Stroke最新文献

{"title":"Guidelines in Action: Physical Activity and Exercise Prescription After Stroke.","authors":"Alicen Whitaker-Hilbig","doi":"10.1161/STROKEAHA.126.056216","DOIUrl":"10.1161/STROKEAHA.126.056216","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e511-e513"},"PeriodicalIF":11.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832387","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":"Microglial P2Y₁₂ Drives Chronic Cerebral Hypoperfusion via Ca²⁺ Activity-Mediated Neuroinflammation and Vascular Injury.","authors":"Qiankang Chen, Shihao Yuan, Yana Wang, Jiaying Li, Xingdong Chen, Zengyu Zhang, Ziyu Shi, Yiwen Yuan, Leilei Mao, Yuzhen Xu, Zeyu Sun, Yanqin Gao","doi":"10.1161/STROKEAHA.126.056302","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056302","url":null,"abstract":"<p><strong>Background: </strong>Chronic cerebral hypoperfusion is a major driver of vascular cognitive impairment (VCI), but the role of microglial purinergic signaling in chronic cerebral hypoperfusion-induced neurovascular dysfunction remains undefined. This hypothesis-testing study with a novel research premise aimed to address this knowledge gap by clarifying whether microglial P2Y<sub>12</sub> (purinergic receptor P2Y<sub>12</sub>), a microglia-enriched G-protein-coupled receptor, mediates VCI pathogenesis through regulation of microglial calcium signaling and microglia-vascular crosstalk under chronic cerebral hypoperfusion conditions.</p><p><strong>Methods: </strong>VCI was induced in adult male mice by asymmetrical bilateral carotid artery stenosis. Microglia-specific P2Y<sub>12</sub> knockout mice were generated using P2Y<sub>12</sub><sup>flox/flox</sup>:CX3CR1<sup>CreER</sup> mice. Cognitive function was assessed by object location recognition, 3-chamber social interaction, and Morris water maze tests. Cerebral blood flow was measured by laser speckle contrast imaging and functional ultrasound. Neuroinflammation, microvascular integrity, and perivascular microglial Ca<sup>2+</sup> activity were evaluated by immunofluorescence, flow cytometry, and 2-photon GCaMP6f imaging. The clinically approved L-type Ca<sup>2+</sup> channel blocker nimodipine was administered starting 42 days postasymmetrical bilateral carotid artery stenosis.</p><p><strong>Results: </strong>All experimental animals exhibited consistent baseline physiological and behavioral status without intergroup differences throughout the procedure. Chronic cerebral hypoperfusion induced persistent upregulation of P2Y<sub>12</sub> in hippocampal microglia. Microglial P2Y<sub>12</sub> genetic ablation effectively ameliorated hypoperfusion-triggered cognitive impairment, hippocampal atrophy, and neuronal loss, preserved cerebral perfusion, and inhibited sustained microglial inflammatory activation and pathological microglia-microvessel interaction. Mechanistically, P2Y<sub>12</sub> signaling mediated aberrant ATP-triggered Ca<sup>2+</sup> hyperactivity in perivascular microglia, and this pathological phenotype was eliminated by microglial P2Y<sub>12</sub> deletion. Pharmacological intervention with nimodipine recapitulated the protective effects of genetic P2Y<sub>12</sub> inhibition, normalizing abnormal microglial calcium activity, alleviating neuroinflammation and disruptive microglia-vascular crosstalk, maintaining cerebral structural and perfusion homeostasis, and rescuing cognitive dysfunction in model mice, while exerting no adverse effects on control animals.</p><p><strong>Conclusions: </strong>The microglial P2Y<sub>12</sub>/Ca<sup>2+</sup> axis is a critical pathogenic driver of chronic cerebral hypoperfusion-induced VCI, linking sustained microglial activation to neuroinflammation and cerebral microvascular injury. Pharmacological inhibition of this axis with nimodipine r","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070209","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":"Deterioration of Peri-Infarct Microvascular Hemodynamics Following Successful Reperfusion in Acute Ischemic Stroke Predicts Infarct Growth.","authors":"Yannan Yu, Mona Asghariahmadabad, Keon Mahmoudi, Corey Arnold, Michael Thomas, Ameera Ismail, Mersedeh Bahr-Hosseini, Jeffrey L Saver, David S Liebeskind, Latisha K Sharma, S Andew Josephson, Christopher P Hess, Kambiz Nael","doi":"10.1161/STROKEAHA.126.056258","DOIUrl":"10.1161/STROKEAHA.126.056258","url":null,"abstract":"<p><strong>Background: </strong>Microvascular hemodynamic deterioration is a proposed mechanism underlying the no-reflow phenomenon in acute ischemic stroke. Experimental studies suggested that relative heterogeneity of capillary transit time (RTH) is a potential imaging biomarker of microvascular impairment. We investigated the relationship between peri-infarct RTH and infarct growth, measured on immediate post-thrombectomy (PT) perfusion magnetic resonance imaging (MRI), and functional outcomes in patients with acute ischemic stroke with successful reperfusion.</p><p><strong>Methods: </strong>In this retrospective case-control study from the University of California, Los Angeles, patients with acute ischemic stroke from 2015 to 2020 were included if they had excellent reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2c) and diffusion- and perfusion-weighted MRIs at baseline, immediately PT, and 24 to 48 hours after thrombectomy. Peri-infarct regions were defined as time to maximum ≥6-second regions on baseline MRI that were not infarcted on immediate PT MRI. Following image coregistration, quantitative values of perfusion parameters, including RTH, were obtained from peri-infarct regions on immediate PT MRI. Two primary outcomes were assessed: (1) infarct growth ≥10 mL and (2) poor functional outcome (90-day modified Rankin Scale score >2). Associations between clinical and imaging parameters and outcomes were evaluated using univariate analysis. Age, sex, and covariates that were significant in univariate analysis were included in logistic regression analyses.</p><p><strong>Results: </strong>Among 47 patients included in the analysis (62% female; mean age, 72±13 years; median National Institutes of Health Stroke Scale score, 14), 20 (43%) patients had substantial infarct progression and poor functional outcome. Peri-infarct RTH was significantly (<i>P</i>=0.005) higher in patients with infarct growth >10 mL than those without and remained as an independent predictor (odds ratio, 1.4 per 10% increase [95% CI, 1.0-2.0]; <i>P</i>=0.04). Similarly, the peri-infarct RTH was significantly higher (<i>P</i><0.001) in patients with poor functional outcomes than those with good functional outcomes and remained as a significant predictor of poor functional outcome (odds ratio, 1.4 per 10% increase [95% CI, 1.0-1.9]; <i>P</i>=0.03).</p><p><strong>Conclusions: </strong>Increased peri-infarct RTH on immediate PT MRI predicts substantial infarct progression and poor functional outcomes in successfully reperfused patients with acute ischemic stroke. Results highlight the role of microvascular dysfunction depicted by elevated RTH as a potential marker of no-reflow phenomenon despite excellent macrovascular reperfusion.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070193","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":"Current Evidence on Periprocedural Flat-Panel CT in Endovascular Stroke Treatment: A Systematic Review and Meta-Analysis.","authors":"Lorenz Grunder, Petra Cimflova, Mousa Zidan, Jeremy Hofmeister, Manuel Requena, Daniel Windecker, Jonathan Poggi, Mikael Mazighi, Franziska Dorn, Aymeric Rouchaud, Felix Ng, Kilian Treurniet, Francesco Diana, Marios Psychogios, Hee-Joon Bae, Valentina Tudisco, Michele Romoli, Arnd Doerfler, Eytan Raz, Jonathan Coutinho, Gregoire Boulouis, Adnan Mujanovic, Manabu Inoue, Diogo Haussen, Bruce Campbell, Urs Fischer, Jan Gralla, Eike Piechowiak, Tomas Dobrocky, Johannes Kaesmacher","doi":"10.1161/STROKEAHA.126.055666","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.055666","url":null,"abstract":"<p><strong>Background: </strong>Periprocedural flat-panel computed tomography (FPCT) may complement real-time decision-making during endovascular treatment for stroke. This study aims to summarize current evidence on diagnostic findings, prognostic associations, and clinical applications of periprocedural FPCT in the angiography suite.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was preregistered (URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD420251142156), conducted and reported according to MOOSE guidelines. Medline, Embase, and Scopus were searched for studies published between January 2019 and September 2025 reporting on periprocedural FPCT in endovascular treatment patients (noncontrast FPCT, 3-dimensional-digital subtraction angiography/contrast-enhanced FPCT, or FPCT perfusion). Random-effects models were used to calculate pooled prevalences and odds ratios for associations with outcomes, primarily functional status assessed via the 90-day modified Rankin Scale score.</p><p><strong>Results: </strong>Forty studies comprising 4139 patients were included. For noncontrast FPCT, 3 distinct imaging biomarkers were identified. Intraparenchymal hyperattenuations were frequent (pooled prevalence 49% [95% CI, 42%-56%]) and associated with any intracranial hemorrhage (odds ratio, 10.4 [95% CI, 4.5-24.1]), parenchymal hematoma (odds ratio, 4.3 [95% CI, 2.2-8.7]) and lower rates of good outcomes (eg, 90-day modified Rankin Scale score 0-2; odds ratio, 0.35 [95% CI, 0.24-0.50]). Subarachnoid hyperattenuations occurred in 23% (95% CI, 14%-35%) of patients and were associated with distal occlusions, markers of procedural aggressiveness, and poor outcome (eg, 90-day modified Rankin Scale score >2; odds ratio, 0.69 [95% CI, 0.53-0.91]). Intravascular hyperattenuations (distal occlusion tracker sign; pooled prevalence 35%, 95% CI, 24%-49%) showed high specificity (93%, 95% CI, 87%-96%) for residual distal occlusions after endovascular treatment. Advanced vessel imaging improved thrombus conspicuity and technical efficacy, while postoperative flat-panel computed tomography perfusion shows added value for the detection of residual hypoperfusion, diagnosis of hemodynamic alterations, and prediction of final infarct. There was evidence for selection bias, suggesting slight overreporting of the above imaging signs.</p><p><strong>Conclusions: </strong>Periprocedural FPCT may offer real-time neurovascular and parenchymal assessment when conventional 3-dimensional imaging is unavailable. In our cohort, FPCT findings were associated with clinical outcomes and improved recognition of complications. FPCT may hence assist intraprocedural decision-making regarding adjunctive manoeuvres or drug administrations if further prospective validation can be demonstrated.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070130","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":"Innovations in Early-Phase Adaptive Trial Designs for Stroke Research.","authors":"Kathryn S Hayward, Bruce C V Campbell, Emily J Dalton, Odkhishig Ganbold, Hannah Johns, Eva Mistry, Michael D Hill, Leonid Churilov","doi":"10.1161/STROKEAHA.126.057817","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.057817","url":null,"abstract":"<p><p>Stroke can occur at any age, and the effects can last for the remaining lifetime. To minimize the clinical and economic burden of stroke, we need to develop and test new treatments that have the potential to improve outcomes for people with stroke. Early-phase trials are foundational to testing new treatments in medicine. Early-phase trials encompass dose-ranging, dose-screening, and dose-finding noncomparative designs. A dose-ranging trial aims to establish the safe and tolerable dose range for a given investigational intervention in a target population to progress to a dose-screening or dose-finding trial that systematically identifies an intervention dose(s) in the target population that has a signal of efficacy, feasibility, safety, and tolerability. Such designs originated in the oncology field and are gaining prominence in stroke literature. In this article, we first outline the features that differentiate the contribution of early-phase trials from late-phase trials and present a stepwise development program approach to frame our discussion. We then review early-phase trial terminology, discuss the characteristics of early-phase trials and high-quality reporting, and the role, value, and contribution of early-phase trials across the continuum of stroke care using published and ongoing trial examples. Finally, we highlight emerging innovations in early-phase trial design and application to inform future work in stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070120","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":"Responsible AI for Acute Stroke Management.","authors":"Joanna Lin, Mumu Aktar, Hakim Baazaoui, Susanne Wegener, Roberto Souza, Leticia Rittner, Johanna Ospel, Mariana Bento","doi":"10.1161/STROKEAHA.126.053795","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.053795","url":null,"abstract":"<p><p>Artificial intelligence is increasingly integrated into acute stroke management, demonstrating strong performance in tasks such as large vessel occlusion detection, Alberta Stroke Program Early Computed Tomography Score scoring, and functional outcome prediction. However, concerns persist regarding both the black-box nature of these models and algorithmic bias that may exacerbate disparities in stroke incidence, treatment, and outcomes across racial and socioeconomic subgroups. This review synthesizes the current literature on explainable artificial intelligence and fairness in artificial intelligence applications for acute stroke management, identifies persistent challenges, and outlines recommendations for the development of equitable and trustworthy systems in stroke care. Recent studies have increasingly adopted post hoc explainability methods, though these are limited by approximation and misleading interpretations, especially since explanations are rarely formally tested. Explainability and fairness remain largely disconnected, with fairness evaluation remaining uncommon due to limited demographic metadata, regulatory constraints, and the absence of stroke-specific fairness criteria. Generalizability also remains a concern due to suboptimal data set partitioning strategies and inadequate reporting practices. Responsible artificial intelligence for acute stroke management requires unified evaluation frameworks that jointly assess explainability, fairness, and generalizability.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991005","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":"Plasma Feeding Protects the Blood-Brain Barrier Post-Asphyxia While the Blood-CSF Barrier Remains Spared.","authors":"Gemma C Ventura, Line I Christiansen, Oksana Dmytriyeva, Viktor K Lund, Thomas Thymann, Per T Sangild, Ping-Ping Jiang, Stanislava Pankratova","doi":"10.1161/STROKEAHA.126.056579","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056579","url":null,"abstract":"<p><strong>Background: </strong>Metabolic and neurovascular disturbances contribute to brain injury after birth asphyxia. We previously showed that plasma feeding attenuated neuropathology after transient umbilical cord occlusion in piglets. This study explored the metabolic and molecular consequences of birth asphyxia and whether plasma feeding preserves metabolic homeostasis and brain barrier integrity.</p><p><strong>Methods: </strong>Piglets (n=89) delivered by cesarean section on gestational day 113 underwent umbilical cord occlusion (asphyxia) or remained nonasphyxiated (control). Asphyxia and control piglets were randomly assigned to receive formula reconstituted with either water (vehicle-treated group) or sow plasma (plasma-treated group). Animals were euthanized at 1 hour, 24 hours, or day 4 after insult. Cerebrospinal fluid metabolites were profiled by untargeted liquid chromatography-mass spectrometry metabolomics at 24 hours. Expression of metabolite transporters and structural components of the blood-brain barrier in the caudate nucleus and the blood-cerebrospinal fluid barrier at the choroid plexus was assessed by reverse transcription quantitative polymerase chain reaction and Western blotting. The CSF/plasma Na⁺ ratio was assessed, and cell-specific <i>AQP4</i> expression was confirmed with RNAscope. Data were analyzed using linear and linear mixed-effects models.</p><p><strong>Results: </strong>Birth asphyxia dysregulated the CSF metabolic profile, with reductions in multiple metabolites and increases in a smaller subset, consistent with impaired amino acid and lipid metabolism. This was accompanied by reduced expression of substrate transporters, including <i>xCT</i>, <i>LAT1</i>, <i>ASCT2</i>, <i>FATP1</i>, <i>CAV1</i>, and <i>MCTs</i>. In the caudate nucleus, expression of blood-brain barrier structural proteins and ion transporters, including Na⁺/K⁺-ATPase, was reduced, whereas the choroid plexus blood-CSF barrier remained largely preserved. Plasma feeding partially restored transporter expression at both brain interfaces and increased <i>AQP4</i> and ion transporter expression at the blood-brain barrier by day 4. Increased VE-cadherin (vascular endothelial cadherin) and ZO-1 (zonula occludens-1) expression and elevated CSF Na⁺ concentrations suggested early modulation of the integrity of the 2 brain barriers.</p><p><strong>Conclusions: </strong>Plasma feeding preserves metabolic homeostasis and supports brain barrier integrity after birth asphyxia, highlighting plasma-derived factors as potential therapeutic targets to reduce neurodevelopmental impairment after perinatal asphyxia.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991529","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":"Global Burden of Pediatric Stroke (1990-2023): A Shift From Mortality Toward Disability.","authors":"Clayton Rawson, Lisa Pabst, Karol P Budohoski, Craig J Kilburg, Sarah Nguyen, Natasha Hongsermeier-Graves, Maria M Galardi, McKenna L Coletti, Gary R Nelson, Sasidhar Goteti, Robert C Rennert, Ramesh Grandhi, Vijay M Ravindra","doi":"10.1161/STROKEAHA.126.056917","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056917","url":null,"abstract":"<p><strong>Background: </strong>Pediatric stroke is a significant cause of long-term disability worldwide, with outcomes influenced by age, stroke subtype, and access to care. Our objective was to define the global burden of pediatric stroke by its impact on mortality and disability.</p><p><strong>Methods: </strong>The Global Burden of Disease study uses advanced statistical modeling to analyze health across locations, synthesizing data on mortality, morbidity, and risk factors. We examined 2023 data from the study to assess deaths, years of life lost, and years lived with disability during 3 eras (1990-2001, 2002-2013, and 2014-2023) across high-income and low- and middle-income countries. We stratified the analysis by sex, age group, and stroke subtype. We calculated the proportion of burden attributable to disability (years lived with disability/[years lived with disability+years of life lost]) to assess shifts from fatal to nonfatal disease over time.</p><p><strong>Results: </strong>Between 1990 and 2023, global age-standardized pediatric stroke incidence declined only modestly, whereas age-standardized years of life lost rates declined significantly, indicating that the lower mortality burden reflected better survival rather than a large reduction in disease occurrence. Because years lived with disability rates remained comparatively stable as mortality declined, the proportion of disease burden attributable to disability rose from 14.6% (1990-2001) to 21.7% (2014-2023). This transition was uneven across settings: high-income countries achieved faster mortality declines and reached a higher disability share, whereas low- and middle-income countries retained a higher mortality burden, reflecting a dual burden of ongoing premature death and rising disability. These patterns were consistent across age and sex strata.</p><p><strong>Conclusions: </strong>These data indicate that pediatric stroke is undergoing an epidemiological transition from a mortality-dominant burden to one increasingly driven by disability, reflecting improved survival but with uneven distribution worldwide. Reducing the disability burden, through better stroke recognition education and expanded access to prevention, acute stroke care systems, reperfusion, and rehabilitation, particularly in low- and middle-income countries, should be prioritized alongside efforts to close persistent global inequities in outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991556","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":"Sodium-Glucose Cotransporter 2 Inhibitor Use and Functional Outcomes After Endovascular Thrombectomy in Diabetic Stroke.","authors":"Wookjin Yang, Ji Sung Lee, Bum Joon Kim, Jun Young Chang, Dong-Wha Kang, Sun U Kwon, Eung-Joon Lee, Jeong-Min Kim, Keun-Hwa Jung, Seung-Hoon Lee, Matteo Paolucci, Maria Maddalena Viola, Andrea Zini, Alexander Salerno, Carl Manuata Tetaria, Patrik Michel","doi":"10.1161/STROKEAHA.126.056159","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056159","url":null,"abstract":"<p><strong>Background: </strong>Although preclinical studies and limited clinical evidence suggest potential benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) after acute ischemic stroke, their effects in patients with moderate-to-severe acute ischemic stroke requiring endovascular thrombectomy remain unclear. This study aimed to evaluate whether SGLT2i use after endovascular thrombectomy is associated with improved 3-month functional outcomes in diabetic patients with acute ischemic stroke.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed prospectively collected data from January 2020 to March 2025 across 4 comprehensive stroke centers in Korea, Italy, and Switzerland. Consecutive adult patients with diabetes were grouped according to whether SGLT2i was used after their endovascular thrombectomy. Propensity score-based methods-including overlap weighting, inverse probability of treatment weighting, and 1:1 propensity score matching-were applied. Outcomes included the shift in 3-month modified Rankin Scale score, favorable (modified Rankin Scale score 0-2), and excellent outcomes (modified Rankin Scale score 0-1) at 3 months. Ordinal and binary logistic regression analyses were performed.</p><p><strong>Results: </strong>Of 429 eligible patients (mean [SD] age, 73.5 [11.1] years; 249 [58.0%] men; median [interquartile range] initial National Institutes of Health Stroke Scale score, 12 [6-18]), 51 (11.9%) received SGLT2i poststroke. Successful recanalization was achieved in 85.3%. In the overlap weighting model (weighted n=37 per group), SGLT2i use was associated with improved 3-month modified Rankin Scale score distribution (common odds ratio, 2.31 [95% CI, 1.30-4.10]) and higher odds of a favorable outcome (odds ratio, 2.26 [95% CI, 1.15-4.43]). Results were consistent across inverse probability of treatment weighting and propensity score matching models, with inverse probability of treatment weighting analyses additionally demonstrating significant associations with excellent outcomes. No significant effect modification was observed across key clinical subgroups.</p><p><strong>Conclusions: </strong>Poststroke SGLT2i therapy after endovascular thrombectomy was associated with improved 3-month functional outcomes in this multicenter retrospective analysis of diabetic patients. These findings suggest a potential therapeutic role for SGLT2i in poststroke diabetes management and support future prospective trials.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963081","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":"Transcarotid Artery Revascularization Versus Carotid Artery Stenting for Asymptomatic Carotid Stenosis.","authors":"Huanwen Chen, Dhairya A Lakhani, Marco Colasurdo, Jay Kakadiya, Matthew K McIntyre, Sridhara S Yaddanapudi, Mohamed A M Labib, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1161/STROKEAHA.126.055324","DOIUrl":"10.1161/STROKEAHA.126.055324","url":null,"abstract":"<p><strong>Background: </strong>The CREST-2 trial demonstrated superiority of carotid artery stenting (CAS) over intensive medical management for asymptomatic carotid stenosis, but it did not evaluate transcarotid artery revascularization (TCAR). Herein, we compared ischemic stroke outcomes between TCAR and CAS among patients with asymptomatic carotid stenosis in contemporary real-world practice.</p><p><strong>Methods: </strong>We identified adults with asymptomatic carotid stenosis undergoing TCAR versus CAS using the 2016 to 2024 TriNetX database, which is a multicenter federated database of electronic health records. Propensity score matching was performed for demographics, laboratory values, risk factors, comorbidities, and medications. The primary outcome was ischemic stroke within 4 years.</p><p><strong>Results: </strong>Among 7303 identified patients, 2207 patients remained in each group after matching. TCAR did not demonstrate a significantly different stroke risk compared with CAS (hazard ratio, 0.68 [95% CI, 0.44-1.06]). The absolute risk difference was numerically but nonsignificantly lower for patients with TCAR throughout the follow-up period, progressively widening over time: 0.35% at 6 months (0.61% versus 0.96%; <i>P</i>=0.18) to 1.55% at 4 years (3.26% versus 4.81%; <i>P</i>=0.086).</p><p><strong>Conclusions: </strong>TCAR did not significantly lower stroke risk compared with CAS for asymptomatic carotid stenosis. Although nonsignificant trends towards lower stroke risk were observed for TCAR, the widening of absolute risk differences over time suggests residual confounding rather than potential procedural benefit.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":11.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963155","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}