Stroke最新文献

{"title":"Quantitative Relationship Between White Matter Hyperintensity Volume and Fazekas Score on Brain MRI.","authors":"Yu-Yuan Xu, Francesca M Chappell, Maria Valdes Hernandez, Carmen Arteaga Reyes, Una Clancy, Daniela Jaime Garcia, Stephen Makin, Michael Stringer, Michael Thrippleton, Stewart Wiseman, Yajun Cheng, Dillys Xiaodi Liu, Rosalind Brown, Fergus Doubal, Ian J Deary, Simon Cox, Danielle Kerkhofs, Julie Staals, Walter Backes, Robert van Oostenbrugge, Anna Kopczak, Marco Duering, Joanna M Wardlaw","doi":"10.1161/STROKEAHA.125.055101","DOIUrl":"10.1161/STROKEAHA.125.055101","url":null,"abstract":"<p><strong>Background: </strong>The Fazekas score is widely used to grade white matter hyperintensities (WMHs) in cerebral small vessel disease, yet the equivalent volume of each grade is unclear. We quantified the correspondence between Fazekas scores and WMH volume, normalized ratios, and derived conversion equations across populations.</p><p><strong>Methods: </strong>We analyzed 1220 participants from 4 mostly United Kingdom-based cohorts representing different cerebral small vessel disease severities: community-dwelling (LBC1936 [Lothian Birth Cohort 1936]), stroke (MSS2 [Mild Stroke Study 2] and MSS3 [Mild Stroke Study 3]), and a cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy-enriched cohort (INVESTIGATE [Imaging Neuro-Vascular, Endothelial and Structural Integrity in Preparation to Treat Small Vessel Diseases]). WMH burden was quantified as absolute WMH volume and as normalized ratios: WMH volume as a percentage of brain volume and WMH volume as a percentage of intracranial volume. Transition zones were defined as the overlap of WMH volume interquartile ranges between adjacent Fazekas scores. Linear, exponential (nonlinear least squares), and log-linear (ln WMH≈Fazekas score and zeros excluded) models were fitted; model fit was assessed using mean squared error, (pseudo-)R², and Vuong tests. Periventricular-versus-deep WMH patterns within each total Fazekas score were compared using the Kruskal-Wallis test.</p><p><strong>Results: </strong>The pooled cohort had a mean age of 69.4±8.9 years; 700 of 1227 records (57.1%) were male. WMH burden increased monotonically with a Fazekas score in all cohorts. Adjacent-grade separation was strongest in LBC1936 (all <i>P</i>≤0.002) but weaker at lower grades in MSS2, MSS3, and INVESTIGATE. The widest transition zones occurred between Fazekas grades of 3 to 4 and 4 to 5, whereas a clear WMH volume gap separated grades 5 and 6. Exponential models generally fit better than linear models, with lower mean squared error and supportive Vuong tests in most cohorts. Log-linear sensitivity analyses showed similar fitted trajectories after back-transformation. WMH burden did not differ consistently by periventricular-versus-deep distribution within Fazekas grades.</p><p><strong>Conclusions: </strong>WMH burden followed an exponential trajectory across Fazekas scores, with population-dependent progression. The resulting conversion equations enabled bidirectional translation between visual Fazekas score and quantitative WMH volume, facilitating cross-study comparison, large-scale epidemiology, and might facilitate clinical decision-making in cerebral small vessel disease.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2801-2812"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449575","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":"Tenecteplase Efficacy in Patients With Distal Occlusions: Secondary Analysis of the TASTE Randomized Clinical Trial.","authors":"Vignan Yogendrakumar, Justin Phung, Hannah T Johns, Leonid Churilov, Carlos Garcia-Esperon, Gagan Sharma, Niruta Dhimal, Chushuang Chen, Longting Lin, Beng Lim Chew, Felix C Ng, Akshay Deepak, Ferdinand Miteff, Philip M C Choi, Timothy J Kleinig, Dennis J Cordato, Teddy Y Wu, Henry Ma, Carlos A Molina, Chon-Haw Tsai, Jiunn-Tay Lee, Jiann-Shing Jeng, Daniel Strbian, Juan F Arenillas, Brian H Buck, Michael J Devlin, Kenneth S Butcher, Geoffrey A Donnan, Stephen M Davis, Neil J Spratt, Christopher R Levi, Bruce C V Campbell, Mark W Parsons","doi":"10.1161/STROKEAHA.126.056290","DOIUrl":"10.1161/STROKEAHA.126.056290","url":null,"abstract":"<p><strong>Background: </strong>Tenecteplase has been previously evaluated in large- and medium-sized vessel occlusion subgroups, but its effectiveness in more distal occlusions, particularly those involving the distal middle cerebral artery branches or the anterior cerebral artery and posterior cerebral artery territories, and across varying ischemic core and perfusion profiles, remains uncertain.</p><p><strong>Methods: </strong>We performed a secondary analysis of TASTE (Tenecteplase Versus Alteplase for Stroke Thrombolysis Evaluation), a randomized clinical trial comparing tenecteplase and alteplase in patients presenting within 4.5 hours of symptom onset with perfusion imaging-confirmed stroke and evidence of target mismatch (penumbra/core ratio >1.8 and an absolute difference >15 mL). The primary outcome was the modified Rankin Scale (mRS) score of 0 to 1 at 90 days. We compared the effect of tenecteplase versus alteplase in subgroups based on occlusion site (proximal M2, distal M2, M3 and beyond, anterior cerebral artery, and posterior cerebral artery), ischemic core, core growth rate, and penumbra. The treatment effect of tenecteplase and alteplase was compared stratifying by the subgroup of interest, adjusting for age, baseline National Institutes of Health Stroke Scale score, and premorbid mRS score in modified Poisson regression models.</p><p><strong>Results: </strong>Of the 680 patients enrolled, 492 were included in the primary analysis (median age, 73 [interquartile range, 63-82] years; male sex: 306/492 [62%]). Two hundred forty-two (49%) received tenecteplase, and 250 (51%) received alteplase. Tenecteplase was associated with a higher proportion of mRS score of 0 to 1 with distal (M3 and beyond) occlusions (tenecteplase: 62/81 [77%] versus alteplase: 59/93 [63%]; adjusted risk ratio, 1.23 [95% CI, 1.04-1.46]). Numerically higher rates of mRS score of 0 to 1 were observed with distal M2 (tenecteplase: 30/46 [65%] versus alteplase 28/48 [58%]; adjusted risk ratio, 1.14 [95% CI, 0.84-1.54]) and anterior cerebral artery occlusions (tenecteplase: 12/21 [57%] versus alteplase 5/13 [38%]; adjusted risk ratio, 1.46 [95% CI, 0.71-3.00]). No treatment differences were seen for proximal M2 or posterior cerebral artery occlusions (<i>P</i>_interaction across all occlusion sites: 0.89). Across ischemic core, penumbra, and core growth rate subgroups, no difference in treatment effect was observed.</p><p><strong>Conclusions: </strong>Patients with distal middle cerebral artery occlusions who are treated with tenecteplase are more likely to achieve an mRS score of 0 to 1 at 90 days than those treated with alteplase.</p><p><strong>Registration: </strong>URL: https://www.anzctr.org.au; Unique identifier: ACTRN12613000243718.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2643-2652"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550429","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":"PREVENT Equations: Implications for Stroke Prevention.","authors":"Taha Ahmed, Roy O Mathew, Mitchell S V Elkind, Ambar Kulshreshtha","doi":"10.1161/STROKEAHA.126.053362","DOIUrl":"10.1161/STROKEAHA.126.053362","url":null,"abstract":"<p><p>Stroke remains a leading cause of death and long-term disability. Yet, much of its burden is preventable through earlier and more intensive management of vascular and cardiovascular-kidney-metabolic risk factors. Primary prevention is challenging as the first clinical event is often unpredictable and may manifest as stroke, myocardial infarction, heart failure, or peripheral arterial disease. Contemporary tools, therefore, estimate overall cardiovascular risk rather than stroke risk in isolation. The goal of this review is to emphasize that effective stroke prevention requires a shift toward global cardiovascular risk assessment and to highlight the potential clinical utility of newer risk prediction tools. The predicting risk of cardiovascular disease events equations, developed by the American Heart Association, update absolute risk estimation by modeling overall cardiovascular disease risk using sex-specific, race-free equations that incorporate kidney function, account for competing noncardiovascular death, and optionally include neighborhood deprivation. External validations suggest improved calibration compared with pooled cohort equations, supporting a more reliable estimation of absolute treatment benefit. For clinicians managing patients at risk for stroke, predicting risk of cardiovascular disease events is most useful when the clinical question is how aggressively to optimize risk factors before the first event, including decisions about blood pressure, lipid-lowering therapy, cardiovascular-kidney-metabolic management, and patient communication using 10-year, 30-year, and risk age outputs. Key limitations include its focus on overall rather than cause-specific cardiovascular risk, lack of stroke mechanism-specific estimates, absence of major nonatherosclerotic stroke drivers such as atrial fibrillation, and lack of imaging-stratified treatment-effect estimates. Predicting the risk of cardiovascular disease events' ultimate clinical impact and equity will depend on implementation within electronic health record workflows, autopopulated inputs, treatment pathways tied to estimated risk, and complementary cause-specific evaluation when clinically indicated.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2913-2924"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406037","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":"Disseminated Cerebral Amyloid Angiopathy With Lobar Hemorrhage.","authors":"Sunil Munakomi","doi":"10.1161/STROKEAHA.126.056827","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056827","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 9","pages":"e475-e476"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814069","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 Hypertrophic Olivary Degeneration and Holmes Tremor Following Pontine Bleed.","authors":"Farsana Mustafa, Ayush Agarwal, Achal Kumar Srivastava, Savyasachi Jain, Divyani Garg","doi":"10.1161/STROKEAHA.126.056577","DOIUrl":"https://doi.org/10.1161/STROKEAHA.126.056577","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"57 9","pages":"e473-e474"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814118","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":"Threshold Effects, Cognitive Decline, and Longitudinal Changes in White Matter Hyperintensity Volume.","authors":"Sarvin Sasannia, Mykola Matsyuk, Shimeng Wang, Jinwei Zhang, Keenan A Walker, Hyeong-Geol Shin, Richard Leigh, Jerry L Prince, Lewis C Becker, Lisa R Yanek, Nicola J Armstrong, Peter van Zijl, Dhananjay Vaidya, Linda Knutsson, Paul A Nyquist","doi":"10.1161/STROKEAHA.125.054810","DOIUrl":"10.1161/STROKEAHA.125.054810","url":null,"abstract":"<p><strong>Background: </strong>Changes in ischemic white matter hyperintensity (WMH) volume on magnetic resonance imaging over time are associated with cognitive decline. We investigated whether changes in WMH volume over time exhibit threshold effects of normalized WMH volume on declining cognitive performance and whether these effects on cognition differ between deep WMHs (DWMHs) and periventricular WMHs (PVWMHs).</p><p><strong>Methods: </strong>We followed 339 participants longitudinally from GeneSTAR (Genetic Study of Atherosclerosis Risk) with brain magnetic resonance imaging and neuropsychological testing at baseline (2009-2013) and at 13-year follow-up (2023 to present; 62% female, and 33% Black; mean baseline age, 49.7±9.6 years). WMHs were classified as PVWMH (within 2 mm of ventricles) or DWMH. Two-segment linear spline regression models using adjusted mixed linear regression identified test-specific thresholds longitudinally beyond which cognitive decline accelerated. Cognitive scores from both timepoints were treated as repeated measures, with WMH included as a time-varying predictor.</p><p><strong>Results: </strong>Declines in motor function and processing speed accelerated beyond thresholds of changing PVWMH and DWMH volumes. For Grooved Pegboard tests, changes in volume were associated with minimal effects below a threshold of changing volume (log-transformed ratio of lesion volume to intracranial volume for PVWMH from -9.42 to -9.29 and DWMH from -11.8 to -11.7). Substantial declines in cognitive performance were observed above thresholds of increases in volume (slope differences: PVWMH: 14.5-15.1 seconds per log-unit; <i>P</i><0.001; and DWMH: 9.54-10.9; <i>P</i><0.001). The digit symbol substitution test demonstrated paradoxical positive associations below changing volume thresholds (PVWMH: β=6.68; <i>P</i>=0.001; and DWMH: β=6.98; <i>P</i><0.001), reversing to decline above thresholds of increase in volume for PVWMH (Δβ=-11.2; <i>P</i><0.001) and DWMH (Δβ=-9.77; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Changes in WMH volume exhibit nonlinear threshold effects on changes in cognitive performance over time and differ by anatomic region. Minimal cognitive impact occurred below thresholds, with accelerated declines above. PVWMHs demonstrate larger effects on declining cognitive function than DWMH, particularly for motor and processing speed functions, and progress at a faster rate.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2695-2708"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406022","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":"Structured Clinical Input-Guided Large Language Model Workflow for Acute Ischemic Stroke Discharge Education: A Multicenter Feasibility Study.","authors":"Juntao Yin, Wan Wang, Lijuan Wu, Zhiwen Li, Weiwei Wang, Tao He, Yafei Wang, Guofeng Li, Lingtao Tang, Xuemeng Zhao, Yanfang Guo, Haolong Fan, Li Feng, Yanfeng Zhang","doi":"10.1161/STROKEAHA.126.055189","DOIUrl":"10.1161/STROKEAHA.126.055189","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) may support patient education, but their clinical use remains challenging. We aimed to evaluate the preliminary feasibility of a structured clinical input-guided LLM workflow for generating discharge education drafts for patients with acute ischemic stroke.</p><p><strong>Methods: </strong>Patients with acute ischemic stroke discharged from 6 tertiary stroke centers in China between September 1, 2024, and March 31, 2025, were included. The workflow comprised electronic medical record-based data extraction, mapping to a predefined deidentified case report form, manual verification, standardized prompt-based LLM draft generation, and clinician-facing draft output. For each patient, Chinese-language discharge education drafts were generated using GPT-4o, Grok-3, and DeepSeek-R1. Physician-written discharge instructions prepared during routine clinical practice served as reference materials. Two blinded senior neurologists evaluated the materials across 5 predefined domains. Patient-centered evaluation was conducted in 50 patients. Interrater agreement between the 2 neurologists was assessed using intraclass correlation coefficients. Group comparisons were performed using Friedman tests followed by Bonferroni-corrected Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>A total of 67 patients with acute ischemic stroke were included. The mean age was 63.6±11.0 years, and 45 patients were men (67.2%). Interrater agreement was good to excellent, with intraclass correlation coefficients ranging from 0.862 to 0.943. Post hoc analyses showed that each LLM-generated draft group received higher expert ratings than physician-written discharge instructions in risk factor control, rehabilitation guidance, follow-up planning, and health education (all Bonferroni-adjusted <i>P</i><0.001), whereas no pairwise difference in medication management remained significant after correction. Patient-centered ratings were generally favorable, and GPT-4o and Grok-3 received higher empathy ratings than physician-written discharge instructions (both Bonferroni-adjusted <i>P</i><0.01). No clear hallucinations were identified during expert review, and LLM drafts had fewer unacceptable ratings.</p><p><strong>Conclusions: </strong>A structured clinical input-guided LLM workflow showed preliminary feasibility for generating clinician-supervised acute ischemic stroke discharge education drafts. Prospective implementation studies are warranted to evaluate workflow integration, usability, and effects on patient-reported and clinical outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2709-2718"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536866","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":"Standard Antiplatelet Therapy Versus Thrombolysis in Acute Spontaneous Spinal Cord Infarction: A Propensity Score-Matched Analysis.","authors":"Majd A AbuAlrob, Ali Al-Salahat, Khaled Zammar, Salman Al Jerdi","doi":"10.1161/STROKEAHA.126.056523","DOIUrl":"10.1161/STROKEAHA.126.056523","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord infarction (SCI) is a rare stroke subtype with no established acute treatment guidelines. Thrombolytic therapy has been used empirically based on extrapolation from cerebral stroke protocols, but comparative effectiveness data are lacking. We compared outcomes between standard care and thrombolysis in acute spontaneous SCI.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the TriNetX Global Collaborative Network. Adult patients with acute SCI (<i>International Classification of Diseases</i>, Tenth Revision, Clinical Modification code G95.11) were divided into the standard care group (antiplatelet therapy within 48 hours) or the thrombolysis group (alteplase or tenecteplase). Patients who underwent aortic repair procedures were excluded. Propensity score matching (1:1) balanced 68 covariates. The prespecified primary outcome was all-cause mortality; readmission and rehabilitation utilization at 180 days were secondary exploratory outcomes. <i>E</i> values were calculated for the significant association.</p><p><strong>Results: </strong>Of the 965 patients in the standard care cohort and 103 in the thrombolysis cohort, 96 patients in each cohort remained after matching. Standard care was associated with significantly lower mortality (13.5% versus 29.2%; hazard ratio, 0.423 [95% CI, 0.219-0.817]; <i>P</i>=0.008); 180-day survival was 84.27% versus 68.69% (log-rank <i>P</i>=0.008), with an <i>E</i> value of 4.16. Readmission (14.6% versus 16.7%; <i>P</i>=0.669) and rehabilitation utilization (43.8% versus 49.0%; <i>P</i>=0.507) did not differ. The mortality association was consistent in direction across 3 sensitivity analyses.</p><p><strong>Conclusions: </strong>In spontaneous SCI, standard care was associated with significantly lower mortality than thrombolysis, without significant differences in readmission rates or rehabilitation utilization. These hypothesis-generating findings raise concerns about off-label thrombolytic use in SCI and support consideration of conservative management until higher-quality evidence emerges.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2687-2694"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664496","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":"Role of Low-Field MRI in Acute Stroke.","authors":"Annabel Sorby-Adams, Nandor K Pinter, Keith W Muir, Kathryn E Keenan, Juan Eugenio Iglesias, Matthew S Rosen, Kevin N Sheth, Joshua N Goldstein, W Taylor Kimberly","doi":"10.1161/STROKEAHA.126.052979","DOIUrl":"10.1161/STROKEAHA.126.052979","url":null,"abstract":"<p><p>Portable, low-field (LF) magnetic resonance imaging (MRI) is emerging as a clinically relevant adjunct in acute stroke care, enabling MRI in environments where conventional neuroimaging access is delayed, unavailable, or impractical. Advances in permanent magnet design, compact gradient and radiofrequency hardware, and the use of contemporary reconstruction methods have improved LF image quality and operational feasibility, supporting deployment at the point-of-care in emergency departments, intensive care units, and resource-limited settings. This review summarizes the evolving role of LF-MRI for acute stroke. LF sequence principles most relevant to stroke evaluation are summarized, focusing on how constraints in signal-to-noise ratio, achievable diffusion weighting, acquisition time, and diffusion direction sampling at LF influence lesion conspicuity and the reliability of quantification. The current clinical evidence base is then reviewed, including the role of LF-MRI in supporting stroke-type classification and tissue confirmation, in wake-up and unknown-onset stroke for tissue-based triage, and in posttherapeutic settings to enable serial assessment after thrombolysis or thrombectomy. Practical implementation considerations emphasize use case-driven deployment that preserves time-critical computed tomography and angiography pathways and clearly defines when LF-MRI should be used as an adjunct rather than a substitute for established initial imaging. Future directions include pragmatic workflow studies to determine where LF-MRI changes management, continued advances in hardware and pulse sequence development, and careful application of artificial intelligence for reconstruction and enhancement with task-specific validation in acute stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2590-2603"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536895","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":"BCKDK, A Novel Hypoxia-Responsive Kinase That Exacerbates Cerebral Ischemia Injury.","authors":"Boya Liao, Fang Zhang, Chang Han, Xinyao Yi, Ziyi Zhang, Leigang Jin, Fei Meng, Stanley Sau-Ching Wong, Ruby L C Hoo, Leiluo Geng, Wei Jia","doi":"10.1161/STROKEAHA.125.053856","DOIUrl":"10.1161/STROKEAHA.125.053856","url":null,"abstract":"<p><strong>Background: </strong>Alterations in circulating amino acid profiles have been observed in ischemic stroke patients; however, whether cerebral ischemia disrupts amino acid metabolism within brain tissue and whether this disruption contributes to cellular stress and cerebral injury remain unknown. This hypothesis-testing study investigates disrupted BCAA (branched-chain amino acid) catabolism as a key mechanism of ischemic brain damage and evaluates BCKDK (branched-chain α-keto acid dehydrogenase kinase) as a novel therapeutic target.</p><p><strong>Methods: </strong>Mouse primary cortical neurons subjected to oxygen-glucose deprivation and brain tissue from a mouse acute ischemic stroke model were used as experimental systems. Untargeted metabolomics and metabolic flux analysis were used to characterize BCAA metabolism in both models. In vivo pharmacological inhibition or in vitro knockdown of BCKDK was performed using BT2 (3,6-dichlorobenzo[b]thiophene-2-carboxylic acid) treatment or RNA interference. Primary outcome variables included infarct volume, BCKDH (branched-chain α-keto acid dehydrogenase) enzyme activity, neuronal viability, and markers of energy metabolism and glutamate excitotoxicity. Between-group differences were evaluated using 1-way ANOVA; data are presented as mean ± SD with 95% CIs and corresponding <i>P</i> values.</p><p><strong>Results: </strong>Metabolomics analysis of oxygen-glucose deprivation-exposed primary neurons revealed impaired BCAA catabolism and significant BCAA accumulation compared with normoxic controls. In ischemic mouse brain tissue, BCKDH activity was significantly suppressed, and BCKDK expression was markedly upregulated relative to sham-operated animals. Both pharmacological and genetic suppression of BCKDK substantially reduced cerebral ischemic injury, as evidenced by decreased infarct volume and improved neuronal survival (95% CI and <i>P</i> values per comparison). Mechanistically, ischemia-induced BCKDK expression via HIF-1α (hypoxia-inducible factor 1α)-mediated transcriptional activation, which inhibited BCAA conversion to tricarboxylic acid cycle substrates, thereby potentiating energy deficiency and glutamate excitotoxicity.</p><p><strong>Conclusions: </strong>These data identify BCKDK as a novel hypoxia-responsive factor whose upregulation drives disrupted BCAA catabolism as a key mechanism of ischemic neuronal injury. BCKDK represents a promising therapeutic target for cerebral ischemia, directly supported by both in vitro and in vivo experimental evidence presented here.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2824-2838"},"PeriodicalIF":11.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562930","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}