Stroke最新文献

{"title":"Optimizing Surgical Timing to Reduce Stroke Risk in Pediatric Moyamoya Disease.","authors":"Jiali Xu, Bin Li, Heguan Fu, Shuangfeng Huang, HouDi Zhang, Xunming Ji, Lian Duan, Xueli Chen, Sijie Li, Cong Han","doi":"10.1161/STROKEAHA.125.052044","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052044","url":null,"abstract":"<p><strong>Background: </strong>Identifying the optimal surgical timing is critical for reducing stroke risk in pediatric patients with Moyamoya disease, but evidence to guide clinical decision-making remains limited. This study aimed to determine the optimal surgical timing based on different symptom onset patterns.</p><p><strong>Methods: </strong>We retrospectively reviewed pediatric patients with Moyamoya disease who underwent revascularization surgery at a single center in China between July 2007 and July 2018. Patients were categorized by symptom onset pattern: infarction-onset, transient ischemic attack (TIA)-onset, or nonischemic. The TIA-onset group was further subdivided into high-risk and low-risk subgroups. Data on preoperative/perioperative stroke events and diagnosis-to-operation intervals were collected. Receiver operating characteristic curves and multivariate analyses were used to identify surgical timing thresholds. Stroke incidences were compared across groups stratified by surgical interval.</p><p><strong>Results: </strong>A total of 736 patients (mean age 7.2±3.9 years; 50.7% male) were included. The incidence density of preoperative cerebral infarction was 11.83 per 1000 person-months, while that of cerebral hemorrhage was 1.21 per 1000 person-months. For patients with infarction-onset and high-risk TIA-onset patterns, a surgical waiting time exceeding 2.5 months (area under the curve, 0.722; specificity, 0.561; sensitivity, 0.882; <i>P</i><0.001) and 6.5 months (area under the curve, 0.631; specificity, 0.400; sensitivity, 0.804; <i>P</i>=0.006), respectively, was associated with a significantly increased risk of preoperative cerebral infarction. In nonischemic patients, a prolonged surgical waiting time exceeding 5 years (area under the curve, 0.761; specificity, 0.856; sensitivity, 0.571; <i>P</i><0.05) was associated with a significantly increased risk of cerebral hemorrhage. For patients with initial symptoms of infarction or high-risk TIA, earlier surgery did not increase the incidence of perioperative stroke events.</p><p><strong>Conclusions: </strong>For children with Moyamoya disease, surgical intervention was beneficial within 2.5 months for patients with infarction-onset, 6.5 months for patients with high-risk TIA onset, and 5 years for nonischemic patients in reducing stroke risk.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076161","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":"Intracerebral Hemorrhage Outcomes After Reversal of Subtherapeutic Warfarin: Analysis of Data From GWTG-Stroke.","authors":"Aaron N LacKamp, Jeremy M Weber, Brian C Mac Grory, Adrien J Caye, Chaeli Stenuf, Eric E Smith, Justin D Daniels, Tiffany T Barkley, Steven R Messe, Brooke Alhanti, Kevin N Sheth, Rosalia G Blanco, Gregg C Fonarow, Ying Xian, Halinder S Mangat","doi":"10.1161/STROKEAHA.124.050281","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050281","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend reversal of warfarin anticoagulation in intracranial hemorrhages. The benefit of reversing subtherapeutic warfarin anticoagulation in acute spontaneous intracerebral hemorrhage is uncertain.</p><p><strong>Methods: </strong>An observational cohort from the entire Get With The Guidelines Stroke registry between January 2015 and January 2022 was used to determine the association of reversal with outcomes for subtherapeutic anticoagulation (international normalized ratio, 1.5-1.9). Inclusion required current warfarin use. Exclusions included thrombolytics, direct oral anticoagulants, transferring out, or leaving against medical advice. The prespecified primary outcome was the modified Rankin Scale (mRS) score of 0 to 3 at discharge. Logistic regression was used to assess the association between reversal and the mRS score of 0 to 3. Propensity scores with overlap weighting were used to control treatment selection bias. Information on the dose and timing of reversal agents was unknown.</p><p><strong>Results: </strong>Initial cohort 239 681 patients, 18 419 on warfarin. Excluded were 15 712 with an international normalized ratio ≤1.5, ≥1.9, or missing, and 701 missing mRS. Final cohort 1868 (mean age 73, 42% female). Reversal occurred in 894 (47.9%). Primary outcome occurred in 188/894 (21.0%) versus 225/974 (23.1%) with reversal versus without (adjusted odds ratio, 0.80 [95% CI, 0.63-1.005]). Ordinal analysis showed higher odds of mRS score of 0 to 4 versus 5 to 6 (52.7% versus 42.5% [adjusted odds ratio, 1.21 [1.001-1.48]). Outcomes not requiring mRS were analyzed among 2569 patients. Mortality or discharge to hospice was lower 30.6% versus 41.5% (adjusted odds ratio, 0.75 [95% CI, 0.63-0.89]). Hospital length of stay was longer (median, 6 versus 4 days; adjusted risk ratio, 1.25 [95% CI, 1.13-1.37]). There was no difference in venous thromboembolism (2.9% versus 2.3%; adjusted odds ratio, 1.47 [0.88-2.46]).</p><p><strong>Conclusions: </strong>Reversal of subtherapeutic warfarin with acute spontaneous intracerebral hemorrhage and international normalized ratio 1.5 to 1.9 was not associated with improvement in functional outcome based on discharge mRS score of 0 to 3 versus 4 to 6. Patients receiving reversal agents had 25% lower odds of dying in hospital or being discharged to hospice, but had a longer hospital stay. This exploratory data has limitations inherent to not being a randomized controlled trial.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076135","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":"Preclinical Ischemic Stroke Multicenter (PRISM) Trials Collective Statement: Opportunities, Challenges, and Recommendations for a New Era.","authors":"Cenk Ayata, Philip M Bath, Ana M Planas, Stuart M Allan, Johannes Boltze, Ryan P Cabeen, Claire L Gibson, Marilyn J Cipolla, Marcio A Diniz, Stefano Fumagalli, Fahmeed Hyder, Raymond C Koehler, Arthur Liesz, Sarah K McCann, Tim Magnus, Louise D McCullough, Emily S Sena, Simone Beretta, Jarek Aronowski, Francesca Bosetti, Clinton B Wright, Patrick D Lyden, Lauren H Sansing","doi":"10.1161/STROKEAHA.125.052056","DOIUrl":"10.1161/STROKEAHA.125.052056","url":null,"abstract":"<p><p>Preclinical stroke research faces a critical translational gap, with animal studies failing to reliably predict clinical efficacy. To address this, the field is moving toward rigorous, multicenter preclinical randomized controlled trials (mpRCTs) that mimic phase 3 clinical trials in several key components. This collective statement, derived from experts involved in mpRCTs, outlines considerations for designing and executing such trials. mpRCTs offer advantages such as increased sample sizes, robust statistical design, incorporation of heterogeneity, and standardized protocols, but they face challenges in finding the right balance between standardization and heterogeneity, appropriate stroke model selection, and outcome measures, as well as the implementation of complex network infrastructure. We discuss the importance of rigorous study design, including appropriate stroke models, representation of biological variables and comorbidities, functional outcome readouts, and handling of attrition and mortality. Statistical considerations such as adaptive sequential designs, covariate adjustments, and appropriate handling of missing data are also addressed. The integration of machine learning, the implementation of common data elements, and the selection of appropriate therapeutic candidates are crucial for maximizing the efficiency and utility of mpRCTs. Furthermore, the transition toward mpRCT platforms, akin to clinical trial platforms, holds promise for facilitating continuous evaluation of therapies. Finally, we discuss data-sharing practices and the collateral benefits of mpRCTs, emphasizing their potential to improve preclinical stroke research and bridge the translational gap. Altogether, we hope that this article will serve as a starting point for a lasting debate on the future of stroke mpRCTs and their evolution toward a universally accepted set of principles.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034144","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":"Timing Matters: How Daily Rhythms Affect Remote Ischemic Postconditioning Therapy for Stroke.","authors":"Ester Licastro, Viviana Viscardi, Ornella Cuomo, Rohan Mahesh Patil, Kazuhide Hayakawa, Eng H Lo, Giuseppe Pignataro, Elga Esposito","doi":"10.1161/STROKEAHA.125.053040","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.053040","url":null,"abstract":"<p><strong>Background: </strong>Despite promising preclinical results, remote limb ischemic postconditioning efficacy in human stroke treatment remains unclear, with mixed clinical trial outcomes. A potential reason for translational difficulties could be differences in circadian rhythms between nocturnal rodent models and diurnal humans.</p><p><strong>Methods: </strong>Male C57BL/6J mice were subjected to transient focal cerebral ischemia and then exposed to remote postconditioning during their active or inactive phase and euthanized at 24 hours and 3 days. Infarct volumes were measured using tetrazolium staining. Behavioral outcomes were assessed using the modified Neurological Severity Score, foot-fault test, and adhesive removal test. Brain (striatum ipsilateral) protein levels of PER2 (period circadian regulator 2) and nNOS (neuronal NO synthase) were analyzed by Western blot at 24 hours and 3 days postischemia. 7-nitroindazole, an nNOS inhibitor, was injected intracerebroventricular, and PER2 protein levels were measured during the inactive phase.</p><p><strong>Results: </strong>Remote postconditioning reduced infarct volumes and improved behavioral outcomes in mice when strokes occurred during the inactive phase (Zeitgeber 1-5) but had no effect during the active phase (Zeitgeber 13-17) 24 hours and 3 days postischemia. During the inactive phase, remote postconditioning reduced PER2 expression and increased nNOS levels; however, these changes were not observed during the active phase. Treatment with the nNOS inhibitor abolished the difference in PER2 expression between the transient middle cerebral artery occlusion and remote limb ischemic postconditioning groups during the inactive phase.</p><p><strong>Conclusions: </strong>Circadian rhythms influence the neuroprotective effects of remote postconditioning, with greater efficacy observed during the rodent inactive phase up to 3 days. The underlying mechanism may involve nNOS-dependent regulation of PER2 during remote limb ischemic postconditioning. These findings suggest that circadian timing should be considered in remote postconditioning stroke research to improve the translation of neuroprotective strategies from animals to humans.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034183","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":"Major ABO-Incompatible Platelet Transfusions Are Associated With Brain Ischemia After Intracerebral Hemorrhage.","authors":"Fernanda Carvalho Poyraz, Mohamed Ridha, Marialaura Simonetto, Aditya Kumar, Shivani Ghoshal, Sachin Agarwal, Soojin Park, Jan Claassen, E Sander Connolly, Elizabeth F Stone, David J Roh","doi":"10.1161/STROKEAHA.125.051427","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051427","url":null,"abstract":"<p><strong>Background: </strong>Major ABO-incompatible platelet transfusions are associated with poor intracerebral hemorrhage (ICH) outcomes, yet drivers for this relationship remain unclear. Brain magnetic resonance imaging (MRI) ischemic lesions after ICH are neuroimaging biomarkers of secondary brain injury and are associated with poor outcomes. Given that ABO-incompatible platelet transfusions can induce immune complex formation, thrombo-inflammation, and endothelial barrier disruption, factors that could exacerbate cerebral ischemia, we explored whether major ABO-incompatible platelet transfusions are risk factors for ischemic lesions on brain MRI after ICH.</p><p><strong>Methods: </strong>Adult patients admitted to a tertiary-care academic center between 2009 and 2016 who received a single-platelet transfusion within 24 hours of admission after an ICH, had available donor/recipient ABO data, and brain MRI during the hospitalization were analyzed. Adjusted regression models evaluated relationships between major ABO-incompatible platelet units and MRI ischemic lesions.</p><p><strong>Results: </strong>A total of 40 patients were included in the study. The mean age was 67.1 (SD, 14.1), and 37.5% were female. Twenty percent of patients received a major ABO-incompatible platelet unit. Major ABO-incompatible platelet transfusions were associated with increased odds of MRI ischemic lesions after adjusting for ICH severity (adjusted odds ratio, 9.2 [95% CI, 1.3-62.7]).</p><p><strong>Conclusions: </strong>Our exploratory findings suggest that major ABO-incompatible platelet transfusions may contribute to secondary brain injury after ICH. Further work is needed to assess whether avoiding major ABO-incompatible platelet transfusions can prevent secondary brain injury burden and improve ICH outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034221","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":"Efficacy of Tenecteplase in Large Vessel Occlusion Stroke Within 24 Hours of Symptom Onset: The ETERNAL-LVO Randomized Controlled Trial.","authors":"Vignan Yogendrakumar, Bruce C V Campbell, Leonid Churilov, Carlos Garcia-Esperon, Philip M C Choi, Dennis J Cordato, Niruta Dhimal, Liudmyla Olenko, Prodipta Guha, Gagan Sharma, Chushuang Chen, Amy McDonald, Vincent Thijs, Abul Mamun, Angela Dos Santos, Anna H Balabanski, Timothy J Kleinig, Ken S Butcher, Michael J Devlin, Fintan O'Rourke, Geoffrey A Donnan, Stephen M Davis, Christopher R Levi, Henry Ma, Mark W Parsons","doi":"10.1161/STROKEAHA.125.052511","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052511","url":null,"abstract":"<p><strong>Background: </strong>To assess the efficacy and safety of tenecteplase in patients presenting within 24 hours of symptom onset with a large vessel occlusion and target mismatch on perfusion computed tomography.</p><p><strong>Methods: </strong>ETERNAL-LVO was a prospective, randomized, open-label, blinded end point, phase 3, superiority trial where adult participants with a large vessel occlusion, presenting within 24 hours of onset with salvageable tissue on computed tomography perfusion, were randomized to tenecteplase 0.25 mg/kg or standard care across 11 primary and comprehensive stroke centers in Australia. The primary outcome was the modified Rankin Scale score of 0 to 1 or return to baseline at 90 days via a modified Poisson regression model. Secondary outcomes include the modified Rankin Scale, considered as an ordinal variable, and symptomatic intracerebral hemorrhage.</p><p><strong>Results: </strong>Following trial initiation, a supply shortage of the investigational product hindered recruitment. When supply resumed, phase 3 evidence had emerged supporting tenecteplase use within 4.5 hours of stroke onset, including large vessel occlusion. ETERNAL-LVO was, therefore, terminated early. Two hundred forty-two participants (median age: 73 years, 43% female, 79% undergoing EVT) were included in the modified intention-to-treat analysis; 120 received tenecteplase and 122 received standard care. No difference in the primary outcome was observed between the tenecteplase (n=44, 37%) and standard care (n=52, 43%; adjusted risk ratio, 0.90 [95% CI, 0.66-1.21]; <i>P</i>=0.48). No significant differences in an ordinal analysis of the modified Rankin Scale were observed between the 2 treatment groups. In a planned per-protocol analysis, the odds of improvement by 1 point in the modified Rankin Scale were doubled in the tenecteplase-treated transfer subgroup compared with standard care transfer patients (odds ratio, 2.61 [95% CI, 1.07-6.40]). Symptomatic intracerebral hemorrhage occurred in 5 (4%) participants assigned to tenecteplase and was present in 1 (1%) participant assigned to standard care.</p><p><strong>Conclusions: </strong>Treatment with tenecteplase did not increase the likelihood of a favorable functional outcome, but early stoppage of the study prevents definitive conclusions from being drawn.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04454788.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030632","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":"PCISOS Risk Profiles Stratify Heterogeneous Outcomes in Minor Posterior Circulation Ischemic Stroke: A Post Hoc Analysis of the CHANCE-2 Trial.","authors":"Xiaoyu Lin, Cang Guo, Xia Meng, Xingquan Zhao, Hao Li, Yongjun Wang, Jialei Yang","doi":"10.1161/STROKEAHA.125.053054","DOIUrl":"10.1161/STROKEAHA.125.053054","url":null,"abstract":"<p><strong>Background: </strong>Risk stratification in posterior circulation ischemic stroke (PCIS) is challenging. Although the Posterior Circulation Ischemic Stroke Outcome Score (PCISOS) was developed to address this, its utility in minor PCIS and in identifying homogeneous populations for clinical trials or treatment-responsive subgroups remains uncertain.</p><p><strong>Methods: </strong>CHANCE-2 (Clopidogrel in High-Risk Patients With Acute Non-disabling Cerebrovascular Events-II) was a multicenter, randomized trial that enrolled patients with minor stroke or high-risk transient ischemic attack who carried CYP2C19 loss-of-function alleles. Patients received ticagrelor-aspirin or clopidogrel-aspirin. This secondary analysis included patients with PCIS, stratified into low- (≤15), intermediate- (16-20), and high-risk (≥21) groups based on PCISOS. The primary outcome was 90-day stroke recurrence. Outcomes were analyzed using Cox and logistic regression models, adjusting for significantly imbalanced baseline covariates relevant to each comparison.</p><p><strong>Results: </strong>Among 1379 patients with PCIS (median age, 64.0 [56.6-70.7] years; 67.4% male), 90-day stroke recurrence occurred in 6.0%, 8.2%, and 18.5% of the low-, intermediate-, and high-risk PCISOS groups, respectively (<i>P</i><0.001). Risk increased progressively (adjusted hazard ratios for intermediate-risk, 1.32 [95% CI, 0.87-2.02]; high-risk, adjusted hazard ratio, 3.02 [95% CI, 1.52-6.02]; <i>P</i>_trend=0.008). Similar associations were observed for modified Rankin Scale (mRS) score of 2 to 6 outcomes (adjusted odds ratio for intermediate-risk, 2.21 [95% CI, 1.28-3.84]; high-risk, 3.53 [95% CI, 1.42-8.74]; <i>P</i>_trend<0.001). A treatment-by-risk interaction was observed: ticagrelor-aspirin reduced the modified Rankin Scale score of 1 to 6 rates in low- and intermediate-risk patients, but not in high-risk patients (<i>P</i>_interaction=0.03). Favorable outcome (modified Rankin Scale score of 0-1) was more common in patients with PCISOS ≤15 than in those with National Institutes of Health Stroke Scale score ≤3 (<i>P</i>=0.02).</p><p><strong>Conclusions: </strong>PCISOS provides effective risk stratification in minor PCIS, identifying subgroups with heterogeneous outcome risks and differential response to ticagrelor-aspirin. Patients with PCISOS ≥21, a high-risk subgroup within National Institutes of Health Stroke Scale-defined minor strokes, remain underexplored and may benefit from tailored strategies in future trials. A threshold of PCISOS ≤15 may more accurately define truly low-risk patients than National Institutes of Health Stroke Scale score ≤3, thereby improving trial efficiency and advancing precision in PCIS research.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04078737.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030696","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":"fNIRS Biomarkers for Stratifying Poststroke Cognitive Impairment: Evidence From Frontal and Temporal Cortex Activation.","authors":"Han Zhang, Kang He, Yu Zhao, Yi Peng, Danling Feng, Jing Wang, Qiang Gao","doi":"10.1161/STROKEAHA.124.050269","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050269","url":null,"abstract":"<p><strong>Background: </strong>Poststroke cognitive impairment (PSCI) affects 30% to 50% of stroke survivors, severely impacting functional outcomes and quality of life. This study uses functional near-infrared spectroscopy (fNIRS) to assess task-evoked brain activation and its potential for stratifying the severity in patients with PSCI.</p><p><strong>Method: </strong>A cross-sectional study was conducted at Nanchong Central Hospital between June 2023 and April 2024. The Montreal Cognitive Assessment was used to evaluate cognitive function. Hemodynamic responses, including oxygenated hemoglobin concentration signals from the frontal and temporal cortices, were measured using fNIRS. Healthy controls were recruited from the local community, matched to the patient group by age and sex. Univariate and multivariate linear regression analyses were performed to assess the correlations between fNIRS features, clinical variables, and group classifications. Significant fNIRS features and clinical variables were then identified and included in a logistic regression model. The final model was developed using a stratified approach based on the severity of cognitive impairment, and the predictive performance was evaluated using receiver operating characteristic analysis.</p><p><strong>Results: </strong>A total of 159 participants were included: 138 patients with PSCI and 21 healthy controls. Patients with PSCI (mean age=53.7, SD=10.2 years, 78.3% male) exhibited significantly reduced oxygenated hemoglobin responses in the left dorsal prefrontal cortex (L-DPFC) compared with healthy controls (mean age=52.8, SD=4.7 years, 76.2% male). Patients were in the subacute to chronic phase poststroke. A multivariate model combining L-DPFC features distinguished PSCI from healthy controls (area under the curve, 0.76). For severity stratification, a model distinguishing mild from moderate PSCI (area under the curve, 0.75 [95% CI, 0.65-0.85]) included age, education level, National Institutes of Health Stroke Scale score, recanalization therapy, and L-DPFC centroid. A model distinguishing moderate from severe PSCI (area under the curve, 0.84 [95% CI, 0.75-0.92]) included disease duration, lesion location, and L-DPFC centroid.</p><p><strong>Conclusions: </strong>This study revealed that individuals with PSCI exhibited significantly reduced cortical activation in the L-DPFC compared with healthy controls. fNIRS features, particularly L-DPFC centroid values combined with clinical variables, effectively stratify PSCI severity. These findings may inform individualized rehabilitation strategies.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030621","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":"Perinatal Arterial Ischemic Stroke in Monochorionic Twins: A Retrospective Observational Single-Center Cohort Study.","authors":"Bregje O van Oldenmark, Mathies Rondagh, Phebe Adama van Scheltema, Femke Slaghekke, Lotte E van der Meeren, Marjolijn S Spruijt, Enrico Lopriore, Linda S de Vries, Sylke J Steggerda","doi":"10.1161/STROKEAHA.125.051702","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051702","url":null,"abstract":"<p><strong>Background: </strong>Monochorionic twins, characterized by placental sharing and vascular anastomoses, carry a high risk of brain injury, including perinatal arterial ischemic stroke (PAIS). However, the pathophysiology and timing-related risk factors of PAIS remain unclear.</p><p><strong>Methods: </strong>Retrospective cohort of all monochorionic twins with neuroimaging-confirmed PAIS born from 2005 to 2024 and evaluated at a Dutch national referral center. PAIS timing was classified as presumed antenatal, direct perinatal, or postnatal onset. Risk factors and neurodevelopmental outcomes, including cerebral palsy and cognitive impairment, were assessed.</p><p><strong>Results: </strong>Eighteen cases of PAIS were identified among 1183 twin pairs born <35 weeks' gestation (1.5%). Mean gestational age at birth was 29.4 weeks (95% CI, 28.3-31.5), and mean birth weight was 1258 (95% CI, 1062-1453) grams. Pregnancy complications were identified in 89%: twin-to-twin transfusion syndrome (n=13), twin anemia polycythemia sequence (n=1), and single fetal demise (n=2). In twin-to-twin transfusion syndrome/twin anemia polycythemia sequence, PAIS was diagnosed in the recipient twin in 12 of 14 (86%) cases. Regarding stroke onset, 6 occurred antenatally, 7 direct perinatally, and 5 occurred in the postnatal period. Stroke patterns involved the middle cerebral artery (anterior, posterior, or main branch) in 10 of 18 (56%); anterior cerebral artery in 1 of 18 (6%), perforator arteries arising from middle cerebral artery, or anterior cerebral artery in 7 of 18 (38%); and posterior cerebral artery in 1 of 18 (6%). Among 7 infants with main branch middle cerebral artery stroke, 2 died in the fetal or neonatal period, and all 4 with a follow-up assessment developed unilateral spastic cerebral palsy. Among 6 infants with perforator stroke and follow-up, 2 had hemiparesis at 24 months corrected age.</p><p><strong>Conclusions: </strong>PAIS in monochorionic twins predominantly affects the recipient twin and can occur in the antenatal, direct perinatal, or postnatal period, with variable stroke patterns and outcomes. We recommend dedicated fetal and postnatal neuroimaging in complicated preterm-born monochorionic twins to detect PAIS and allow early rehabilitation therapy.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030693","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":"BOLD Long-Range Temporal Correlations Reflect Changes in Language and Depression Across Intensive Aphasia Therapy.","authors":"Anna-Thekla P Jäger, Christopher J Steele, Felix R Dreyer, Milena R Osterloh, Anna Sadlon, Vadim Nikulin, Bettina Mohr, Friedemann Pulvermüller","doi":"10.1161/STROKEAHA.124.050064","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050064","url":null,"abstract":"<p><strong>Background: </strong>Intensive language-action therapy treats language deficits and depressive symptoms in chronic poststroke aphasia, yet the underlying neural mechanisms remain underexplored. Long-range temporal correlations (LRTCs) in blood oxygenation level-dependent signals indicate persistence in brain activity patterns and may relate to learning and levels of depression. This observational study investigates blood oxygenation level-dependent LRTC changes alongside therapy-induced language and mood improvements in perisylvian and domain-general brain areas.</p><p><strong>Methods: </strong>Sixteen patients with chronic poststroke aphasia underwent functional magnetic resonance imaging before and after 2 to 4 weeks of intensive language-action therapy. Therapy took place at Freie Universität Berlin (2014-2020). Language functions and depression were assessed using the Aachen Aphasia Test, the Beck Depression Inventory, and the Montgomery-Åsberg Depression Rating Scale. We implemented a passive reading functional magnetic resonance imaging paradigm and analyzed data using detrended fluctuation analysis to assess LRTC. A 2×2×2 (time, hemisphere, and region of interest) repeated measures ANCOVA (covariates: age, lesion size, time poststroke, and therapy intensity) was conducted in frontoparietal/temporal perisylvian areas across hemispheres before/after therapy. Correlation analyses explored links between changes in behavior and LRTC in focal perisylvian areas and across the whole brain.</p><p><strong>Results: </strong>Younger patients (relative to the continuous age range of our sample) showed reductions in LRTC across therapy, whereas relatively older patients tended toward increases. We found that changes in LRTC correlated with changes in language performance in right hemisphere perisylvian regions and bilateral domain-general and memory areas (eg, hippocampus, thalamus, supplementary motor area, and putamen). Similarly, changes in depressive symptoms correlated with LRTC changes in right hemisphere perisylvian regions.</p><p><strong>Conclusions: </strong>LRTC changes across therapy reflect changes in both language performance and depression in chronic poststroke aphasia. Predominantly right perisylvian and domain-general regions seem critical for neuroplasticity in language rehabilitation. In addition, the observed role of right perisylvian regions in mood regulation highlights the interconnection of cognitive recovery and emotional well-being. LRTC may represent a valuable biomarker for tracking therapy-related neuroplasticity.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030650","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}