Stroke最新文献

{"title":"Daytime DNase-I Administration Protects Mice From Ischemic Stroke Without Inducing Bleeding or tPA-Induced Hemorrhagic Transformation, Even With Aspirin Pretreatment.","authors":"Gaohong Di, Sandra Vázquez-Reyes, Blanca Díaz, Carolina Peña-Martinez, Alicia García-Culebras, María I Cuartero, Ana Moraga, Jesús M Pradillo, Elga Esposito, Eng H Lo, María A Moro, Ignacio Lizasoain","doi":"10.1161/STROKEAHA.124.049961","DOIUrl":"10.1161/STROKEAHA.124.049961","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke treatment typically involves tissue-type plasminogen activator (tPA) or tenecteplase, but about 50% of patients do not achieve successful reperfusion. The causes of tPA resistance, influenced by thrombus composition and timing, are not fully clear. Neutrophil extracellular traps (NETs), associated with poor outcomes and reperfusion resistance, contribute to thrombosis. DNase-I, which degrades neutrophil extracellular traps, could improve thrombolytic efficacy. However, more studies are needed to understand the impact of DNase-I in tPA-sensitive stroke models, the safety of coadministering DNase-I and tPA regarding hemorrhagic transformation (HT), optimal timing for use, and effects on aspirin-treated animals.</p><p><strong>Methods: </strong>We used in situ thromboembolic stroke, a tPA-sensitive model, where late tPA administration causes HT. Middle cerebral artery occlusion was induced at different zeitgeber times (ZT) to study the optimal timing for administration. DNase-I, tPA, and aspirin were administered at various times to evaluate their effects.</p><p><strong>Results: </strong>DNase-I reduced infarct volume and improved functional outcomes 24 hours post-middle cerebral artery occlusion by decreasing plasma and cortical neutrophil extracellular trap levels. DNase-I caused no bleeding or impact on HT induced by late tPA. Its protective effect was only seen when given during the daytime (rodent inactive phase; ZT4-7), not overnight (active phase; ZT13-16). Chronic aspirin pretreatment increased tPA-induced HT but did not change the protective effects of DNase-I, with or without tPA.</p><p><strong>Conclusions: </strong>Our study demonstrates that daytime (inactive phase) DNase-I administration is a safe and effective treatment for experimental stroke. This is particularly important given the 2 ongoing clinical trials for stroke patients.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05203224 and NCT05880524.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 2","pages":"527-532"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053652","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":"Poor Olfaction and Risk of Stroke in Older Adults: The Atherosclerosis Risk in Communities Study.","authors":"Keran W Chamberlin, Chenxi Li, Anna Kucharska-Newton, Zhehui Luo, Mathew Reeves, Srishti Shrestha, Jayant M Pinto, Jennifer A Deal, Vidyulata Kamath, Priya Palta, David Couper, Thomas H Mosley, Honglei Chen","doi":"10.1161/STROKEAHA.124.048713","DOIUrl":"10.1161/STROKEAHA.124.048713","url":null,"abstract":"<p><strong>Background: </strong>Poor olfaction may be associated with adverse cerebrovascular events, but empirical evidence is limited. We aimed to investigate the association of olfaction with the risk of stroke in the Atherosclerosis Risk in Communities Study.</p><p><strong>Methods: </strong>We included 5799 older adults with no history of stroke at baseline from 2011 to 2013 (75.5±5.1 years, 59.0% female and 22.2% Black). Olfaction was assessed by the 12-item Sniffin' Sticks odor identification test and defined as poor (number correct ≤8), moderate (9-10), or good (11-12). Participants were followed from baseline to the date of the first stroke, death, last contact, or December 31, 2020, whichever occurred first. We used the discrete-time subdistribution hazard model to estimate the marginal cumulative incidence of stroke across olfactory statuses and adjusted risk ratios, accounting for covariates and competing risk of death.</p><p><strong>Results: </strong>After up to 9.6 years of follow-up, we identified 332 incident stroke events. The adjusted marginal cumulative incidence of stroke at 9.6-year follow-up was 5.3% (95% CI, 4.2%-6.3%), 5.9% (95% CI, 4.8%-7.1%), and 7.7% (95% CI, 6.5%-9.1%) for good, moderate, and poor olfaction, respectively. Compared with good olfaction, poor olfaction was significantly associated with higher stroke risk throughout follow-up, albeit the association modestly attenuated after 6 years. Specifically, the adjusted risk ratios were 2.14 (95% CI, 1.22-3.94) at year 2, 1.98 (95% CI, 1.43-3.02) at year 4, 1.91 (95% CI, 1.43-2.77) at year 6, 1.49 (95% CI, 1.17-2.00) at year 8, and 1.45 (95% CI, 1.16-1.95) at year 9.6. Results were robust in multiple subgroup and sensitivity analyses.</p><p><strong>Conclusions: </strong>In older adults, poor olfaction assessed by a single olfaction test was associated with the higher risk of stroke in the next 10 years.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 2","pages":"465-474"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053658","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":"Accurate Detection of Spinal Dural Arteriovenous Fistula With Spinal Photon-Counting Computed Tomography Angiography: A Report of Two Cases.","authors":"Naying He, Haiying Lyu, Yong Lu, Fuhua Yan, Hong Jiang","doi":"10.1161/STROKEAHA.124.049475","DOIUrl":"10.1161/STROKEAHA.124.049475","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e44-e46"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829818","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":"Bilateral Basal Ganglia Region Infarction After Trauma in a Patient With Bilateral Basal Ganglia Calcification.","authors":"Qian Zhang, Qian Jia, Yue Suo, Xingquan Zhao, Yi Ju","doi":"10.1161/STROKEAHA.124.049509","DOIUrl":"10.1161/STROKEAHA.124.049509","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e47-e48"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829822","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":"Tenecteplase Thrombolysis for Stroke up to 24 Hours After Onset With Perfusion Imaging Selection: The CHABLIS-T II Randomized Clinical Trial.","authors":"Xin Cheng, Lan Hong, Longting Lin, Leonid Churilov, Yifeng Ling, Nan Yang, Jianliang Fu, Guozhi Lu, Yunhua Yue, Jin Zhang, Feng Wang, Ziran Wang, Yanxin Zhao, Xiaoyu Zhou, Zhaolong Peng, Danhong Wu, Liandong Zhao, Qijin Zhai, Xiaofei Yu, Qi Fang, Xiangzhong Shao, Ying Tang, Diwen Zhang, Yu Geng, Yue Zhang, Bosheng Fan, Bing Zhang, Congguo Yin, Yangmei Chen, Yiran Zhang, Xinyu Liu, Siyuan Li, Lumeng Yang, Mark Parsons, Qiang Dong","doi":"10.1161/STROKEAHA.124.048375","DOIUrl":"10.1161/STROKEAHA.124.048375","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Whether it is effective and safe to extend the time window of intravenous thrombolysis up to 24 hours after the last known well is unknown. We aimed to determine the efficacy and safety of tenecteplase in Chinese patients with acute ischemic stroke due to large/medium vessel occlusion within an extended time window.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with ischemic stroke presenting 4.5 to 24 hours from the last known well, with a favorable penumbral profile and an associated large/medium vessel occlusion, were randomized 1:1 to either 0.25 mg/kg tenecteplase or the best medical treatment. A favorable penumbral profile was defined as a hypoperfusion lesion volume to infarct core volume ratio &gt;1.2, with an absolute volume difference &gt;10 mL, and an ischemic core volume &lt;70 mL. The primary outcome was the achievement of major reperfusion without symptomatic intracranial hemorrhage within 24 to 48 hours post-randomization. Major reperfusion was defined as the restoration of blood flow of &gt;50% of the involved ischemic territory. Secondary outcomes included recanalization, infarct growth, major neurological improvements, change in the National Institutes of Health Stroke Scale score, hemorrhagic transformation within 24 to 48 hours, systemic bleeding at discharge, and modified Rankin Scale (score 0-1, score 0-2, score 5-6, and modified Rankin Scale distribution) at 90 days. The comparison of the primary outcome between groups was conducted using modified Poisson regression with a log-link function and robust error variance, adjusted for time from the last known well to randomization, the site of vessel occlusion, and planned endovascular treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 224 enrolled patients, 111 were assigned to receive tenecteplase and 113 to receive the best medical treatment (including 23% [n=26] of participants who received intravenous tissue-type plasminogen activator). The mean (SD) age of the tenecteplase group and the best medical treatment group was 64.2 (10.4) and 63.6 (11.0) years old, with 72.1% (n=80) and 70.8% (n=80) male enrolled, respectively. A proportion of 54.9% (n=123) of patients were transferred to the catheter room for preplanned endovascular treatment. The primary outcome occurred in 33.3% (n=37) of the tenecteplase group versus 10.8% (n=12) in the best medical treatment group (adjusted relative risk, 3.0 [95% CI, 1.6-5.7]; &lt;i&gt;P&lt;/i&gt;=0.001). Tenecteplase significantly increased the recanalization rate compared with the best medical treatment (35.8% [n=39] versus 14.3% [n=16], adjusted relative risk, 2.5 [95% CI, 1.4-4.4]; &lt;i&gt;P&lt;/i&gt;=0.002). There were no significant differences in clinical efficacy outcomes or rates of hemorrhagic transformation between the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Administered at a dose of 0.25 mg/kg intravenously, tenecteplase increased reperfusion without symptomatic intracranial hemorrhage in patients with ischemic stroke selected by imagi","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"344-354"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915649","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":"Novel Vascular Territory Mapping Algorithm as a Predictive Tool for Identification of Antegrade Flow in Middle Cerebral Artery Occlusion.","authors":"Michael Valente, Andrew Bivard, Bernard Yan, Chushuang Chen, Milanka Visser, Henry Ma, Longting Lin, Mark Parsons","doi":"10.1161/STROKEAHA.124.048892","DOIUrl":"10.1161/STROKEAHA.124.048892","url":null,"abstract":"<p><strong>Background: </strong>Vascular territory mapping (VTM) software estimates which intracerebral vessel provides predominant arterial flow to a brain voxel. The presence of antegrade flow in the setting of acute middle cerebral artery (MCA) occlusion is associated with improved outcomes. We identify whether VTM software is a determinant of antegrade flow in patients with proximal MCA occlusion.</p><p><strong>Methods: </strong>Consecutive patients with the first branch of MCA (M1) occlusion were analyzed from the International Stroke Perfusion Imaging Registry with their computed tomography perfusion reprocessed through VTM software. Authors reviewed dynamic 4-dimensional computed tomography angiography for the presence of an acute M1 thrombus and also for the presence of residual antegrade flow. The VTM software assigned regions of the brain to an estimated feeding vessel (anterior cerebral artery, MCA, and posterior cerebral artery). A binomial logistic regression was performed to determine the effects of VTM, ischemic core (cerebral blood flow <30), and perfusion lesion (delay time >3) on the likelihood that patients had the presence of any antegrade flow in the MCA territory. A secondary analysis was performed to assess the relationship between imaging variables and 3-month modified Rankin Scale outcomes.</p><p><strong>Results: </strong>The final data set included 130 patients with M1 occlusion. The median age of participants was 74 years (interquartile range, 62-81) with an onset-to-scan time of 2.1 hours (interquartile range, 1.4-3.8) and a National Institutes of Health Stroke Scale score of 15 (interquartile range, 12-20). Eighteen patients were identified with antegrade flow on 4-dimensional digital subtraction angiography. Patients with antegrade flow had significantly larger VTM volume normal side MCA, 101 (72-180) mL, compared with those with complete occlusion, 41 (21-71) mL. VTM volume normal side MCA volume significantly predicted antegrade flow and outcome, and 1 mL VTM volume normal side MCA volume increased odds of antegrade flow by 1.024 (95% CI, 1.013-1.036). Ischemic core and the perfusion lesion volumes did not predict antegrade flow.</p><p><strong>Conclusions: </strong>VTM software was more effective than traditional perfusion parameters in the detection of antegrade flow. The results demonstrate a potential clinical utility for VTM; however, larger cohorts will be required to detect whether VTM can predict clinical outcome after reperfusion treatment.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"488-493"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932642","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":"Thrombectomy for Artery of Percheron Occlusion.","authors":"He Li, Jinping Zhang","doi":"10.1161/STROKEAHA.124.049043","DOIUrl":"10.1161/STROKEAHA.124.049043","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e40-e41"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955378","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":"Combination Antithrombotic Therapy for Reduction of Recurrent Ischemic Stroke in Intracranial Atherosclerotic Disease.","authors":"Kanjana S Perera, Mukul A Sharma, John W Eikelboom, Kelvin Kuan Huei Ng, Thalia S Field, Brian H Buck, Michael D Hill, Grant Stotts, Leanne K Casaubon, Jennifer Mandzia, Aristeidis H Katsanos, Samuel Yip, Ashkan Shoamanesh, G Bryan Young, Ramana Appireddy, Sumiti Nayar, Rick Swartz, Amanda Taylor, Alexandra Carrier, Abhilekh Srivastava, Aviraj S Deshmukh, Robin Zhao, Robert G Hart","doi":"10.1161/STROKEAHA.124.047715","DOIUrl":"10.1161/STROKEAHA.124.047715","url":null,"abstract":"<p><strong>Background: </strong>Stroke secondary to intracranial atherosclerotic disease (ICAD) is associated with high recurrence risk despite currently available secondary prevention strategies. In patients with systemic atherosclerosis, a significant reduction of stroke risk with no increase in intracranial or fatal hemorrhage was seen when rivaroxaban 2.5 mg twice daily was added to aspirin. However, there are no trials in ICAD using this combination. To facilitate the design of future ICAD trials, the CATIS-ICAD study (Combination Antithrombotic Treatment for Prevention of Recurrent Ischemic Stroke in Intracranial Atherosclerotic Disease) assessed (1) the feasibility of recruitment, (2) the safety of low-dose rivaroxaban plus aspirin compared with standard-of-care antiplatelet therapy, and (3) trends toward efficacy.</p><p><strong>Methods: </strong>This was a prospective, randomized, open-label, blinded end point pilot trial conducted in 10 Canadian centers. Eligible participants aged ≥40 years, with acute ischemic stroke or high-risk transient ischemic attack, were randomly assigned in a 1:1 ratio to receive low-dose rivaroxaban plus aspirin or aspirin alone within 7 to 100 days of their index event. The primary safety outcome was hemorrhagic stroke. The main efficacy end point was the composite of ischemic stroke or covert brain infarct on magnetic resonance imaging at the end of the study.</p><p><strong>Results: </strong>A total of 101 participants were randomized. Average enrollment was 10 participants/site per year. Average follow-up was 20 months. Median time from index stroke to randomization was 67 days. The median age of participants was 67 years (±10.94), and 29% of participants were women. There was no hemorrhagic stroke in either arm. The composite efficacy outcome was less frequent in the combination arm (15.7%) compared with the aspirin arm (24.0%), with a hazard ratio of 0.78 ([95% CI, 0.32-1.93]; <i>P</i>=0.59) favoring the intervention.</p><p><strong>Conclusions: </strong>A multicenter randomized trial comparing the combination of low-dose rivaroxaban and aspirin in patients with recent ischemic stroke or transient ischemic attack due to ICAD is feasible and appears safe without an increased risk of hemorrhagic stroke. A numerical trend toward efficacy for the composite primary end point of symptomatic ischemic stroke and covert infarcts was observed. These findings will inform the design of a phase III trial.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04142125.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"380-389"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955444","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":"Cerebral Microbleeds and Their Association With Inflammation and Blood-Brain Barrier Leakage in Small Vessel Disease.","authors":"Lupei Cai, Daniel J Tozer, Hugh S Markus","doi":"10.1161/STROKEAHA.124.048974","DOIUrl":"10.1161/STROKEAHA.124.048974","url":null,"abstract":"<p><strong>Background: </strong>How cerebral microbleeds (CMBs) are formed, and how they cause tissue damage is not fully understood, but it has been suggested they are associated with inflammation, and they could also be related to increased blood-brain barrier (BBB) leakage. We investigated the relationship of CMBs with inflammation and BBB leakage in cerebral small vessel disease, and in particular, whether these 2 processes were increased in the vicinity of CMBs.</p><p><strong>Methods: </strong>In 54 patients with sporadic cerebral small vessel disease presenting with lacunar stroke, we simultaneously assessed microglial activation using the positron emission tomography ligand [11C]PK11195 and BBB leakage using dynamic contrast enhanced magnetic resonance imaging, on a positron emission tomography-magnetic resonance imaging system. To assess local inflammation and BBB leakage, 3 one-voxel concentric shells were generated around each CMB on susceptibility-weighted imaging and resampled to positron emission tomography and T1 mapping images, respectively. In these 3 shells, we calculated the mean of PK11195 nondisplaceable binding potential (BPND) as a marker of microglial activation, as well as the mean influx rate as a marker of BBB leakage. In addition, 93 blood biomarkers related to cardiovascular disease, inflammation, and endothelial activation were measured to quantify systemic inflammation.</p><p><strong>Results: </strong>No significant associations were found between the number of CMBs and the measures for microglial activation (<i>β</i>=2.6×10^-5, <i>P</i>=0.050) and BBB leakage (<i>β</i>=-0.0001, <i>P</i>=0.400) in the white matter. There was no difference in measures of microglial activation (<i>P</i>=0.403) or BBB leakage (<i>P</i>=0.423) across the 3 shells surrounding the CMBs. Furthermore, after correcting for multiple comparisons, no associations were observed between systemic inflammation biomarkers and the number of CMBs.</p><p><strong>Conclusions: </strong>We found no evidence that CMBs are associated with either microglial activation assessed by [11]CPK11195 positron emission tomography or BBB leakage assessed by dynamic contrast enhanced magnetic resonance imaging, either globally or locally, in sporadic cerebral small vessel disease. There was also no association with markers of systemic inflammation.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"427-436"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915580","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":"Identifying Best Practices for Improving the Evaluation and Management of Stroke in Rural Lower-Resourced Settings: A Scientific Statement From the American Heart Association.","authors":"Kori S Zachrison, Kaiz S Asif, Sherita Chapman, Karen E Joynt Maddox, Enrique C Leira, Susan Maynard, Christa O'Hana S Nobleza, Charles R Wira","doi":"10.1161/STR.0000000000000478","DOIUrl":"10.1161/STR.0000000000000478","url":null,"abstract":"<p><p>Considerable variation exists in the delivery of acute stroke care and stroke outcomes across settings and population groups. This is attributable in part to variation in resources among emergency departments in the United States, most notably in rural regions. Structural constraints of the US health care system, including the geographic distribution of where patients live relative to the location of hospitals and certified stroke centers, will continue to mean that many patients with stroke initially present to community emergency departments that have fewer stroke-related resources. These sites also tend to serve populations in rural areas who experience disparities in care and outcomes. Reducing health disparities related to stroke for populations in rural areas requires investment in these more remote community settings as the anchor of the stroke chain of survival for their respective communities. This scientific statement performs a critical appraisal examining challenges in rural stroke care related to access and variation in stroke-related capabilities for the acute phase of care to inform strategies and propose solutions. The scientific statement considers the value of expansion of Acute Stroke Ready Hospital and Primary Stroke Center certification in rural areas, the role of telehealth and improved transfer processes, as well as increased engagement and mentorship from larger, comprehensive centers to the rural hospitals to which they are connected. Multistakeholder collaboration and policy interventions need to be directed to enhance public awareness, impart staff training, grow infrastructure, enhance access to clinical expertise, streamline data management, and implement quality assessment and improvement programs.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e62-e74"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814430","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}