European Stroke Journal最新文献

{"title":"Intensive blood-pressure control for the prevention of major cardiovascular events in stroke patients: rationale and design of the OPTIMAL-STROKE trial.","authors":"Gisele S Silva, M J Machline-Carrion, Karla Santo, João B Clares de Andrade, Eduardo Martins, Patrícia Guimarães, Frederico Monfardini, Josué Nieri, Silvia R L Assis, Sheila Cristina O Martins, Octávio M Pontes Neto, Audes D M Feitosa, Carla H C Moro, Sandra C Fuchs, Rubens Gagliardi, Odilson Silvestre, Ricardo Pereira Silva, Murillo Antunes, Maramélia M Alves, Cesar Minelli, Lilia N Maia, Luiz A Bortolotto, Marcio G Sousa, Luciano F Drager, Rodrigo Bazan, José F Vilela-Martin, Jamary Oliveira-Filho, Viviane Zetola, Wagner Avelar, Leonardo A Carbonera, Gabriel P Braga, Adriana B Conforto, Caio A M Tavares, Fabrício O Lima, Gladys L Martins, Letícia Costa Rebello, Anthony Rodgers, Paul K Whelton, Flavio D Fuchs, Otavio Berwanger","doi":"10.1093/esj/aakag118","DOIUrl":"10.1093/esj/aakag118","url":null,"abstract":"<p><strong>Background: </strong>In high cardiovascular risk populations without prior stroke, intensive blood pressure (BP) lowering confers greater reductions in cardiovascular events than standard targets. However, optimal BP targets in patients with ischaemic stroke (IS) or TIA remain uncertain. The primary objective of the OPTIMAL-STROKE trial is to assess whether an intensive systolic BP (SBP) target (SBP < 120 mmHg) reduces major cardiovascular events in patients with previous IS or TIA compared to a standard SBP target (SBP < 140 mmHg).</p><p><strong>Study design: </strong>OPTIMAL-STROKE is a multicentre, randomised, controlled, open-label clinical trial with blinded and independent assessment of clinical outcomes and intention-to-treat primary analysis. Patients with a history of IS or TIA and high BP (SBP of 130-180 mmHg), clinically stable for at least 48 h prior to trial inclusion, are centrally randomised with concealed allocation in a 1:1 ratio to either an intensive BP control strategy targeting a SBP < 120 mmHg or a standard control strategy targeting a SBP < 140 mmHg. A total of 495 primary outcome events, 4368 patients enrolled.</p><p><strong>Study endpoints: </strong>The primary outcome is the first occurrence of a composite outcome of major cardiovascular events (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, hospitalisation for unstable angina or hospitalisation for heart failure).</p><p><strong>Summary: </strong>OPTIMAL-STROKE will be the first adequately powered trial of intensive BP control in the prevention of major cardiovascular events in patients with a history of IS or TIA.</p><p><strong>Trial registration: </strong>The trial is registered at ClinicalTrials.gov (NCT04036409).</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predominantly mild thrombocytopenia, haematoma expansion and clinical outcomes in intracerebral haemorrhage.","authors":"Han Wang, Rui Cheng, Sijia Liu, Zijie Wang, Xiao Hu, Min Liu, Jiaxin Luo, Zizhen Meng, Qi Li","doi":"10.1093/esj/aakag123","DOIUrl":"https://doi.org/10.1093/esj/aakag123","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence regarding the prognostic significance of thrombocytopenia in spontaneous intracerebral haemorrhage (ICH) remains limited and inconsistent. We investigated its associations with haematoma expansion (HE), functional outcomes and mortality.</p><p><strong>Patients and methods: </strong>We retrospectively analysed prospectively collected data from consecutive patients with spontaneous ICH in a single-centre registry between August 2022 and March 2025. Thrombocytopenia was defined as an admission platelet count <150 × 109/L. HE was defined as a haematoma-volume increase >6 mL or >33% on follow-up noncontrast computed tomography. Poor functional outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 3 months. Associations were assessed using multivariable logistic regression, restricted cubic splines, ordinal regression and sensitivity analyses.</p><p><strong>Results: </strong>Among 496 patients, 106 (21.4%) had thrombocytopenia; 368 were included in the HE analysis. After adjustment, thrombocytopenia showed no statistically significant association with HE (adjusted OR 0.97, 95% CI, 0.52-1.76; P = .920), 3-month poor functional outcome (adjusted OR 0.88, 95% CI, 0.46-1.66; P = .693), or 3-month mortality (adjusted OR 1.43, 95% CI, 0.70-2.89; P = .324). Restricted cubic spline analysis showed no statistically significant overall association and the test for nonlinearity was not statistically significant. Findings were similar across platelet-count categories, continuous haematoma-volume changes, ordinal mRS analyses and sensitivity analyses addressing imaging timing, early surgery, acute treatments and prior anticoagulant use.</p><p><strong>Discussion: </strong>Admission thrombocytopenia showed no statistically significant association with HE, poor functional outcome, or mortality after ICH. Because few patients had platelet counts <100 × 109/L, these findings mainly apply to mild thrombocytopenia.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial comment: Periprocedural antiplatelet therapy during mechanical thrombectomy: navigating limited evidence.","authors":"Paolo Candelaresi, Antonio De Mase, Vincenzo Andreone","doi":"10.1093/esj/aakag125","DOIUrl":"10.1093/esj/aakag125","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early change and new onset of vascular pathology in cervical artery dissection: implications for surveillance.","authors":"Robin Seihu, Tobias Hofmann, Frank Dömges, Hakan Cangür, Martin Döltz, Jens Neumann, Steffen Eue, Alexander Knörnschild, Daniel Behme, Stefanie Schreiber, Michael Görtler, For The Tasc-San Network","doi":"10.1093/esj/aakag117","DOIUrl":"10.1093/esj/aakag117","url":null,"abstract":"<p><strong>Introduction: </strong>Antithrombotic therapy is central to stroke prevention after spontaneous cervical artery dissection (sCAD), but its efficacy may depend on the underlying vascular morphology. We examined the temporal course of vascular changes after sCAD.</p><p><strong>Patients and methods: </strong>Consecutive patients with first-time sCAD underwent prospective serial duplex sonography for up to 10 years. In this retrospective cohort analysis, pathology change was defined as recanalisation of an occluded artery or progression from stenosis to occlusion. New pathology resulting from dissection recurrence was considered if an occlusion occurred in the presence of pre-existing stenosis or vice versa.</p><p><strong>Results: </strong>In total, 159 patients (83 men; mean age 44.8 years) with first-time sCAD were followed-up starting 1.3 days (median) after symptom onset. Bilateral dissections occurred in 6 patients and recurrent dissections in 26 arteries, resulting in follow-up of 191 arteries (108 internal carotid, 83 vertebral). Recanalisation occurred in 40/80 occluded arteries (cumulative rate 70.4%), whereas progression to occlusion occurred in 9/109 stenosed arteries (10.0%). All changes except one (recanalisation) occurred within 4 months. Recurrent dissection occurred within 6 weeks in 20 patients (14.7%) and between 2 and 7 years in 7 patients (13.7%). Overall, 62 vascular changes or new pathologies were observed in 50 patients (31.4%), with 42 occurring within the first 6 weeks.</p><p><strong>Conclusions: </strong>Under intensive surveillance, vessel morphology after sCAD is highly dynamic during the early phase, with frequent recanalisation and recurrent dissection. Structured early vascular follow-up may be important if evolving vessel morphology is to guide future individualised antithrombotic treatment strategies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular thrombectomy activity as a candidate marker of organised acute stroke-service capacity: a global burden of disease-based European panel study.","authors":"Felix Gunzer, Fatih Dudic, Taylan D Kuzu, Benedikt Frank, Natalie van Landeghem, Michael Forsting, Yan Li, Johannes Haubold","doi":"10.1093/esj/aakag121","DOIUrl":"10.1093/esj/aakag121","url":null,"abstract":"<p><strong>Introduction: </strong>Acute stroke-care organisation might contribute to variation in ischaemic stroke outcomes across Europe. We assessed whether national endovascular thrombectomy activity was associated with Global Burden of Disease-derived ischaemic stroke burden across European and adjacent countries.</p><p><strong>Patients and methods: </strong>We conducted a repeated cross-sectional ecological analysis of a balanced three-wave panel of 39 countries (2016, 2019 and 2020) using a consistent thrombectomy data source. The primary outcome was the ischaemic stroke mortality-to-incidence ratio. We used a within-between model with wave fixed effects, adjusted for Socio-Demographic Index and population aged 65 years or older.</p><p><strong>Results: </strong>Between countries, higher thrombectomy activity was associated with a lower mortality-to-incidence ratio (fully standardised β = -0.42, 95% confidence interval -0.79 to -0.05; P = .027), whereas no within-country association was detected (β = +0.10, -0.07 to +0.26). The between-country estimate attenuated after joint adjustment for health expenditure and Universal Health Coverage (β = -0.28; P = .051) and after adjustment for stroke incidence (β = -0.33; P = .061). In leave-one-country-out analyses, P values ranged from .007 to .061.</p><p><strong>Discussion: </strong>The between-country estimate is more vulnerable to unmeasured national differences and could not be separated from health-system resources. This ecological study cannot estimate the causal effect of increasing thrombectomy provision.</p><p><strong>Conclusion: </strong>National thrombectomy activity distinguished countries with lower ischaemic stroke mortality relative to incidence but did not track within-country change. It remains a candidate marker for cross-country comparison, not an established indicator for monitoring change, and should be interpreted alongside directly measured quality-of-care indicators.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise-based cardiac rehabilitation after stroke and the risk of incident dementia: an observational study from a global federated network.","authors":"Leandra Serio, Amir Askarinejad, Chen Wang, Koohyar Ahmadzadeh, Tianshu Gu, Riccardo Proietti, Claudio Ferri, Ben Buckley, Gregory Y H Lip","doi":"10.1093/esj/aakag127","DOIUrl":"https://doi.org/10.1093/esj/aakag127","url":null,"abstract":"<p><strong>Introduction: </strong>Dementia is a common and disabling complication after stroke. Exercise-based cardiac rehabilitation (EXCR) may influence vascular and inflammatory mechanisms relevant to cognitive decline. We investigated the association between EXCR initiation after stroke and incident dementia.</p><p><strong>Patients and methods: </strong>Using TriNetX, we identified adults with ischaemic stroke or TIA. Patients with recorded ICD-10-CM codes indicating an NIHSS score ≥ 16 were excluded from the primary analysis. Patients initiating EXCR within 6 months were compared with those without documented post-index EXCR. Propensity score matching balanced demographics, comorbidities, medication use and available stroke-severity measures. Outcomes were assessed at 3 and 5 years.</p><p><strong>Results: </strong>The unmatched cohorts included 4226 patients initiating EXCR (mean age, 64.7 years; 60.8% male) and 1,889,796 without EXCR (mean age, 66.3 years; 48.2% male). After matching, 4138 patients remained in each cohort. At 5 years, EXCR was associated with lower hazards of incident dementia (HR, 0.70; 95% CI, 0.59-0.82), all-cause mortality (HR, 0.50; 95% CI, 0.45-0.55) and recurrent stroke (HR, 0.75; 95% CI, 0.61-0.91), but a higher hazard of rehospitalisation (HR, 1.21; 95% CI, 1.06-1.38); no significant association was observed for acute myocardial infarction. The association with incident dementia remained consistent across sensitivity analyses.</p><p><strong>Discussion: </strong>The observed association with lower dementia risk suggests that the potential benefits of post-stroke EXCR may extend beyond cardiovascular and functional outcomes.</p><p><strong>Conclusions: </strong>EXCR initiation after ischaemic stroke or TIA was associated with a lower hazard of incident dementia. This association remained consistent across the 3-year, 30-day landmark, 1-year lagged and all-stroke-severity sensitivity analyses.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.","authors":"Adam A Dmytriw, Iman Kiani, Kartik Bhatia, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Melissa G Chung, Warren Lo, Ahmed Othmann, Sebastian Steinmetz, Ulf Jensen-Kondering, Stefan Schob, Daniel P O Kaiser, Wolfgang Marik, Christina Wendl, Ilka Kleffner, Hans Henkes, Hermann Kraehling, Thi Dan Linh Nguyen-Kim, René Chapot, Umut Yilmaz, Furene Wang, Muhammad Ubaid Hafeez, Flavio Requejo, Nicola Limbucci, Birgit Kauffmann, Markus Möhlenbruch, Omid Nikoubashman, Peter D Schellinger, Franja Dugar, Patricia Musolino, Ali Alawieh, Jenny Wilson, Dominik Grieb, Alexandra S Gersing, Thomas Liebig, Martin Olivieri, Jaroslava Paulasova Schwabova, Ales Tomek, Panagiotis Papanagiotou, Grégoire Boulouis, Olivier Naggara, Christine K Fox, Kirill Orlov, Alexandra Kuznetsova, Carmen Parra-Farinas, Prakash Muthusami, Robert W Regenhardt, Mesha L Martinez, Daniel Brechbühl, Maja Steinlin, Lisa R Sun, Ameer E Hassan, Adrien Guenego, Andrew Molyneux, André Kemmling, Sarah Lee, Heather J Fullerton, Jens Fiehler, Marios-Nikos Psychogios, Moritz Wildgruber, Peter B Sporns","doi":"10.1093/esj/aakag128","DOIUrl":"10.1093/esj/aakag128","url":null,"abstract":"<p><strong>Introduction: </strong>In adult endovascular thrombectomy (EVT), first-pass success is associated with better outcomes, but whether this \"first-pass effect\" also holds true in childhood stroke remains unknown. We investigated the association of thrombectomy pass counts with 90-day outcomes after paediatric EVT.</p><p><strong>Patients and methods: </strong>We analysed prospectively collected data from the international Save ChildS Pro registry (ages 0-17 years). All EVT-treated patients were included irrespective of the reperfusion grade achieved. Successful reperfusion was defined as expanded thrombolysis in cerebral infarction (eTICI) ≥ 2b and complete/near-complete reperfusion as eTICI 2c-3. The primary outcome was ordinal 90-day mRS in a proportional odds model. Single-pass and multiple-pass patients were then compared with each other within the subgroup achieving eTICI 2c-3. Logistic regression for mRS > 2 was fitted with pass count and eTICI grade as covariates.</p><p><strong>Results: </strong>Of 103 patients (median age 11 years [IQR 6-15]; 55/102 [53.9%] male), median passes were 2 (IQR 1-3); 39 (37.9%) had 1 pass, 61 (59.2%) more than 1 and 3 (2.9%) recanalised without a thrombectomy pass. Multiple passes were associated with lower eTICI 2c-3 rates (30.0% vs 82.1%; P < .001), and worse 90-day mRS (common odds ratio 3.47; 95% CI, 1.63-7.38; P = .001). However, among patients achieving eTICI 2c-3 (n = 50), we detected no difference by pass count (mRS 0-2: 93.8% vs 94.4%; risk difference - 0.6%, 95% CI, -15% to +20%; P = 1.000). After accounting for eTICI, pass count was not independently associated with mRS > 2, while eTICI remained significant.</p><p><strong>Conclusions: </strong>In this analysis of the first-pass effect in paediatric thrombectomy, multiple passes were associated with worse functional outcomes, but this effect appeared to be largely mediated through recanalisation quality. Subgroup analyses were underpowered to exclude a clinically relevant residual effect of pass count, and these findings should be considered hypothesis-generating.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149239903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Albumin for patients with acute large vessel occlusive stroke undergoing endovascular therapy-2 (ARISE-2): protocol for a randomised controlled trial.","authors":"Zilin Xu, Yuanyuan Liu, Yanbo Huang, Yuzhang Bei, Yong He, Yanling Li, Hao Wang, Lingling Meng, Le Gao, Yan Li, Yuhang Cao, Lan Liu, Jinyue Li, Xunming Ji, Chuanjie Wu","doi":"10.1093/esj/aakag119","DOIUrl":"10.1093/esj/aakag119","url":null,"abstract":"<p><strong>Background: </strong>Endovascular therapy is the standard of care for eligible patients with acute ischemic stroke due to LVO. However, nearly half of patients remain functionally dependent even after successful reperfusion. Albumin is a biologically plausible adjunctive cerebroprotective therapy and has shown neuroprotective effects in preclinical studies, but the clinical benefit of albumin combined with EVT remains uncertain.</p><p><strong>Study design: </strong>Albumin for patients with acute large vessel occlusive stroke undergoing endovascular therapy-2 (ARISE-2) is an investigator-initiated, prospective, multicenter, randomised, open-label, controlled trial with blinded endpoint assessment (PROBE design). Eligible participants will be randomly assigned in a 1:1 ratio to receive either EVT plus intravenous 25% albumin at 0.5 g/kg (maximum dose, 37.5 g) initiated within 60 min after randomisation and then repeated once daily on days 2-4, or EVT alone. The initial target sample size is 1192 participants (596 per group). A prespecified adaptive sample size re-estimation will be performed after approximately 50% of participants have completed the 90-day follow-up, allowing the total sample size to be increased, but not reduced, to a maximum of 1788 participants. This trial aims to evaluate the efficacy and safety of albumin administered in combination with EVT in patients with acute ischemic stroke caused by anterior circulation LVO.</p><p><strong>Study endpoints: </strong>The primary outcome is a favourable functional outcome at 90 days, defined as a mRS score of 0-2, or return to the premorbid mRS for participants with a prestroke mRS score of 3-4.</p><p><strong>Summary: </strong>The ARISE-2 trial is designed to evaluate the efficacy and safety of moderate-dose albumin combined with EVT in participants with acute ischemic stroke caused by anterior circulation LVO. The trial will provide evidence on whether albumin can improve functional outcomes as an adjunctive cerebroprotective strategy in patients undergoing reperfusion therapy.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT07263308.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative cangrelor during mechanical thrombectomy: is the systematic addition of aspirin needed?","authors":"Małgorzata Milnerowicz, Federico Cagnazzo, Jean-Philippe Desilles, Maéva Kyheng, Julien Labreuche, Arturo Consoli, Benjamin Gory, Victor Dumas, Jildaz Caroff, Louis Veunac, Frederic Clarençon, Jean-Christophe Gentric, Christophe Cognard, Aymeric Rouchaud, Sebastien Soize, Bertrand Lapergue, Gaultier Marnat","doi":"10.1093/esj/aakag124","DOIUrl":"10.1093/esj/aakag124","url":null,"abstract":"<p><strong>Objectives: </strong>In the hyperacute setting of mechanical thrombectomy (MT) for large-vessel-occlusion stroke, periprocedural platelet inhibition may be required in cases of refractory occlusions or underlying cervical or intracranial arterial disease at risk of reocclusion. Cangrelor is increasingly used in this context, although its use remains largely supported by observational evidence, and the impact of concomitant aspirin remains uncertain. This study investigated the safety and efficacy of the addition of intravenous aspirin to cangrelor during MT.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry across 34 French comprehensive stroke centres. All consecutive MT patients receiving intraoperative cangrelor between July 2018 and April 2025 were included, irrespective of the indication for intravenous antiplatelet therapy. The primary endpoint was 90-day favourable outcome (modified Rankin Scale [mRS] 0-2 or equal to pre-stroke mRS). Secondary outcomes included excellent outcome, early neurological improvement, angiographic recanalisation, day-1 arterial patency and intracranial haemorrhage (ICH). Propensity-score overlap weighting was used to adjust for confounding.</p><p><strong>Results: </strong>A total of 644 patients were analysed (cangrelor + aspirin combination: 226; cangrelor alone: 418). Favourable outcomes at 90 days were similar between groups (57.1% vs 58.8%; adjusted odds ratio [aOR] = 0.93; 95% confidence interval, 0.67-1.30; P = 0.69), as were excellent outcomes and early neurological improvement. Rates of successful and complete reperfusion were similar across groups. No differences were observed for symptomatic ICH (6.2% vs 9.2%; aOR = 0.66), any ICH, intra- and extracranial arterial patency on day-1 imaging, or 90-day mortality (22.3% vs 23.9%; aOR = 0.91).</p><p><strong>Conclusions: </strong>No significant differences in clinical, angiographic or safety outcomes were observed between cangrelor monotherapy and cangrelor combined with intravenous aspirin during MT. These findings provide comparative evidence on two cangrelor-based strategies currently used in clinical practice, although they should not be interpreted as demonstrating equivalence or excluding a potential benefit of adjunctive aspirin. Further prospective studies are needed to clarify the role of aspirin coadministration in this setting.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to reduce cognitive decline post-stroke: an umbrella review.","authors":"Eugene Yee Hing Tang, Emma Jackson, Ram Bajpai, Adriana Di Bernardo, Mishal Fatima, Muhammad Hamza, Jennifer Dunne, Paula Grammatikos, Claire V Burley, Rhiannon De Ivey, Khalifa Mohammed, Nele Demeyere, Linda Errington, Blossom Christa Maree Stephan, Louise Robinson, Christopher Price, Terence Quinn","doi":"10.1093/esj/aakag122","DOIUrl":"10.1093/esj/aakag122","url":null,"abstract":"<p><strong>Introduction: </strong>Post-stroke cognitive impairment (PSCI) remains a common problem that can lead to significant disability and dependency. Previous work suggested that methodologically robust trials were lacking and that there is continued uncertainty on the benefits and limitations of pharmacological and non-pharmacological interventions. This umbrella review aims to update and synthesise evidence on pharmacological and non-pharmacological interventions for PSCI.</p><p><strong>Patients and methods: </strong>This review was pre-registered on PROSPERO (CRD42024611909) with searches from 2019 to 2024. Eligible studies were systematic reviews (SRs) of randomised controlled trials (RCTs) evaluating pharmacological or non-pharmacological interventions in adult stroke survivors (≥18 years) of any severity and reporting change in global cognition (eg, Mini-Mental State Examination). AMSTAR2 was used for risk of bias.</p><p><strong>Results: </strong>Of 4889 records identified, 69 SRs (global cognition data from 747 unique RCTs; 57,176 participants) met inclusion criteria. Interventions were grouped into 37 categories including both single (eg, acupuncture, exercise, cognitive rehabilitation) and combined modalities and assessed at categorical level. Most intervention types were associated with statistically significant improvements in global cognition. Substantial heterogeneity and wide prediction intervals indicate that effect sizes may vary considerably across populations and settings.</p><p><strong>Discussion: </strong>This review identifies promising evidence that several interventions may produce clinically meaningful improvements in global cognition post-stroke. However, confidence in this evidence is low: despite a substantial increase in the number of RCTs most included reviews were rated as critically low in quality with methodological limitations.</p><p><strong>Conclusion: </strong>Current evidence is insufficient to support firm recommendations for the inclusion of specific interventions in guidance.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}