Stroke最新文献

{"title":"Resolution of Carotid Artery Stenosis: A 7-Year Ultrasonographic Observation.","authors":"Sumito Sato, Ryosuke Sato, Shigeki Muto","doi":"10.1161/STROKEAHA.125.050536","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050536","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 7","pages":"e170-e171"},"PeriodicalIF":7.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476691","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":"Simplified Edinburgh Criteria in Probable Iatrogenic Cerebral Amyloid Angiopathy.","authors":"Senta Frol, Tomaz Venar, Sophie Biedermann, Ulf Jensen-Kondering","doi":"10.1161/STROKEAHA.125.051647","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051647","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 7","pages":"e172-e173"},"PeriodicalIF":7.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476693","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 of Covert Cerebrovascular Disease With Falls Requiring Medical Attention.","authors":"Úna Clancy, Eric J Puttock, Wansu Chen, William Whiteley, Ellen M Vickery, Lester Y Leung, Patrick H Luetmer, David F Kallmes, Sunyang Fu, Chengyi Zheng, Hongfang Liu, David M Kent","doi":"10.1161/STROKEAHA.124.050137","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050137","url":null,"abstract":"<p><strong>Background: </strong>The impact of covert cerebrovascular disease on falls in the general population is not well-known. Here, we determine the time to a first fall following incidentally detected covert cerebrovascular disease during a clinical neuroimaging episode.</p><p><strong>Methods: </strong>This longitudinal cohort study assessed computed tomography (CT) and magnetic resonance imaging from 2009 to 2019 of patients aged >50 years registered with Kaiser Permanente Southern California which is a healthcare organization combining health plan coverage with coordinated medical services, excluding those with before stroke/dementia. We extracted evidence of incidental covert brain infarcts (CBI) and white matter hyperintensities/hypoattenuation (WMH) from imaging reports using natural language processing. We examined associations of CBI and WMH with falls requiring medical attention, using Cox proportional hazards regression models with adjustment for 12 variables including age, sex, ethnicity multimorbidity, polypharmacy, and incontinence.</p><p><strong>Results: </strong>We assessed 241 050 patients, mean age 64.9 (SD, 10.42) years, 61.3% female, detecting covert cerebrovascular disease in 31.1% over a mean follow-up duration of 3.04 years. A recorded fall occurred in 21.2% (51 239/241 050) during follow-up. On CT, single fall incidence rate/1000 person-years (p-y) was highest in individuals with both CBI and WMH on CT (129.3 falls/1000 p-y [95% CI, 123.4-135.5]), followed by WMH (109.9 falls/1000 p-y [108.0-111.9]). On magnetic resonance imaging, the incidence rate was the highest with both CBI and WMH (76.3 falls/1000 p-y [95% CI, 69.7-83.2]), followed by CBI (71.4 falls/1000 p-y [95% CI, 65.9-77.2]). The adjusted hazard ratio for single index fall in individuals with CBI on CT was 1.13 (95% CI, 1.09-1.17); versus magnetic resonance imaging 1.17 (95% CI, 1.08-1.27). On CT, the risk for single index fall incrementally increased for mild (1.37 [95% CI, 1.32-1.43]), moderate (1.57 [95% CI, 1.48-1.67]), or severe WMH (1.57 [95% CI, 1.45-1.70]). On magnetic resonance imaging, index fall risk similarly increased with increasing WMH severity: mild (1.11 [95% CI, 1.07-1.17]), moderate (1.21 [95% CI, 1.13-1.28]), and severe WMH (1.34 [95% CI, 1.22-1.46]).</p><p><strong>Conclusions: </strong>In a large population with neuroimaging, CBI and WMH are independently associated with greater risks of an index fall. Increasing severities of WMH are associated incrementally with fall risk across imaging modalities.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508310","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":"Familial Hypercholesterolemia, as an Independent Risk of Cerebral Small Vessel Disease.","authors":"Hiroaki Murata, Yorito Hattori, Kotaro Noda, Mika Hori, Soshiro Ogata, Yuriko Nakaoku, Yoshiaki Morita, Kunihiro Nishimura, Atsushi Nagai, Mariko Harada-Shiba, Shuhei Yamaguchi, Masafumi Ihara","doi":"10.1161/STROKEAHA.124.050070","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050070","url":null,"abstract":"<p><strong>Background: </strong>Familial hypercholesterolemia (FH) is characterized by elevated levels of LDL-C (low-density lipoprotein cholesterol) since birth. However, the association between FH and cerebrovascular diseases, including cerebral small vessel disease (CSVD), is controversial. To investigate the association between FH and CSVD, we compared the prevalence and severity of CSVD neuroradiological findings between patients with FH and control participants.</p><p><strong>Methods: </strong>Patients with FH who visited the lipid clinic and underwent brain magnetic resonance imaging at the National Cerebral and Cardiovascular Center in Japan from November 2006 to April 2021 and control participants who voluntarily underwent brain magnetic resonance imaging as a checkup between December 2000 and December 2010 at the Health Science Center Shimane, Japan, were enrolled into the study. The prevalence and severity of CSVD neuroradiological findings were investigated in patients with FH and control participants, and potential risk factors for CSVD development were identified using multivariable logistic and quasi-Poisson regression analyses.</p><p><strong>Results: </strong>A total of 151 patients with FH and 3172 control participants were enrolled in this study. FH was identified as an independent risk factor of prevalent lacunes (adjusted odds ratio, 1.60 [95% CI, 1.03-2.51]; <i>P</i>=0.039) and increased number of lacunes (1.67 times [95% CI, 1.17-2.31]; <i>P</i>=0.003). Furthermore, FH was also an independent risk factor of prevalent cerebral microbleeds (adjusted odds ratio, 9.42 [95% CI, 5.81-15.28]; <i>P</i><0.001) and increased number of cerebral microbleeds (6.95 times [95% CI, 4.34-10.83]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>The association of FH with lacunes and cerebral microbleeds may warrant routine brain imaging for primary prevention of symptomatic stroke in patients with FH.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498058","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":"White Matter Hyperintensity Multispot Pattern Lesions and Cerebrovascular Amyloid Burden in Cerebral Amyloid Angiopathy.","authors":"Andreas Charidimou, Jean-Claude Baron","doi":"10.1161/STROKEAHA.125.051482","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051482","url":null,"abstract":"<p><strong>Background: </strong>We investigated the relationship between white matter hyperintensity (WMH) multispot pattern lesions, a supporting magnetic resonance imaging marker of cerebral amyloid angiopathy (CAA), and positron emission tomography-based amyloid-β burden across a range of cerebrovascular amyloid deposition.</p><p><strong>Methods: </strong>Twenty-one nondemented subjects (11 patients with probable CAA; median age, 71 [63-77] years; 82% males; and 10 healthy subjects; median age, 63.5 [61-68] years; 50% males) underwent brain magnetic resonance imaging and 11C-Pittsburgh compound B-positron emission tomography imaging. WMH multispot lesions were evaluated on FLAIR sequences. The association between whole cortex 11C-Pittsburgh compound B binding and WMH multispot lesions count was assessed using Kendall tau, adjusting for key markers of CAA through a hierarchical residualization approach.</p><p><strong>Results: </strong>The unadjusted analysis showed a positive correlation between WMH multispot lesions count and whole cortex 11C-Pittsburgh compound B binding (tau-b=0.495; <i>P</i>=0.0017). Sequential adjustments for the presence of severe magnetic resonance imaging-visible perivascular spaces in the centrum semiovale, lobar cerebral microbleeds, age, and total WMH burden led to a progressive decline in correlation. The largest reduction occurred after adjusting for age (tau-b=0.307; <i>P</i>=0.0484) indicating its role as a potential confounder. In the fully adjusted model, the association remained significant (tau-b=0.316; <i>P</i>=0.0423), suggesting a partially independent relationship between WMH multispot lesions count and whole cortex amyloid burden. The results were consistent in a subanalysis within the probable CAA.</p><p><strong>Conclusions: </strong>This pilot study suggests a positive association between cerebrovascular amyloid deposition and WMH multispot lesions in CAA, with potential pathophysiological and clinical implications. These exploratory observations require confirmation in larger studies.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498074","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":"Large-Core Paradox.","authors":"Adrien Ter Schiphorst, Pierre Seners, Caroline Arquizan, Vivek Yedavalli, Jean-Marc Olivot, Maarten G Lansberg, Keith W Muir, Mark W Parsons, Jeffrey L Saver, Marc Fisher, Gregory W Albers, Vincent Costalat, Jean-Claude Baron","doi":"10.1161/STROKEAHA.125.050397","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050397","url":null,"abstract":"<p><p>Recently, 6 randomized controlled trials of endovascular treatment (EVT) versus medical management in anterior circulation large vessel occlusion with large-core documented significant benefit of EVT on functional outcome. Moreover, one trial reported the benefit of EVT in the large-core category (Alberta Stroke Program Early Computed Tomography Score, 0-2). These results are considered paradoxical by some as they contradict the prevailing view that the presence of a large core precludes the possibility of good outcomes following reperfusion. They, in turn, led some investigators to question the applicability of the core/penumbra model in the case of large-core stroke and even its overall validity, specifically regarding the notion that the core reliably predicts tissue infarction. Here, we discuss the trial results and propose alternative explanations for the large-core paradox. First, although EVT does improve outcomes as compared with medical management, overall outcomes remain poor in ≈80% of the treated population. Second, the assessment of core extent on imaging, particularly with computed tomography, is potentially inaccurate, especially in the early time window. Third, consistent with observational studies, some randomized controlled trial substudies suggest that the benefit of EVT in this population derives at least in part from the salvage of penumbra, which appears to have been present in a large percentage of enrolled patients. Fourth, the markedly reduced perfusion that prevails within large cores facilitates the early development of vasogenic edema. This heterogeneity of tissue injury may, in turn, lead to an overestimation of true core/neuronal death as estimated with computed tomography and magnetic resonance imaging. Assessing patients with apparent large core should consider these notions when discussing eligibility for EVT. Early reperfusion of large-core patients is expected to both target any residual penumbra and prevent the development of vasogenic edema within the severely hypoperfused areas. These considerations underscore the need for more reliable methods to identify irreversible neuronal injury inside the imaging-based estimated core.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498059","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":"Regional Differences in Presentation, Cause, and Outcome of Reversible Cerebral Vasoconstriction Syndrome.","authors":"Kristin Sophie Lange, Shuu-Jiun Wang, Alessandro Pezzini, Giulia Avola, So Youn Choi, Yu-Hsiang Ling, Yen-Feng Wang, Jong-Ling Fuh, Jérôme Mawet, Caroline Roos, Gabrielle Tuloup, Claire Duflos, Shih-Pin Chen, Mi Ji Lee, Anne Ducros","doi":"10.1161/STROKEAHA.125.051733","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051733","url":null,"abstract":"<p><strong>Background: </strong>National studies on reversible cerebral vasoconstriction syndrome (RCVS) point to differences between Asian and European patients. We investigated geographic variations in neurological complications, outcomes, and causes.</p><p><strong>Methods: </strong>We conducted an exploratory analysis of pooled individual patient data from the Reversible Cerebral Vasoconstriction Syndrome International Collaborative network, a multicenter observational cohort study including patients with definite RCVS from 2 French, 32 Italian, 1 South Korean, and 1 Taiwanese centers. Data on demographics, precipitants, symptoms, imaging, treatment, and outcomes were collected. The primary end point was RCVS-associated brain lesions, including ischemic stroke, cortical subarachnoid hemorrhage, intracerebral hemorrhage, posterior reversible encephalopathy syndrome, and subdural hematoma. Secondary end points included unfavorable 3-month outcomes (modified Rankin Scale score ≥1) and causes (idiopathic versus secondary). Odds ratios and 95% CIs were calculated using multivariable logistic regression, adjusting for potential confounders.</p><p><strong>Results: </strong>From 2009 to 2021, we included 1127 patients (528 European and 599 Asian). Recruitment occurred either through emergency settings or outpatient clinics, with most Asian patients recruited from outpatient clinics (65.8%) and most European patients from emergency settings (99.8%). Brain lesions were more frequent in European patients (29.2% versus 6.3%; odds ratio, 4.09 [95% CI, 2.66-6.30]). In a sensitivity analysis restricted to hospitalized patients (n=651), the association persisted. Unfavorable 3-month outcomes (5.5% versus 1.7%; odds ratio, 3.01 [95% CI, 1.35-6.68]) and secondary RCVS (50.4% versus 10.9%; odds ratio, 7.09 [95% CI, 5.14-9.76]) were also associated with European residency.</p><p><strong>Conclusions: </strong>RCVS presentations vary across regions, with higher lesion rates, more secondary forms, and worse outcomes in European patients. While these exploratory results may reflect selection bias from differing health care structures, further research is needed to determine the contribution of genetic, environmental, and societal factors.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498073","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":"Postacute Discharge Destination and Major Adverse Cardiovascular Events Among Patients With Intracerebral Hemorrhage.","authors":"Abdulaziz T Bako, Thomas Potter, Alan Pan, Cynthia Chih-Ying Li, Catherine Cooper Hay, Mathew Reeves, Rhonda Abott, Farhaan S Vahidy","doi":"10.1161/STROKEAHA.125.050620","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050620","url":null,"abstract":"<p><strong>Background: </strong>Studies evaluating health system factors associated with major adverse cardiovascular events (MACE) among intracerebral hemorrhage (ICH) survivors are lacking. We evaluate differences in MACE incidence across postacute ICH care settings-inpatient rehabilitation facilities (IRF), home, or skilled nursing facilities (SNF).</p><p><strong>Methods: </strong>Using data from Florida, New York, Maryland, Washington, and Georgia, we identified adult ICH survivors discharged to home, IRF, or SNF (April 2016-December 2018). Multivariable logistic models, adjusted for sociodemographic factors, treatment intensity, comorbidities, and frailty, estimated adjusted odds ratios (aORs) and 95% CIs for the association between discharge disposition (IRF versus home; IRF versus SNF) and MACE (a composite of acute stroke, acute myocardial infarction, systemic embolism, and vascular death), recurrent ICH, acute ischemic stroke, acute myocardial infarction, vascular death, and all-cause mortality within 1 year. Cardiovascular outcomes were ascertained using <i>International Classification of Diseases, Tenth Revision</i> codes. We assessed age-discharge disposition interaction, performing stratified analyses for patients <65 and ≥65 years when the interaction was significant.</p><p><strong>Results: </strong>Among 58 591 patients with ICH (mean age [SD], 68.1 [16.0] years; 47.1% female), 17 647 ICH survivors discharged home (46.4%), to IRF (25.5%), or to SNF (28.1%) were included. Within 1 year, 1302 (7.4%) patients experienced MACE, with rates for recurrent ICH, acute ischemic stroke, acute myocardial infarction, vascular death, and mortality at 2.5%, 3.2%, 0.6%, 1.3%, and 3.5%, respectively. In fully adjusted models, patients discharged to IRF had significantly lower odds of MACE (versus home: aOR, 0.84 [CI, 0.71-0.98]; versus SNF: aOR, 0.79 [CI, 0.67-0.93]), with a significant discharge disposition-age interaction (<i>P</i>=0.047). In stratified analysis, IRF discharge (versus home) was only significantly associated with MACE in patients aged <65 years (aOR, 0.70 [CI, 0.54-0.92]), not in those aged ≥65 years (aOR, 0.94 [CI, 0.77-1.15]). Patients discharged to IRF had significantly lower odds of recurrent ICH (versus SNF: aOR, 0.60 [CI, 0.45-0.80]), vascular death (versus SNF: aOR, 0.70 [CI, 0.49-0.99]), and all-cause mortality (versus SNF: aOR, 0.63 [CI, 0.50-0.79]).</p><p><strong>Conclusions: </strong>IRF care (versus SNF and home) was associated with lower odds of MACE. Further research is needed to determine specific components of IRF care contributing to better outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498072","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":"Translational Insights Into Pericyte-Mediated Regulation of Cerebral Blood Flow: Implications for Ischemic Stroke.","authors":"Yi-Jia Fangma, Zhu-Chen Zhou, Zhong Chen, Yan-Rong Zheng","doi":"10.1161/STROKEAHA.125.052018","DOIUrl":"10.1161/STROKEAHA.125.052018","url":null,"abstract":"<p><p>Microvascular reperfusion stands as a critical therapeutic objective in ischemic stroke management. Pericytes, specialized contractile mural cells enveloping cerebral capillaries, serve as master regulators of capillary tone and regional hemodynamics, exerting a profound influence on post-ischemic stroke blood flow dynamics. Despite their pivotal role in microcirculatory control, there are limited therapeutic targets specifically aimed at regulating their activity. Here, we summarize the multifaceted roles of pericytes in ischemic stroke and discuss various pericyte-related strategies for ischemic stroke. While these interventions offer some benefits, they also present notable limitations, including adverse reactions, structural instability, suboptimal efficacy, and challenges in clinical translation. Future efforts directed toward deciphering the spatiotemporal responses of pericytes across different ischemic phases and achieving their selective and effective regulation are expected to yield novel strategies for precision microcirculatory rehabilitation.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485726","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":"Brain-Body Interactions in Ischemic Stroke: VNS Reprograms Microglia and FNS Enhances Cerebellar Neuroprotection.","authors":"Yuchun Wang, Zhe Yang, Jinling Wang, Minyan Ge, Nianhong Wang, Shumao Xu","doi":"10.1161/STROKEAHA.125.051470","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051470","url":null,"abstract":"<p><p>Stroke significantly impacts mortality and long-term disability, necessitating effective rehabilitation strategies to enhance recovery. This review examines the roles of vagus nerve stimulation (VNS) and fastigial nucleus stimulation (FNS) in facilitating ischemic stroke recovery through brain-body interactions. VNS enhances ischemic stroke recovery by reprogramming microglia from proinflammatory (M1) to neuroprotective (M2) phenotypes, reducing neuroinflammation and promoting tissue repair via neurotrophic factors. It has shown promise in clinically improving chronic upper limb deficits when combined with rehabilitation therapies. Conversely, FNS provides cerebellar-mediated neuroprotection by mainly mitigating excitotoxic damage and inflammatory responses independent of cerebral blood flow alterations, as evidenced by preclinical models of middle cerebral artery occlusion. By integrating VNS-driven immunomodulation with FNS-mediated excitotoxicity suppression, this review highlights their synergistic potential to improve rehabilitation outcomes for ischemic stroke survivors. Biomarker-guided protocols: VNS for cortical/subcortical ischemic deficits and FNS for cerebellar network recovery are advocated to address postischemic disability via anti-inflammatory rewiring, neuroplasticity enhancement, and cerebellar-thalamocortical circuit stabilization. Critical gaps remain in hemorrhagic stroke, where FNS's excitotoxicity suppression may destabilize clots, necessitating subtype-specific safety validations.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485723","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}