73-3.08]). In addition, mechanical VTRFs were associated with CIS in cases with clinically relevant patent foramen ovale in a fully adjusted model (OR, 2.06 [95% CI, 1.21-3.51]) but not in those without (OR, 1.29 [95% CI, 0.76-2.18]). No significant associations were observed for mechanical VTRFs occurring >14 days before stroke. Baseline blood thrombophilia markers did not differ between cases with and without mechanical VTRFs 0 to 14 or 15 to 90 days before stroke.</p><p><strong>Conclusions: </strong>Recent mechanical VTRFs occurring within 14 days preceding stroke contribute to the risk of young-onset CIS, particularly in younger individuals and those with a clinically relevant patent foramen ovale. This risk does not appear to be conveyed by thrombophilic factors assessed.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01934725.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3010-3023"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819449","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":"Correction to: Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke.","authors":"Norma J Diel, Davide Strambo, Mohamad Abdalkader, Muhammad M Qureshi, Vincent Dunet, Bruno Bartolini, Silvia Pistocchi, Daniel Strbian, Silja Räty, Christian Herweh, Markus Möhlenbruch, Marta Olivé-Gadea, Marc Ribo, Marios Psychogios, Urs Fischer, Anh Nguyen, Joji B Kuramatsu, David Haupenthal, Martin Köhrmann, Cornelius Deuschl, Jordi Kühne Escolà, Jelle Demeestere, Robin Lemmens, Lieselotte Vandewalle, Shadi Yaghi, Liqi Shu, Vivek Yedavalli, S Farzad Maroufi, Volker Puetz, Daniel P O Kaiser, Johannes Kaesmacher, Adnan Mujanovic, Dominique Cornelius Marterstock, Tobias Engelhorn, Manuel Requena, Piers Klein, Brandon Doan, Teresa Jordà-Baleri, Diogo C Haussen, Mahmoud H Mohammaden, Hend Abdelhamid, Lorena Souza Viana, Bruno Cunha, Isabel Fragata, Michele Romoli, Maria Ruggiero, Francesco Diana, Wei Hu, Chao Zhang, Pekka Virtanen, Riikka Lauha, Stavros Matsoukas, Johanna T Fifi, Sunil A Sheth, Sergio A Salazar-Marioni, João Pedro Marto, João Nuno Ramos, Milena Miszczuk, Christoph Riegler, Sven Poli, Khouloud Poli, Luca Scarcia, Ashutosh P Jadhav, Volker Maus, Alexandra Aust, Furkan Yapici, Adnan H Siddiqui, Andre Monteiro, Vinay Jaikumar, Hesham E Masoud, Momotaz Begum, Maxim Mokin, Shail Thanki, Kemal Alpay, Pauli Ylikotila, James Ernest Siegler, Italo Linfante, Guilherme Dabus, Negar Asdaghi, Vasu Saini, Christian H Nolte, Eberhard Siebert, Bettina L Serrallach, Charlotte S Weyland, Lukas Meyer, Anne Berberich, Peter Arthur Ringleb, Raul G Nogueira, Patrik Michel, Simon Nagel, Thanh N Nguyen","doi":"10.1161/STR.0000000000000538","DOIUrl":"https://doi.org/10.1161/STR.0000000000000538","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 10","pages":"e670"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075878","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":"Hyperdense Anterior Cerebral Artery Sign in Anterior Cerebral Artery Dissection.","authors":"Jiacai Zuo, Qi Yang, Xiaoqin Yuan, Yi Yang, Yufeng Tang","doi":"10.1161/STROKEAHA.126.056890","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056890","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 10","pages":"e487-e488"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075926","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":"Early Life Vascular Risk and Midlife Markers of Brain Aging.","authors":"Shahin Yaghoobi, Fatemeh Salboukh, Donald Llyod-Jones, Norrina Allen, David R Jacobs, Lenore J Launer, Kristine Yaffe, M Marsel Mesulam, Philip B Gorelick, R Nick Bryan, Ilya M Nasrallah, Farzaneh A Sorond","doi":"10.1161/STROKEAHA.126.055765","DOIUrl":"10.1161/STROKEAHA.126.055765","url":null,"abstract":"<p><strong>Background: </strong>Early-life vascular risk factors are increasingly linked to midlife cognitive decline, though critical risk periods remain unclear. These factors also relate to structural brain changes, yet midlife alterations tied to cognitive decline are poorly defined. We leveraged data from the CARDIA study (Coronary Artery Risk Development in Young Adults) to identify critical periods and factors associated with midlife cognition and neuroimaging signatures.</p><p><strong>Methods: </strong>We utilized longitudinal cognitive and neuroimaging data from the prospective CARDIA study with vascular risk factor data spanning 35 years (1985-2020). K-means clustering of cognitive trajectories identified Declined and Stable clusters. A gradient boosting classifier identified factors predictive of cluster membership. Linear mixed-effects models assessed cluster differences in structural brain changes, and structural covariance analyses identified brain network remodeling linked to cognitive decline. Cross-sectional late-midlife cognitive data were used to examine associations between early adulthood (ages 18-40 years) systolic blood pressure strata and cognitive outcomes.</p><p><strong>Results: </strong>Among 280 participants with longitudinal data (mean age, 50±3.5 years at baseline; 52% to 56% female, 40% to 41% Black race) followed for a median of 10 years, higher systolic blood pressure and smoking before age 40 years were critical factors for cognitive cluster membership in late midlife (feature importance ≈0.3 and 0.2, respectively). Accelerated accumulation of white matter hyperintensities, gray matter volume changes involving frontal and temporal association cortices, occipital pole and thalamus (β range, -0.0006 to -0.002; <i>P</i>≤0.02), and network-level reorganization predominantly involving the basal forebrain spanning early- to late-midlife distinguished clusters. A stepwise, dose-dependent association between early-life systolic blood pressure strata and late-midlife cognitive performance was replicated in 720 participants (mean age, 61±3.5 years).</p><p><strong>Conclusions: </strong>Before age 40 years may be a critical window to manage vascular risk factors and preserve midlife cognition. Linked white matter hyperintensity and gray matter changes suggest that vascular factors drive both cerebrovascular and neurodegenerative injury. A basal forebrain-centered neuroimaging signature, possibly reflecting cholinergic and glial responses to early vascular stress, may serve as an early biomarker for prevention trials.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3055-3068"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971414","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":"2026 Guideline for Adult Stroke Rehabilitation and Recovery: A Guideline From the American Heart Association and American Stroke Association.","authors":"Lorie G Richards, Nneka L Ifejika, Joel Stein, Mona N Bahouth, Martha Abshire Saylor, A M Barrett, Peii Chen, Anne F Deutsch, Wendy Dusenbury, Charles Ellis, Janice Eng, Jamie Fleet, Heather R Ford, Emily S Grattan, Richard L Harvey, Corinne A Jones, Chandramouli Krishnan, Sara Kutzle, Deven Matthews, Nicole Mazwi, Jamila Minga, Dawn M Nilsen, Elizabeth Noser, Heather R Porter, Preeti Raghavan, Dorian K Rose, Elizabeth R Skidmore, Marie-Pierre St-Onge, Mary Ellen Stoykov, Amelia Tenberg Schettini, Alexandra L Terrill, David L Tirschwell, Paul Vilar, Alicen Whitaker-Hilbig, Richard Zorowitz","doi":"10.1161/STR.0000000000000536","DOIUrl":"10.1161/STR.0000000000000536","url":null,"abstract":"<p><strong>Aim: </strong>The \"2026 Guidelines for Adult Stroke Rehabilitation and Recovery\" replaces the 2016 \"Guidelines for Adult Stroke Rehabilitation and Recovery.\" This updated guideline is intended to provide a comprehensive, up-to-date, evidence-based set of recommendations. The intended audience includes physicians, allied health professionals, and caregivers.</p><p><strong>Methods: </strong>A comprehensive search for literature published since the 2016 guideline, derived from research involving human participants, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between June and October 2025. Other documents on related subject matter previously published by the American Heart Association were also reviewed.</p><p><strong>Structure: </strong>This guideline provides recommendations based on the most current evidence available for stroke rehabilitation and recovery. Key updates include new and revised recommendations across the stroke recovery continuum, including the assessment and treatment of medical comorbidities, fracture risk, fall prevention, technology-enabled rehabilitation, caregiver support, participation, and safe return to work and driving. Although this guideline reflects significant advances, it also highlights gaps in knowledge and underscores the urgent need for continued research to further refine and improve treatment strategies.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e514-e658"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832224","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":"Guidelines in Action: Targeting Tone-Management of Spasticity Poststroke.","authors":"Jamie L Fleet","doi":"10.1161/STROKEAHA.126.056213","DOIUrl":"10.1161/STROKEAHA.126.056213","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e507-e510"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832430","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":"Thrombus Perviousness Is Associated With Differential Treatment Outcomes Following IVT and EVT in MeVO Stroke.","authors":"Mingchen Zhang, Xiaoyu Wu, Yang Qu, Jiale Zhang, Wenbo Jia, Yifei Zhang, Siyuan Wang, Zhen-Ni Guo, Hang Jin","doi":"10.1161/STROKEAHA.126.055948","DOIUrl":"10.1161/STROKEAHA.126.055948","url":null,"abstract":"<p><strong>Background: </strong>In acute ischemic stroke due to medium vessel occlusion, the relative effectiveness of intravenous thrombolysis (IVT) and endovascular therapy (EVT) remains controversial, and treatment benefits may vary across patients. We evaluated the interaction between thrombus perviousness and treatment modality on 90-day functional outcome in patients with medium vessel occlusion.</p><p><strong>Methods: </strong>This single-center retrospective cohort study analyzed 255 patients with imaging-confirmed medium vessel occlusion treated at a stroke center in China between 2018 and 2024 (154 IVT and 101 EVT with or without prior IVT). Thrombus perviousness was quantified using the thrombus perviousness index (TPI) from noncontrast computed tomography and computed tomography angiography. Multivariable logistic regression and inverse probability of treatment weighting evaluated the TPI-by-treatment interaction for 90-day functional independence (modified Rankin Scale score ≤2). Sensitivity analyses used alternative weighting strategies and a surrogate thrombus perviousness measure.</p><p><strong>Results: </strong>The 90-day functional independence rate was similar between the IVT and EVT groups (51.9% versus 51.5%; <i>P</i>=0.96), and TPI was not independently associated with outcome. In the inverse probability of treatment weighting-weighted model, a significant interaction between TPI and treatment modality was observed (interaction odds ratio, 0.37 [95% CI, 0.24-0.56]; <i>P</i><0.001). Higher TPI was associated with a greater likelihood of functional independence in IVT-treated patients (odds ratio per 0.05-unit increase, 1.73 [95% CI, 1.19-2.53]; <i>P</i>=0.005), but lower odds in EVT-treated patients (odds ratio, 0.65 [95% CI, 0.49-0.87]; <i>P</i>=0.003). Exploratory analyses in the IVT subgroup revealed a continuous increase in functional independence as TPI increased, without a stable cutoff. Rates of symptomatic intracranial hemorrhage and 90-day mortality did not differ between groups, and TPI was not associated with hemorrhage risk.</p><p><strong>Conclusions: </strong>In medium vessel occlusion, thrombus perviousness was associated with treatment outcomes, with higher perviousness favoring IVT-related benefits, whereas the use of EVT may be relatively advantageous in patients with low-perviousness thrombi.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3069-3080"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760328","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":"Updated Meta-Analysis of Left Atrial Appendage Closure Versus Oral Anticoagulation to Prevent Stroke in Atrial Fibrillation.","authors":"Prince K Pekyi-Boateng, Arankesh Mahadevan, Smith Kofi Frimpong, Lilly Kanishka, Stephen Gbekor, Hamilton Abimbilla, Brian Jose Villafuerte Trisolini, George Akyea Blankson, Patrick Deladem Pekyi-Boateng, Dan Youg Nguyen, Omid Shoraka, Jana Wold, Aaron Shoskes, Stephanie Lyden, Pugazhendhi Vijayaraman, Jaydevsinh Dolia, Jennifer J Majersik, Anwar Tandar, Karol P Budohoski, Ramesh Grandhi","doi":"10.1161/STROKEAHA.126.057089","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.057089","url":null,"abstract":"<p><strong>Background: </strong>Ninety percent of left atrial thrombi in nonvalvular atrial fibrillation arise in the left atrial appendage, which can be occluded percutaneously (left atrial appendage closure [LAAC]). Two 2026 trials (CHAMPION-AF and CLOSURE-AF) more than doubled the available randomized evidence comparing LAAC with oral anticoagulation. We evaluated pooled effects of LAAC on stroke, bleeding, and mortality by bleeding risk, anticoagulation eligibility, and comparator.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we searched PubMed, Scopus, and Embase from inception to April 15, 2026, for randomized controlled trials comparing percutaneous LAAC with oral anticoagulation in nonvalvular atrial fibrillation. Risk of bias was assessed with the Cochrane Risk of Bias 2 tool. Cumulative-incidence outcomes were pooled as odds ratios using random-effects models, with prediction intervals, prespecified subgroups, and trial sequential analysis.</p><p><strong>Results: </strong>Six randomized controlled trials (2014-2026; 358 sites in North America, Europe, and Asia; 7028 patients) compared LAAC with warfarin (2 trials) or a direct oral anticoagulant (4 trials); populations were predominantly anticoagulation-eligible with low prior-stroke prevalence, plus 2 high-bleeding-risk and 1 postablation trial. Overall stroke rates were similar between arms (odds ratio, 1.10 [95% CI, 0.78-1.56]). Ischemic stroke was more frequent with LAAC (odds ratio, 1.41 [95% CI, 1.07-1.86]) but did not reach the required information size. Nonprocedural bleeding was lower with LAAC (odds ratio, 0.58 [95% CI, 0.35-0.96]), the only outcome reaching a sufficient information size, in standard-risk and postablation but not high-bleeding-risk patients.</p><p><strong>Conclusions: </strong>LAAC is best positioned to reduce nonprocedural bleeding in anticoagulation-eligible patients at standard-to-moderate bleeding risk, rather than as a stroke-equivalent substitute for oral anticoagulation.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD420261370546.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114926","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":"Guidelines in Action: Central Poststroke Pain.","authors":"Monica Sarkar, Paneeni Lohana, Oluwole O Awosika","doi":"10.1161/STROKEAHA.126.056212","DOIUrl":"10.1161/STROKEAHA.126.056212","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e495-e498"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832179","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}