Stroke最新文献

{"title":"Fisher One-and-a-Half Syndrome, Half Basilar Artery.","authors":"Flavie Borel, Vincent Schneider, Yannick Béjot, Marc Lenfant","doi":"10.1161/STROKEAHA.126.055798","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.055798","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 10","pages":"e485-e486"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075908","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":"Peripheral Capillary Rarefaction Is Associated With Cerebral Small Vessel Disease Burden: A Population-Based Study.","authors":"Oscar H Del Brutto, Denisse A Rumbea, Robertino M Mera, Fernando Góngora-Rivera, Eduardo J Guzmán, Carlos Ríos, Emilio E Arias, Víctor J Del Brutto","doi":"10.1161/STROKEAHA.126.056694","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056694","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 10","pages":"e483-e484"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075866","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":"Concurrent Intracranial Arterial Dolichoectasia and Nevus Comedonicus: Genetic Insights From Whole Genome Sequencing.","authors":"Dezhi Shan, Shen Hu, Jiachun Liu","doi":"10.1161/STROKEAHA.126.056587","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056587","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 10","pages":"e489-e490"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075913","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":"Role of Clinical Trials in Implementation Science and Organization Change: An Overview of Cluster, Stepped-Wedge, and Hybrid Effectiveness-Implementation Studies.","authors":"Kelly Coughlan, Oyebola Fasugba, Simeon Dale, Nicola Straiton, Caleb Ferguson, Catherine D'Este, Sandy Middleton","doi":"10.1161/STROKEAHA.125.052073","DOIUrl":"10.1161/STROKEAHA.125.052073","url":null,"abstract":"<p><p>Implementation science plays a pivotal role in advancing organizational change within stroke healthcare settings by systematically evaluating and facilitating the adoption of evidence-based practices. This topical review examines the use of key trial designs relevant to implementation science research that aim to change organizational practice, highlighting their unique design features and methodological considerations. It also provides case studies of stroke research that have used each of the methods discussed demonstrating the practical applications in real-world environments. This overview aims to guide researchers and clinicians in selecting appropriate trial designs to optimize the translation of research into sustainable organizational systems and processes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3170-3179"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881429","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: Care Coordination Poststroke.","authors":"Amelia Tenberg Schettini","doi":"10.1161/STROKEAHA.126.056215","DOIUrl":"10.1161/STROKEAHA.126.056215","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e503-e506"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832213","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":"Leptomeningeal Collaterals Constitute an Immune-Responsive Vascular Niche in Ischemic Stroke.","authors":"Jing Ju, Kylee Smith, Collin E Tanchanco, Caroline de Jager, Thinna Svetanant, Biraj M Patel, Michelle H Theus","doi":"10.1161/STROKEAHA.126.056479","DOIUrl":"10.1161/STROKEAHA.126.056479","url":null,"abstract":"<p><strong>Background: </strong>Leptomeningeal collaterals form a critical vascular network that enlarges to support retrograde reperfusion after ischemic stroke, yet the cellular mechanisms governing their structural plasticity remain poorly defined. Here we identify an immune-responsive vascular niche and uncover a central role for bone marrow-derived monocytes in regulating collateral remodeling.</p><p><strong>Methods: </strong>GFP (green fluorescent protein)⁺ bone marrow chimeric mice and inducible monocyte-specific <i>Ccr2-CreERT2</i> (C-C chemokine receptor 2 promoter-driven tamoxifen-inducible Cre recombinase-estrogen receptor T2)<i>/EphA4</i>^<i>f</i>^<i>/f</i> and <i>Ccr2-CreERT2/EphA4</i>^<i>f/f</i><i>/Tie2</i>^<i>f/f</i> (tyrosine kinase with immunoglobulin-like and EGF-like domains 2) mice underwent permanent middle cerebral artery occlusion to assess monocyte recruitment, collateral remodeling, cerebral blood flow, infarct volume, and functional recovery. Mechanistic studies evaluated EphA4 (ephrin receptor A4)/Tie2-PI3K (phosphatidylinositol 3-kinase) α signaling in macrophages, while serum sTie2 (soluble Tie2) levels and immune transcriptomic profiles were analyzed in patients with acute large vessel occlusion and correlated with angiographic collateral grade.</p><p><strong>Results: </strong>We observed rapid recruitment of EphA4-expressing monocytes to pial collateral vessels after permanent middle cerebral artery occlusion. EphA4 knockout chimeric mice show a marked increase in monocyte recruitment, enhanced collateral diameters, improved cerebral blood flow, reduced infarct volume, and accelerated motor recovery. EphA4-null macrophages exhibited elevated Tie2, p-Akt (phosphorylated protein kinase B), and PI3Kα, a phenotype reversed by PI3Kα inhibition or sTie2. We further show enhanced permanent middle cerebral artery occlusion-induced collateral enlargement, neuroprotection, and monocyte recruitment using <i>Ccr2-Cre</i>^<i>ERT2</i><i>/EphA4</i>^<i>f/f</i> mice, which is attenuated in <i>Ccr2-Cre</i>^<i>ERT2</i><i>/EphA4</i>^<i>f/f</i><i>/Tie2</i>^<i>f/f</i> double-knockout mice. Notably, we find that serum sTie2 levels are elevated in human patients with large vessel occlusion, and these levels correlate with improved digital subtraction angiography collateral scoring and key immune-specific bulk transcriptomic changes.</p><p><strong>Conclusions: </strong>Together, these findings establish immune cell-intrinsic EphA4/Tie2 signaling as a key regulator of leptomeningeal collateral enlargement and reveal a therapeutic axis for augmenting perfusion after stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3134-3151"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580236","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":"Modulation of Brain Injury After Intracerebral Hemorrhage via the Scalp-Skull-Dura Interface in Mice.","authors":"Peizheng Li, Ziling Deng, Ling Meng, Lijuan Mao, Bin Wu, Zhifang Dong","doi":"10.1161/STROKEAHA.126.056286","DOIUrl":"10.1161/STROKEAHA.126.056286","url":null,"abstract":"<p><strong>Background: </strong>Neuroinflammation critically contributes to secondary brain injury after intracerebral hemorrhage (ICH). The skull-dura interface allows immune trafficking from skull bone marrow (SBM) to the brain, but its role in ICH remains unclear.</p><p><strong>Methods: </strong>ICH was induced in male C57BL/6J mice by collagenase injection. To compare the immune landscape of SBM and femur bone marrow (FBM), single-cell RNA sequencing was performed on sham-operated and ICH mice. Flow cytometry at serial time points, combined with cell-tracking experiments, was used to assess time-dependent neutrophil accumulation in SBM, dura, and brain, as well as the relative contribution of SBM- versus FBM-derived neutrophils after ICH. To test whether SBM-derived neutrophil migration contributes to neuroinflammation, the CXCR2 (C-X-C motif chemokine receptor 2) antagonist SB225002 was delivered subscalp. Finally, dural delivery of anti-CCL3 (C-C motif chemokine ligand 3) neutralizing antibodies was performed to determine the role of dural CCL3 in SBM neutrophil priming. Outcomes included evaluations of behavioral deficits, brain edema, integrity of the blood-brain barrier, hematoma removal, and brain neutrophil infiltration.</p><p><strong>Results: </strong>Single-cell RNA sequencing revealed that ICH shifted hematopoiesis toward the myeloid lineage in both SBM and FBM; however, SBM neutrophils exhibited significantly stronger proinflammatory and migratory gene signatures than FBM neutrophils. Skull-derived neutrophils preferentially migrated to the dura and brain parenchyma post-ICH. Subscalp delivery of SB225002 reduced neutrophil infiltration, attenuated brain edema and blood-brain barrier disruption, and improved short-term and long-term neurological deficits. In addition, CCL3 was specifically upregulated in dural neutrophils after ICH. Unexpectedly, dural delivery of an anti-CCL3 antibody markedly reduced neutrophil accumulation in the brain and protected against ICH-induced brain injury, accompanied by inhibition of neutrophil activation in SBM but not in FBM.</p><p><strong>Conclusions: </strong>SBM may serve as a primary source of pathogenic neutrophils driving neuroinflammation after ICH. Targeting this immune compartment through the scalp-skull-dura interface represents an accessible strategy for mitigating ICH-induced brain injury.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3124-3133"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920169","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":"Cilostazol Treatment for Intracerebral Hemorrhage: Targeting Dural Lymphatics.","authors":"Chen-Kai Lan, Wan-Ru Chen, Yung Chia Hsieh, Tze-Yen Lin, Shao-Chun Hsu, Zi-Rou Jiang, Shih-Pin Chen, Danye Jiang, Louise D McCullough, Jaroslaw Aronowski, Li-Kai Tsai, Hsin-Hsi Tsai, Che-Feng Chang","doi":"10.1161/STROKEAHA.126.055192","DOIUrl":"10.1161/STROKEAHA.126.055192","url":null,"abstract":"<p><strong>Background: </strong>The meningeal lymphatic system contributes to hematoma resolution and neurological recovery after intracerebral hemorrhage (ICH). We previously demonstrated that intraperitoneal cilostazol administration promotes dural lymphatic growth and enhances clearance of intracerebrally injected red blood cells; however, the antiplatelet effects of cilostazol raise safety concerns in ICH, potentially limiting clinical translation. Here, we evaluated whether oral cilostazol at clinical-equivalent doses in mice enhances dural lymphatic function and improves outcomes after ICH.</p><p><strong>Methods: </strong>ICH was induced by collagenase injection to model microvascular rupture. Cilostazol was orally administered to ICH mice at clinically equivalent doses, given at different time points and for varying durations. Prolymphangiogenic effects of cilostazol were examined in healthy in vivo and ex vivo meninges. Flow cytometry and immunofluorescence were performed to assess lymphatic endothelial cell proliferation and dural lymphatic remodeling. Lymphatic function was evaluated by in vivo live imaging and histological analysis of fluorescent tracer drainage. Short- and long-term histopathologic and behavioral outcomes were also evaluated.</p><p><strong>Results: </strong>Oral cilostazol treatment initiated either 3 hours or 3 days after ICH enhanced dural lymphatic coverage and function, accompanied by reduced hematoma volume, neuronal injury, synapse loss, and long-term neurological deficits. Cilostazol increased CD31⁺PDPN⁺ lymphatic endothelial cells in ex vivo meninges, induced dural lymphatic hyperplasia, and enhanced lymphatic drainage in healthy mice. Both pretreatment and delayed treatment of cilostazol did not increase hematoma volume but rather improved ICH outcomes.</p><p><strong>Conclusions: </strong>By promoting dural lymphatic remodeling and drainage, cilostazol facilitates hematoma resolution and neurological recovery after ICH. Cilostazol treatment does not exacerbate initial bleeding or provoke hematoma expansion in the experimental ICH. These findings support clinical translation and provide mechanistic and dosing rationale for an ongoing phase II randomized trial (URL: https://www.clinicaltrials.gov; Unique identifier: NCT06504576).</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3091-3105"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881386","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":"Stroke Prevention in the Longevity Era: An Integrated Framework for Cerebrovascular and Biological Aging.","authors":"Gustavo Saposnik, Conrado E Estol","doi":"10.1161/STROKEAHA.126.056919","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056919","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 10","pages":"3213-3218"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075938","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":"Body Weight in Relation to the Effectiveness of Intravenous Alteplase in Acute Ischemic Stroke: The ENCHANTED Trial.","authors":"Yilun Ge, Yijie Gao, Xiaoying Chen, Chunfeng Liu, Richard I Lindley, Hisatomi Arima, Guofang Chen, Candice Delcourt, Philip M Bath, Joseph P Broderick, Andrew M Demchuk, Geoffrey A Donnan, Pablo M Lavados, Tsong-Hai Lee, Sheila O Martins, Jeyaraj D Pandian, Mark W Parsons, Octavio M Pontes-Neto, Thang H Nguyen, John Chalmers, Lili Song, Thompson G Robinson, Xia Wang, Craig S Anderson","doi":"10.1161/STROKEAHA.125.053569","DOIUrl":"10.1161/STROKEAHA.125.053569","url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of body weight in patients receiving thrombolysis for acute ischemic stroke remains uncertain. This study aimed to determine whether body weight modifies the comparative effects of low- versus standard-dose intravenous alteplase and to evaluate the associations of body weight and clinical outcomes in patients with acute ischemic stroke.</p><p><strong>Methods: </strong>A post hoc analysis of the ENCHANTED trial (Enhanced Control of Hypertension and Thrombolysis Stroke Study), an international partial-factorial randomized controlled trial comparing low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) intravenous alteplase and intensive (target systolic blood pressure 130-140 mm Hg) versus guideline-recommended (target systolic blood pressure <180 mm Hg) treatment. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale score of 2 to 6 (versus 0-1). For the first objective, the exposure was defined as alteplase dose and body weight, whereas for the second objective, body weight alone was considered as the exposure. Logistic regression models were performed to analyze the association between body weight and outcome. The association shape between treatment effect and body weight was evaluated using restricted cubic splines.</p><p><strong>Results: </strong>Among 3206 patients (mean age, 66.6 years; female 37.9%) in the alteplase-dose arm, body weight did not significantly modify the comparative effects of low- versus standard-dose alteplase on functional recovery (<i>P</i>_interaction=0.60), death (<i>P</i>_interaction=0.56), or symptomatic intracerebral hemorrhage (<i>P</i>_interaction=0.46). In the full cohort of 4458 patients (mean age 66.7 years; female 37.8%), a nonlinear relationship was observed between continuous body weight and 90-day modified Rankin Scale score, with an inflection point at ≈74 kg. Patients weighing <74 kg had a significantly higher likelihood of poor functional outcome (odds ratio, 1.41 [95% CI, 1.06-1.87]; <i>P</i>=0.017) and death (1.65 [95% CI, 1.04-2.61]; 0.03), but not an increase in symptomatic intracerebral hemorrhage.</p><p><strong>Conclusions: </strong>There was no evidence of effect modification by body weight on the effectiveness of low- versus standard-dose intravenous alteplase in patients with acute ischemic stroke. Low body weight predicts a poor outcome but not an increased risk of symptomatic intracerebral hemorrhage after thrombolysis treatment for acute ischemic stroke.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01422616. URL: https://anzctr.org.au; Unique identifier: ACTRN12611000236998.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2991-2999"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819418","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}