Stroke最新文献

{"title":"Sex Differences in Prehospital Stroke Medicine (SESAME): A Systematic Review and Meta-Analysis.","authors":"Brittany Wells, Ahmed Nasreldein, Karianne Larsen, Frederike van Wijck, Cheryl Carcel, Hanne Christensen, Maren Ranhoff Hov, Valeria Caso, Mark Woodward, Deidre Anne De Silva, Thanh N Nguyen, Vilde Teigene Maloy, Maria Ignacia Allende, Priscilla Abrafi Opare-Addo, Klaus Fassbender, Monika Bachhuber, Else C Sandset, Silke Walter","doi":"10.1161/STROKEAHA.124.050414","DOIUrl":"10.1161/STROKEAHA.124.050414","url":null,"abstract":"<p><strong>Background: </strong>Several studies have evaluated sex discrepancies in the prehospital management of patients with acute stroke. This systematic review and meta-analysis aims to summarize reported knowledge about sex differences in dispatch center and emergency medical service management. It proposes a roadmap of questions and the next necessary steps to ensure equitable prehospital stroke care.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis, using a random-effects model with inverse weighting. PubMed, CINAHL, EMBASE, and EMCARE were searched for studies investigating sex differences in the prehospital management of patients with suspected and acute stroke. The main outcome was the relative risk (RR) for receiving a correct prehospital stroke diagnosis. Additional outcomes are related to prehospital management and time metrics.</p><p><strong>Results: </strong>Sixteen studies were included, comprising 571 024 male patients and 622 764 female patients. No relevant risk of bias was detected. Female patients were less often correctly identified as stroke suspects than male patients (RR, 0.92 [95% CI, 0.89-0.96]; I²=73%). No differences were observed in the number receiving a dispatch code stroke (RR, 0.95 [95% CI, 0.88-1.02]; I²=96%), prenotification to hospital by emergency medical service (RR, 0.98 [95% CI, 0.96-1.00]; I²=92%), or conveyance to a stroke center (RR, 0.99 [95% CI, 0.79-1.24]; I²=82%). There was no difference in mean time from emergency call to hospital door (mean difference, 1.12 [95% CI, -0.64 to 2.89] minutes; I²=96%). No conclusion could be drawn for outcomes of on-site clinical management, emergency medical service-to-hospital team interaction, and most of the time metrics due to a lack of data.</p><p><strong>Conclusions: </strong>This analysis indicates sex differences in the prehospital recognition of acute stroke. However, significant heterogeneity and a lack of data for most steps of prehospital care also highlight the urgent need for high-quality studies to systematically investigate prehospital management disparity between female and male patients with suspected acute stroke.</p><p><strong>Registration: </strong>URL: https://crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023442997.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2976-2987"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776152","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":"Aging and Sex Modify the Risk of Carotid Plaque Thrombosis Related to Dyslipidemic Profile.","authors":"Francesca Servadei, Manuel Scimeca, Valeria Palumbo, Fabio Massimo Oddi, Rita Bonfiglio, Erica Giacobbi, Rossella Menghini, Viviana Casagrande, Marina Cardellini, Eugenio Martelli, Eleonora Candi, Gerry Melino, Massimo Federici, Arnaldo Ippoliti, Alessandro Mauriello","doi":"10.1161/STROKEAHA.125.051754","DOIUrl":"10.1161/STROKEAHA.125.051754","url":null,"abstract":"<p><strong>Background: </strong>Dyslipidemia plays a critical role in carotid plaque instability and related cerebrovascular events. Reduction of low-density lipoprotein cholesterol (LDL-C) levels decreases ischemic stroke risk; however, a residual cardiovascular risk persists. Starting from this evidence, this study evaluated the impact of dyslipidemia on carotid plaque instability while also considering age and sex.</p><p><strong>Methods: </strong>In this observational study, a total of 354 carotid plaques from symptomatic and asymptomatic patients undergoing endarterectomy were analyzed histologically. Dyslipidemic profiles, including high LDL-C, remnant cholesterol, triglycerides, and low high-density lipoprotein cholesterol, were assessed alongside other risk factors. Logistic regression identified independent predictors of unstable plaques, and subgroup analyses evaluated the influence of age (<70, ≥70 years) and sex.</p><p><strong>Results: </strong>Unstable plaques were observed in 45.2% of cases. High LDL-C emerged as the strongest independent risk factor for plaque instability. The combination of high LDL-C with elevated remnant cholesterol or triglycerides significantly increased the risk of plaque destabilization. Age and sex influenced the risk associated with dyslipidemic profiles, with women who had elevated LDL-C combined with high-remnant cholesterol or triglycerides showing a substantially higher risk of carotid plaque instability compared with men. Furthermore, individuals <70 years of age exhibited a greater risk of plaque instability compared with older patients, highlighting the critical role of these nonmodifiable factors.</p><p><strong>Conclusions: </strong>The data reported here highlight the importance of a personalized medicine approach to lipid management, addressing not only LDL-C but also remnant cholesterol and triglycerides. Tailored interventions targeting specific dyslipidemic profiles could more effectively reduce the risk of carotid plaque rupture and cerebrovascular events, particularly in women and patients aged <70 years.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2879-2887"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683194","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":"Long-Term Follow-Up of Participants in the Taking Charge After Stroke Randomized Controlled Trial.","authors":"Alexander Martin, Vivian Fu, Zamir Joya, Sajida Joya, Allie Eathorne, Mark Weatherall, Gabrielle Shortt, Alex Semprini, John Gommans, Harry McNaughton","doi":"10.1161/STROKEAHA.125.052545","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052545","url":null,"abstract":"<p><strong>Background: </strong>The take charge intervention-a conversation-based, community intervention to improve motivation, improved independence, and physical health 12 months after stroke in 2 randomized controlled trials with 572 participants. This article reports long-term outcomes for the 400 participants in the TaCAS study (Taking Charge After Stroke).</p><p><strong>Methods: </strong>Follow-up study of a New Zealand multicenter, randomized, controlled, parallel-group trial. Outcomes were collected by postal questionnaire or telephone call. The TaCAS study recruited 400 participants discharged after stroke, randomized within 16 weeks to one of 3 groups: 1 session of the take charge intervention, 2 sessions 6 weeks apart, or no sessions (control). This study is of participants still alive and willing to answer a questionnaire 5 to 6 years after their index stroke, undertaken in 2022. The primary outcome was the Physical Component Summary of the Short Form 36, comparing the take charge intervention and control. Secondary outcomes were: Frenchay Activities Index; modified Rankin Scale (mRS); survival; and stroke recurrence. These outcomes were compared with those 12 months after stroke. Analysis was by ANOVA or logistic regression.</p><p><strong>Results: </strong>Mortality data were available for all 400 participants, and functional data for 204/297 (69%) of survivors. The mean difference (95% CI) in Physical Component Summary between take charge and control groups was 2.8 (-0.8 to 6.5) units, <i>P</i>=0.12, and for independence (modified Rankin Scale score, 0-2) the odds ratio (95% CI) was 0.56 (0.28-1.16), <i>P</i>=0.11, both favoring take charge with similar point estimates to those after 12 months. Differences between take charge and control participants for Frenchay Activities Index scores, survival, and stroke recurrence were small and nonsignificant.</p><p><strong>Conclusions: </strong>The clinically significant improvements in physical health and independence for take charge participants, observed at 12 months, were sustained 5 to 6 years after stroke, but no longer statistically significant.</p><p><strong>Registration: </strong>URL: https://anzctr.org.au; Unique identifier: ACTRN12622000311752.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193144","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":"Artificial Intelligence and Novel Trial Designs for Acute Ischemic Stroke: Opportunities and Challenges.","authors":"Joseph P Broderick, Eva A Mistry, Paul M Wechsler, Mitchell S V Elkind, David S Liebeskind, George Harston, Jake Wolenberg, Jennifer A Frontera, W Taylor Kimberly, Christopher G Favilla, Johannes Boltze, Johanna Ospel, Edgar A Samaniego, Opeolu Adeoye, Scott E Kasner, Lee H Schwamm, Gregory W Albers","doi":"10.1161/STROKEAHA.125.052146","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052146","url":null,"abstract":"<p><p>The Stroke Treatment Academic Industry Roundtable convened a workshop regarding artificial intelligence (AI) and innovative clinical trial designs during the Stroke Treatment Academic Industry Roundtable XIII meeting on March 28, 2025. This forum brought together stroke physicians and researchers, and industry representatives to discuss the current use and future opportunities for AI and novel trial designs in acute stroke trials. AI already plays a substantial role in the treatment of acute stroke with regards to imaging but is poised to have a much larger impact in clinical care and research trials over the coming years. The quality and understanding of the data are used to train the AI, the human element needed to ensure training is successful, and the clinician and trialist at the bedside, the humans in the loop, will be necessary to maximize AI's effectiveness in clinical practice and trials. Platform trials address multiple scientific questions in an area of medicine simultaneously within the same trial structure by sharing controls across multiple interventions. While platform trials increase efficiency and potentially decrease the time needed to answer important clinical scientific questions, they also can introduce complexity to standard workflows. Future acute ischemic stroke clinical trials should incorporate elements of pragmatic and patient-centered trial design when possible. Pragmatic trials aim to assess the effectiveness of treatments when they are implemented into routine clinical care rather than under idealized conditions. AI models and platform, pragmatic, and patient-centered trial designs are new tools to answer important clinical questions, but understanding how they work, their best uses, and their limitations is critical for accelerating successful new treatments for stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193157","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":"Microemboli Detection in Acute Ischemic Stroke Could Be an Early Marker of Poor Cognitive Outcome.","authors":"Juliana Ferreira, Gilberto Pereira, Frederica Alves, Tiago Pedro, Luísa Fonseca, Guilherme Gama, Goreti Moreira, Elsa Azevedo, Pedro Castro","doi":"10.1161/STROKEAHA.125.052253","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052253","url":null,"abstract":"<p><strong>Background: </strong>We investigated the burden of microembolic signals (MESs) in patients with acute ischemic stroke and their impact on long-term cognitive function.</p><p><strong>Methods: </strong>This prospective study included consecutive patients with ischemic stroke without prior dementia or severe neurological deficits, recruited from the stroke unit (Centro Hospitalar Universitário de São João, Porto, Portugal), between December 2020 and May 2022. Transcranial Doppler monitoring was performed within 72 hours of symptom onset for 60 minutes of monitoring, with 30 minutes dedicated to each cerebral circulation: bilateral M1 segments of the middle cerebral artery and bilateral segments P2 of the posterior cerebral artery. Recordings were analyzed for MES by a blinded expert. The primary aim was to determine the association of MES with cognitive status at 12 months, evaluated using a 7-point cognitive scale.</p><p><strong>Results: </strong>Between November 2020 and May 2022, we included 316 patients, with a median age of 67 (interquartile range, 59-76) years with 68% males. Thirty-nine patients had MES (12.3%), with a median (interquartile range) of 3 (1-7) counts among those who were positive. The occurrence of MES was higher in patients who underwent thrombolysis and thrombectomy, those who were not previously on statins, and those with a higher National Institutes of Health Stroke Scale score (<i>P</i><0.05). The worst cognitive outcome occurred in patients with MES with an adjusted odds ratio of 2.04 (95% CI, 1.27-3.28; <i>P</i><0.01).</p><p><strong>Conclusions: </strong>Patients who are MES-positive in the acute phase have twice the likelihood of experiencing worse cognitive outcomes 12 months after stroke. The detection of MES using transcranial Doppler could be considered in future studies as an early marker of poor cognitive performance, helping to stratify high-risk patients. Future trials should investigate whether early antithrombotic treatment could improve long-term cognitive function in stroke survivors (Clinicaltrials.gov ID: 06735274).</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193131","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":"Prefrontal Cortex as a Central Hub of Structural Diaschisis Following Subcortical Stroke.","authors":"Yuanyuan Li, Xinyue Shi, Yan Shen, Linlu Wu, Xirui Sun, Kang Wu, Kuangshi Li, Yi Ren, Tianjiao Xu, Muzhao Zhang, Tianzhu Chen, Mengfang Xu, Renzhao Ma, Yuqing Lin, Juwei Zhang, Zhongjian Tan, Dan Xu, Lixin Tang, Yuan Feng, Yong Zhang, Yihuai Zou","doi":"10.1161/STROKEAHA.125.051768","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051768","url":null,"abstract":"<p><strong>Background: </strong>After a subcortical stroke, structural and functional alterations have often been observed in brain regions far from the lesion, a phenomenon suspected but not yet confirmed as diaschisis. This study investigated the existence and patterns of diaschisis following subcortical stroke.</p><p><strong>Methods: </strong>This observational, single-center, cross-sectional study was conducted in China from August 2014 to September 2023. We recruited patients with subcortical stroke with hemiplegia and unilateral lesions in the basal ganglia and corona radiata. Healthy controls were recruited from the community using an age- and sex-matching strategy with the patients. Patients were categorized by the National Institutes of Health Stroke Scale scores: mild (<5) and moderate (5-15) deficits. Using magnetic resonance imaging techniques, we analyzed gray matter volume alterations with voxel-based morphometry and causal structural networks with the causal structural covariance network method.</p><p><strong>Results: </strong>Of the 566 patients initially screened, 102 were enrolled. Due to recruitment constraints, only 46 healthy controls were recruited, limiting successful matching. The final analysis included 90 patients and 44 controls. The patient group (62 males and 28 females) had a mean age of 60.64±9.93 years, while the healthy group (23 males and 21 females) had a mean age of 59.43±5.01 years. We found significant gray matter volume loss in the medial superior frontal gyrus and identified both positive and negative directional connectivity patterns between this region and other areas in the prefrontal cortex (inferior frontal gyrus), temporal regions (superior and middle temporal gyri), limbic structures (insula, cingulate gyrus, and parahippocampus), and precentral. Notably, the causal network in patients with mild deficits was more complex.</p><p><strong>Conclusions: </strong>These findings support the existence of structural diaschisis following subcortical stroke, centered in the prefrontal cortex. This study underscores the importance of brain-wide imaging markers and may contribute to developing brain stimulation targets.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193081","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":"Functional Outcomes of Human Urinary Kallindinogenases in Treatment of Acute Ischemic Stroke.","authors":"Diandian Huang, Yuxuan Lu, Weiping Sun, Wei Sun, Yongan Sun, Yining Huang, Yijun Song, Liwen Tai, Guozhong Li, Huisheng Chen, Guiru Zhang, Lei Zhang, Xuwen Sun, Jinhua Qiu, Yan Wei, Haiqiang Jin","doi":"10.1161/STROKEAHA.124.050188","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050188","url":null,"abstract":"<p><strong>Background: </strong>The neurorestorative potential of HUK (human urinary kallidinogenase) has drawn considerable clinical attention. Our study aimed to explore the therapeutic efficacy of HUK in patients with acute ischemic stroke.</p><p><strong>Methods: </strong>Our data were retrospectively extracted from CASTOR (Chinese Acute Ischemic Stroke Treatment Outcome Registry), a prospective, multicenter study from 2015 to 2019 in China. The data was separated into 2 categories, the mild group (0-5 points) and the moderate group (6-25 points), according to the National Institutes of Health Stroke Scale score measured at admission and analyzed by propensity score matching with HUK or non-HUK ratio of 1:1. The percentage of patients with modified Rankin Scale score ≤1 at 3 months after onset was the primary outcome.</p><p><strong>Results: </strong>Ten thousand two patients were recruited, after the criteria were filtered, 9005 patients were investigated. Following propensity score matching, a total of 6530 patients were ultimately enrolled in the analysis, consisting of 4284 patients in the mild group and 2246 patients in the moderate group. In the mild group, the mean age was 63.5±11.7 years, and females accounted for 31.91%. In the moderate group, the mean age was 64.7±10.9 years, and females occupied a proportion of 36.78%. At the 3-month follow-up, a significantly higher proportion of HUK-treated patients achieved the primary outcome compared with controls in both mild (76.89% [1647/2142] versus 74.13% [1588/2142]; <i>P</i>=0.0013) and moderate (43.10% [484/1123] versus 38.02% [427/1123]; <i>P</i>=0.03) groups.</p><p><strong>Conclusions: </strong>HUK therapy has potential efficacy in improving the prognosis of patients with both mild and moderate severity of acute ischemic stroke. Nevertheless, additional rigorously designed randomized controlled trials are essential to substantiate these findings.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02470624.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186725","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":"Multicenter Translational Trial of Remote Ischemic Conditioning in Acute Ischemic Stroke (TRICS BASIC).","authors":"Simone Beretta, Mauro Tettamanti, Jacopo Mariani, Susanna Diamanti, Alessia Valente, Ornella Cuomo, Chiara Di Santo, Ilaria Dettori, Martina Venturini, Irene Bulli, Elisabetta Coppi, Manuel Alejandro Montano Castillo, Erica Butti, Giorgia Serena Gullotta, Martina Viganò, Francesco Santangelo, Francesco Andrea Pedrazzini, Carlo Perego, Serena Seminara, Serenella Anzilotti, Joanna Rzemieniec, Laura Castiglioni, Benedetta Mercuriali, Majeda Muluhie, Chiara Paola Zoia, Gessica Sala, Luigi Sironi, Marco Bacigaluppi, Gianvito Martino, Felicita Pedata, Anna Maria Pugliese, Diana Amantea, Giacinto Bagetta, Antonio Vinciguerra, Giuseppe Pignataro, Stefano Fumagalli, Maria-Grazia De Simoni, Carlo Ferrarese","doi":"10.1161/STROKEAHA.125.051532","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051532","url":null,"abstract":"<p><strong>Background: </strong>Basic science studies have reported remote ischemic conditioning (RIC) as neuroprotective in acute ischemic stroke, although clinical evidence remains conflicting. The TRICS BASIC study (Multicenter Translational Trial of Remote Ischemic Conditioning in Acute Ischemic Stroke) investigated the efficacy and safety of RIC in experimental ischemic stroke using a rigorous clinical trial methodology.</p><p><strong>Methods: </strong>Multicenter, multispecies, parallel group, randomized, controlled, preclinical trial of transient femoral artery clipping to induce RIC in female and male rats and mice subjected to transient endovascular occlusion of the middle cerebral artery. Animals were randomized to receive RIC, or sham surgery, after reperfusion. The primary end point was a good functional outcome at 48 hours, assessed using a composite functional neuroscore. Secondary end points were infarct volume at 48 hours and safety, assessed using a standardized health report at 24 and 48 hours. Preenrollment harmonization, centralized monitoring, allocation concealment, blinded outcome assessment, and intention-to-treat analysis were applied.</p><p><strong>Results: </strong>The trial enrolled 164 rodents (82 mice and 82 rats) of both sexes (53% females), across 7 laboratories. A greater proportion of RIC-treated rodents achieved a favorable functional outcome compared with controls, at 48 hours postischemia (55% versus 36%; odds ratio, 2.2 [95% CI, 1.23-4.4]; <i>P</i>=0.009). RIC was associated with a small reduction in infarct volume (standardized mean difference, -0.38 [95% CI, -0.70 to -0.05]; <i>P</i>=0.024). Health monitoring indicated no major safety concerns, and postoperative analgesia requirements were lower in RIC-treated mice.</p><p><strong>Conclusions: </strong>Surgically induced RIC provided a modest but evident neuroprotective effect in experimental ischemic stroke, underscoring the potential of this strategy as an adjunctive treatment in stroke care. The findings of the TRICS BASIC study highlighted the importance of multicenter preclinical trials in addressing variability and enhancing translational validity.</p><p><strong>Registration: </strong>URL: https://www.preclinicaltrials.eu; Unique identifier: PCTE0000177.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150857","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":"Influence of Ancestral and Geographic Factors on Intracerebral Hemorrhage Risks Among Africans and Americans.","authors":"Paul Olowoyo, Osahon J Asowata, Onoja Akpa, Mary E Comeau, Christopher D Anderson, Jacob L McCauley, Joshua Akinyemi, Morenikeji Komolafe, Albert Akpalu, Oyedunni Arulogun, Fred Sarfo, Reginald Obiako, Godwin Osaigbovo, Adekunle Fakunle, Olufunmilola Macaulay, Olayinka Adebajo, Godwin Ogbole, Akinkunmi Paul Okekunle, Arti Singh, Innocent Chukwuonye, Oladotun Olalusi, Ayomide Owolabi, Atinuke Agunloye, Yaw Mensah, Carolyn Jenkins, Mayowa Ogunronbi, Osimhiarherhuo Adeleye, Ezinne Uvere, Kolawole Wahab, Philip Ibinaiye, Okechukwu Ogah, Lambert Appiah, Michael B Fawale, Samuel Diala, Hemant Tiwari, Rufus Akinyemi, Donna K Arnett, Carl D Langefeld, Bruce Ovbiagele, Daniel Woo, Mayowa Owolabi","doi":"10.1161/STROKEAHA.125.051911","DOIUrl":"10.1161/STROKEAHA.125.051911","url":null,"abstract":"<p><strong>Background: </strong>We investigated whether risk factors for intracerebral hemorrhage (ICH) among indigenous Africans (IA) would vary in prevalence and effect compared with self-reported African, Hispanic, and White Americans by comparing data from 2 independent population-based case-control studies conducted in West Africa and the United States.</p><p><strong>Methods: </strong>We compared ICH risk factors common to the SIREN (Stroke Investigative Research and Educational Network: 1100 case-control pairs) and the ERICH (Ethnic/Racial Variation of Intracerebral Hemorrhage: 999 case-control pairs Black participants, 998 case-control pairs, Hispanic Americans, 1000 case-control pairs, White Americans) studies. Ethnicity/Race was self-reported. The effect measure of interest is the odds ratio (OR). To test for differences in the effects of the risk factors between the SIREN IA study population and each of the ERICH study populations, a test for heterogeneity was computed using the R program, metagen (version 4.9-6).</p><p><strong>Results: </strong>ICH occurred at a younger age among IA (54.3±13.4 years), Balck participants (58.0±12.7), and Hispanic Americans (58.9±14.3), compared with White Americans (69.1±13.9). The largest distinction was for hypertension, where IA exhibited a much larger risk of ICH than the American study population (OR, 67.02 [95% CI, 33.30-134.85]), Black population (OR, 3.71 [95% CI, 2.53-5.44]); Hispanic (OR, 3.55 [95% CI, 2.54-4.92]), and White population (OR, 2.69 [95% CI, 1.95-3.69]). Current alcohol use exhibited increased risk in IA (OR, 2.24 [95% CI, 1.36-3.67]), but not in Black participants (OR, 0.63 [95% CI, 0.46-0.86]), Hispanic (OR, 0.87 [95% CI, 0.65-1.17]), and White Americans (OR, 0.51 [95% CI, 0.38-0.69]).</p><p><strong>Conclusions: </strong>Identical or comparable risk factors do not consistently result in the same disease risk across different cultures and regions. Therefore, to improve our understanding of the genetic determinants and biological pathways driving ICH risk, it is crucial to study multiple populations, including IA, while accounting for the influence of environmental and social factors.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131966","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":"Effect of Perforator Territory Infarction on Functional Outcome in Patients With Large Vessel Occlusion.","authors":"Yasmin Sadigh, Valerie I Vogels, Pieter Jan van Doormaal, Iris S C Verploegh, Dana Pisica, Diederik W J Dippel, Clemens M F Dirven, Aad van der Lugt, Charles B L M Majoie, Ruben Dammers, Victor Volovici","doi":"10.1161/STROKEAHA.125.051745","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051745","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of the anatomic distribution of cerebral perforating arteries and the consequences of ischemia in these territories is limited. This study aims to evaluate the effect of perforator territory ischemia on functional outcome in patients with anterior circulation large vessel occlusion.</p><p><strong>Methods: </strong>A post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands, MR CLEAN-MED and NO IV participants, recruited between January 2018 and January 2021 from 20 European stroke centers, was performed. Patients undergoing endovascular thrombectomy for anterior circulation large vessel occlusion with available posttreatment magnetic resonance imaging were included. Patients were assigned to 3 groups based on infarct location identified on ≤24 hours posttreatment magnetic resonance imaging: cortex group, perforator and insular group, and both groups (cortical alongside insular and perforator territory). Multivariable linear and ordinal regression analyses were performed separately with the National Institutes of Health Stroke Scale score at 24 hours as the primary outcome and modified Rankin Scale at 90 days as the secondary outcome, adjusted for baseline scores and prognostic factors.</p><p><strong>Results: </strong>Out of 1167 patients, a total of 397 were included. The median age was 71 (interquartile range, 62-79), and 204 (51%) were men. Although no significant association was found in multivariable analysis between perforator territory infarctions and 24 hours National Institutes of Health Stroke Scale, patients with perforator territory ischemia were more likely to have a worse 90-days modified Rankin Scale (median modified Rankin Scale, 2 [interquartile range, 1-3]; common odds ratio, 2.94 [95% CI, 1.73-4.98]). Besides infarct locations, Thrombolysis in Cerebral Infarction grade 2B-3 and Heidelberg bleeding classifications 1c and 2 significantly influenced the 24-hour National Institutes of Health Stroke Scale and 90-day modified Rankin Scale outcomes.</p><p><strong>Conclusions: </strong>Patients with anterior circulation large vessel occlusion leading to perforator territory infarctions are more likely to have an unfavorable functional outcome at 90 days. Future research should focus on better visualization of perforating arteries and understanding their functional anatomy to prevent perforator territory ischemia and improve patient outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087080","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}