Stroke (Hoboken, N.J.)最新文献

{"title":"Shifts in Clinical Practice-Changing Acute Ischemic Stroke Research Over the Past Decade.","authors":"Mahnoor Khalid, Connor Nguyen, Jack Li, Aditya Bala, Tudor G Jovin, Ashutosh P Jadhav, Ngoc Mai Le, Javier Gomez Farias, Freya Kanakhara, Eunyoung A Lee, David S Liebeskind, Joseph N Samaha, Hussain Azeem, Bruna Kfoury, Aman Yarlagadda, Sunil A Sheth","doi":"10.1161/SVIN.126.002479","DOIUrl":"10.1161/SVIN.126.002479","url":null,"abstract":"<p><strong>Background: </strong>The past decade has witnessed rapid growth of clinical trial programs in Europe and Asia, with randomized clinical trials (RCTs) publications from these regions outpacing those of the United States. However, limited data exist quantifying their relative influence on practice-defining results. Here, we evaluate these shifts by analyzing the geographic origin, funding source, and clinical impact of practice-changing RCTs.</p><p><strong>Methods: </strong>From the 2018 and 2026 American Heart Association/American Stroke Association Acute Ischemic Stroke guidelines, we identified RCTs supporting new recommendations and extracted geographic origin (China/Europe/United States/Other), funding source (government/academic/nonprofit versus industry (private/mixed); National Institutes of Health versus non-National Institutes of Health), and research topic (endovascular therapy, thrombolysis, imaging, poststroke care, and prehospital and systems of care). Analyses used unweighted, reference-density-weighted, and clinical-impact-weighted strategies. Temporal trends were assessed using the χ²/Fisher exact tests, with the Rao-Scott adjusted χ² tests accounting for weighting.</p><p><strong>Results: </strong>We identified 21 new recommendations (47 RCTs) in 2018 and 45 (89 RCTs) in 2026. In 2018, Europe led (51.1%), followed by the United States (31.9%), while China and other regions contributed minimally. By 2026, Europe remained first (36%), China rose to second (29.2%), and the United States declined to the smallest share (14.6%), across all weighted analyses (<i>P</i><0.01). National Institutes of Health-funded trials declined significantly from 21.3% (unweighted), 27.4% (reference-density-weighted), and 27.3% (clinical-impact-weighted) in 2018 to 4.5%, 4.8%, and 3.5% respectively in 2026 (<i>P</i><0.01 across all weighted strategies).</p><p><strong>Conclusions: </strong>In this analysis, we identify a shift in practice-guiding research away from United States-based clinical trials and increasingly towards Europe and China. United States-based RCTs fell from the second most cited to the least cited sources of recommendations. National Institutes of Health-funded RCTs fell from nearly one-quarter of guideline-cited RCTs in 2018 to <5% in 2026, highlighting increasing reliance on non-US studies to inform US clinical care.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002479"},"PeriodicalIF":3.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Telemedicine Stroke Nurse Practitioner Care on Inpatient Management in Vascular Neurologist Underserved Primary Stroke Centers.","authors":"Wendy Dusenbury, Victoria M Swatzell, Balaji Krishnaiah, Cheran Elangovan, Katherine Nearing, Andrei V Alexandrov, Anne W Alexandrov","doi":"10.1161/SVIN.125.002313","DOIUrl":"10.1161/SVIN.125.002313","url":null,"abstract":"<p><strong>Background: </strong>Many primary stroke centers (PSCs) lack vascular neurologists, unnecessarily transferring thrombolysis patients to comprehensive stroke centers (CSCs). We implemented a telemedicine inpatient stroke nurse practitioner (NP) PSC service to reduce unnecessary transfers.</p><p><strong>Methods: </strong>A prospective observational study was conducted to assess the feasibility and quality of telemedicine-delivered inpatient NP acute stroke management at CSC-affiliated PSCs. Following systemic thrombolysis treatment directed by telemedicine CSC vascular neurologists, uncomplicated patients were admitted to PSC internal medicine hospitalists; hospitalists ordered stroke consultation by either in-person community general neurologists (GNs) or a CSC stroke-trained telemedicine NP. We analyzed demographics, clinical management variables, complications, and stroke core measure compliance between patients receiving GN or NP consultation.</p><p><strong>Results: </strong>Among 1237 patients, 720 (58.2%) were managed by GNs and 517 (41.8%) by NPs. Patient sex and admission National Institutes of Health Stroke Scale scores were similar, but NP patients were younger than GN patients (64.5 + 14 versus 69 + 13 years; <i>P</i><0.001) and more racially diverse (<i>P</i>=0.012), with more admitted to the low socioeconomic hospital (<i>P</i><0.001). NPs managed most (98.5%; <i>P</i><0.001) post-tPA (tissue-type plasminogen activator) patients due to GN refusal. GN patients had higher modified Rankin Scale score prestroke disability (<i>P</i>=0.006) and more with left middle cerebral artery or posterior circulation (<i>P</i><0.001) stroke. On multivariate analyses, National Institutes of Health Stroke Scale score documentation within 12 hours of admission was better by NPs (90.5%) than GNs (69.7%; <i>P</i><0.001). NPs were also significantly more compliant than GNs (92.6% versus 41.3%; <i>P</i><0.001) in documenting stroke mechanism and more compliant (83.3% versus 19.9%; <i>P</i><0.001) than GNs with ordering extended external cardiac monitoring or implantable loop recorders for embolic stroke of unknown source; readmissions within 30 days of discharge for new stroke events were clinically but not statistically different (GN 34.4% versus NP 17.6%; <i>P</i>=ns).</p><p><strong>Conclusions: </strong>NP telemedicine-delivered inpatient stroke care in vascular neurologist-underserved PSCs is feasible and results in improved adherence to several guideline-directed core measures for stroke center quality monitoring. These findings support expanded use with further study of the impact of telemedicine stroke NPs in PSC hospitals to prevent unnecessary patient transfers to CSCs.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002313"},"PeriodicalIF":3.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin Use and the Risk of Symptomatic Hemorrhage in Patients With Cerebral Cavernous Malformations and Ischemic Cerebrovascular Disease.","authors":"Jie Wang, Jinyi Tang, Xiudan Bai, Yuming Jiao, Ran Huo, Wenqian Zhang, Yi Wang, Yongbo Yang, Yong Cao","doi":"10.1161/SVIN.126.002381","DOIUrl":"10.1161/SVIN.126.002381","url":null,"abstract":"<p><strong>Background: </strong>Cerebral cavernous malformations (CCMs) are a common cause of spontaneous intracerebral hemorrhage (ICH). However, the association of aspirin with the hemorrhage risk of CCMs remains unclear.</p><p><strong>Methods: </strong>This retrospective study consecutively enrolled patients with CCMs and asymptomatic or symptomatic ischemic cerebrovascular disease between March 2015 and July 2024. Baseline and follow-up information, including ICH presentation and aspirin use, were recorded. The primary outcome was a CCM-related hemorrhage event, defined as the onset of any new or worsened clinical symptoms caused by overt ICH, confirmed by radiological evidence. Independent factors of symptomatic hemorrhage were analyzed using Cox regression before and after 1:1 propensity score matching.</p><p><strong>Results: </strong>Among 259 patients with untreated CCMs, 129 (49.8%) patients took aspirin daily. Over a total follow-up time of 793.0 person-years, new clinical hemorrhage events occurred in 30 (11.6%) patients, including 27 (20.8%) in the nonaspirin group and 3 (2.3%) in the aspirin group. Multivariable Cox analysis revealed that CCM size, developmental venous anomaly, and ICH presentation were associated with a high risk of CCM hemorrhage, whereas aspirin use (hazard ratio, 0.13 [95% CI, 0.03-0.61]; <i>P</i>=0.010) was associated with a lower risk. In the subgroup analysis, aspirin use was associated with a significantly reduced risk of recurrent hemorrhage in patients with ICH presentation (<i>χ</i> ²=10.62, <i>P</i>=0.001). After 1:1 propensity score matching to control for size, ICH presentation, diabetes, hyperlipidemia, and statin use, CCM hemorrhage occurred in 12 (10.0%) of 120 patients, and further analysis revealed that aspirin was still associated with a low hemorrhage rate in CCMs (hazard ratio, 0.09 [95% CI, 0.01-0.70]; <i>P</i>=0.021).</p><p><strong>Conclusions: </strong>Aspirin use is associated with a lower risk of symptomatic hemorrhage in patients with CCMs and ischemic cerebrovascular disease. Prospective studies are needed to validate these findings.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002381"},"PeriodicalIF":3.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Safety and Efficacy of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Retrospective Cohort Study of 38 049 Patients.","authors":"Ariel Sacknovitz, Isaac B Thorman, Dinusha Wanniarachchige, Eris Spirollari, Ankita Jain, Michael C Schubert, Sauson Soldozy, Ilya Frid, Gurmeen Kaur, Stephan A Mayer, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.1161/SVIN.125.001826","DOIUrl":"10.1161/SVIN.125.001826","url":null,"abstract":"<p><strong>Background: </strong>Chronic subdural hematoma is a complex but commonly treated neurosurgical condition, particularly affecting the elderly. Traditional treatment involves open surgeries, but middle meningeal artery embolization (MMAE) has emerged as an effective, minimally invasive adjunctive. The objective of this study is to assess the safety and efficacy of MMAE in combination with surgery using real-world data.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from the TriNetX Research Network. Outcomes of mortality, reoperation, and hospital readmission were studied using Cox proportional hazard models controlling for age, sex, indications of severity, type of surgical intervention, antiplatelet/anticoagulant use, comorbidities, and hospitalization events. Patients were followed for up to 6 years.</p><p><strong>Results: </strong>This study included 38 049 patients with chronic subdural hematoma, of which 486 received surgery with MMAE and 5362 received surgery monotherapy. At 90 days after surgery, mortality was 5.2% in the MMAE group and 7.7% in the surgery monotherapy group (<i>P</i>=0.0467). After 6 years, mortality was 11.2% in the MMAE group and 19.0% in the surgery monotherapy group (<i>P</i><0.0001). However, the hazard of 90-day mortality was not significantly lower in the MMAE group after controlling for covariates (hazard ratio, 0.739 [95% CI, 0.479-1.141]; <i>P</i>=0.173). Patients with MMAE had significantly lower rates of rehospitalization at 1 year (2.1% versus 4.4%; <i>P</i>=0.0195), even after adjustment (hazard ratio, 0.414 [95% CI, 0.203-0.845]; <i>P</i>=0.015).</p><p><strong>Conclusions: </strong>Among patients with chronic subdural hematoma who received surgery, patients receiving adjunctive MMAE experienced lower mortality rates out to 6 years of follow-up, but the difference was not significant after full adjustment. Beginning 1 year after surgery, patients receiving combination therapy had significantly lower long-term rehospitalization compared with patients receiving surgery monotherapy. Future prospective studies will help identify strengths and weaknesses of this highly promising treatment modality.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e001826"},"PeriodicalIF":3.1,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Demographic Factors Associated With Hemorrhagic Transformation Subtypes After Endovascular Thrombectomy for Acute Ischemic Stroke.","authors":"Nicole Khezri, Marie K Luff, Salvador Miralbés, Bharath Naravetla, Alejandro Spiotta, Christian Loehr, Mario Martínez-Galdámez, Ryan McTaggart, Luc Defreyne, Pedro Vega, Osama O Zaidat, Lori Lyn Price, Rishi Gupta, Markus Möhlenbruch, David S Liebeskind","doi":"10.1161/SVIN.125.001899","DOIUrl":"10.1161/SVIN.125.001899","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhagic transformation (HT) after endovascular thrombectomy (EVT) is associated with worse neurological outcomes. We sought to identify clinical and demographic factors associated with HT and HT subtypes after EVT.</p><p><strong>Methods: </strong>Patients with anterior circulation large vessel occlusion who underwent first-pass EVT using different thrombectomy devices were enrolled in a global multicenter prospective registry. Baseline clinical characteristics were compared between individuals with and without HT and across HT subtypes 24 hours after EVT. Multivariable logistic regression models were used to determine risk factors associated with HT and HT subtypes.</p><p><strong>Results: </strong>The study cohort comprised 1453 patients. Imaging evidence of HT occurred in 40% of patients, of whom 3.2% had symptomatic HT. In a multivariable regression analysis, diabetes (odds ratio [OR], 1.47 [95% CI, 1.09-1.99]; <i>P</i>=0.01), National Institutes of Health Stroke Scale score of 16 to 19 (OR, 1.45 [95% CI, 1.09-1.94]; <i>P</i>=0.01), National Institutes of Health Stroke Scale score ≥20 (OR, 1.98 [95% CI, 1.56-2.50]; <i>P</i><0.0001), Alberta Stroke Program Early Computed Tomography Score ≥8 (OR, 0.31 [95% CI, 0.24-0.39]; <i>P</i><0.0001), and elevated baseline serum glucose (OR, 1.56 [95% CI, 1.23-1.98]; <i>P</i>=0.0003) were independent risk factors for HT. Atrial fibrillation (OR, 0.75 [95% CI, 0.58-0.96]; <i>P</i>=0.02) was a protective factor against HT. Baseline Alberta Stroke Program Early Computed Tomography Score <8, elevated baseline serum glucose, and higher baseline National Institutes of Health Stroke Scale scores were independent predictors of hemorrhagic infarction-1 and hemorrhagic infarction-2. Diabetes was significantly associated with hemorrhagic infarction-2, and Alberta Stroke Program Early Computed Tomography Score <8 was significantly associated with subarachnoid hemorrhage.</p><p><strong>Conclusions: </strong>Given that certain risk factors are associated with specific subtypes of HT, our analysis demonstrates the importance of not only reporting symptomatic HT but also classifying HT into subtypes in clinical trials. Identifying risk factors associated with HT subtypes may improve prognostic accuracy and guide post-EVT monitoring.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03845491.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e001899"},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flow Diversion for Anterior Communicating Artery Aneurysms: Systematic Review and Meta-Analysis.","authors":"Anderson Brito, William Davis Haselden, Leonardo Cruz-Criollo, Nashwa Abdelhakim, Jorge Cespedes, Edgar A Samaniego, Santiago Ortega-Gutierrez, Mario Zanaty","doi":"10.1161/SVIN.125.002259","DOIUrl":"10.1161/SVIN.125.002259","url":null,"abstract":"<p><strong>Background: </strong>Anterior communicating artery (ACoA) aneurysms are associated with a higher risk of rupture. Flow diverters are considered a first-line treatment for intracranial aneurysms. However, the safety and efficacy of ACoA aneurysms are less established. This systematic review and meta-analysis aimed to evaluate the safety and effectiveness of flow diverters for ACoA aneurysms.</p><p><strong>Methods: </strong>We conducted a systematic search from inception until June 2025. The primary effectiveness outcome was the complete occlusion rate at last follow-up, defined by the Raymond-Roy or O'Kelly-Marotta scales, and the primary safety outcome was mortality. Secondary safety outcomes included good functional outcome and major and minor neurological complications. Pooled estimates were calculated using a random-effects model. Subgroup analysis was performed based on follow-up time.</p><p><strong>Results: </strong>Fifteen studies were included (involving 350 patients with 358 ACoA aneurysms). The complete occlusion rate at last follow-up was 84.29% (95% CI, 79.36-88.22; <i>P</i>=0.95; <i>I</i> ²=0%). The mortality rate was 0.86% (95% CI, 0.28-2.62; <i>P</i>=0.98; <i>I</i> ²=0%). Good functional outcome was 91.15% (95% CI, 73.32-97.48; <i>P</i>=0.84; <i>I</i> ²=0%). Major and minor neurological complications were 2.74% (95% CI, 1.38-5.38; <i>P</i>=0.97; <i>I</i> ²=0%) and 10.57% (95% CI, 6.17-17.53; <i>P</i>=0.13; <i>I</i> ²=32.8%), respectively. Subgroup analysis revealed no significant differences in the complete occlusion rate between follow-up times (overall pooled rate for follow-up ≤12 months was 85.92% compared with 83.68% for follow-up >12 months).</p><p><strong>Conclusions: </strong>Our results suggest that flow diverters could represent a potential treatment option for ACoA aneurysms, given the observed complete occlusion rate at last follow-up. However, larger prospective trials are required to further evaluate these findings.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002259"},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Ischemic Conditioning in Patients With Acute Ischemic Stroke Ineligible for Recanalization Therapies: A Phase II Trial.","authors":"Susanna Diamanti, Mauro Tettamanti, Raffaele Ornello, Francesco Andrea Pedrazzini, Matteo Farè, Enrico Colangeli, Cindy Tiseo, Gabriele Mainini, Angela Giglio, Caterina Sozzi, Federica Ferrari, Mario Beccia, Elisa Bianchi, Anna Bersano, Chiara Bazzini, Massimo Cartabia, Chiara Paola Zoia, Jacopo Mariani, Giuseppe Pignataro, Anna Cavallini, Giuliano Sette, Simona Sacco, Carlo Ferrarese, Simone Beretta","doi":"10.1161/SVIN.125.002277","DOIUrl":"10.1161/SVIN.125.002277","url":null,"abstract":"<p><strong>Background: </strong>Remote ischemic conditioning (RIC) has shown neuroprotective potential in preclinical stroke models. In patients with acute ischemic stroke, trials report heterogeneous results, supporting ongoing debate about clinical efficacy, especially in those ineligible for recanalization. This trial assessed RIC benefit in this population and evaluated HSP27 (heat shock protein 27) and HIF-1α (hypoxia-inducible factor 1-alpha) as biomarkers of RIC-related biological activity.</p><p><strong>Methods: </strong>This was a multicenter, phase II, proof-of-concept, block-randomized, controlled, parallel-arm, PROBE (Prospective Randomized Open Blinded End Point)-designed clinical trial. Patients with acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 5-25) who were ineligible for recanalization therapies were randomized 1:1 within 9 hours of symptom onset to RIC (4 5-minute cycles of upper-arm ischemia/reperfusion) plus standard medical therapy or standard therapy alone. The primary outcome was the percentage change in NIHSS score at 72 hours. Secondary outcomes included NIHSS score changes at 24 and 48 hours, 90-day modified Rankin Scale, tolerability, and changes in plasma HSP27 and HIF-1α concentrations from 24 to 72 hours.</p><p><strong>Results: </strong>Eighty patients (40 per group) were enrolled across 4 centers from August 2021 to March 2024. Although slightly in favor of RIC treatment, median NIHSS score percentage change at 72 hours did not differ between the RIC and control groups (23.6% versus 29.9%; adjusted coefficient, -3.8 [95% CI, -19.7 to 12.1]; <i>P</i>=0.635). No significant differences in NIHSS score percentage change were observed at 24 or 48 hours. Ninety-day poor functional outcome (modified Rankin Scale score, 3-6) was similar between groups (57.5% versus 65.0%; adjusted odds ratio, 0.79 [95% CI, 0.21-2.97]; <i>P</i>=0.732). RIC was completed by 97.5% of patients with minimal treatment-related discomfort. No major adverse events occurred. No between-group differences were detected in HIF-1α or HSP27 changes from 24 to 72 hours.</p><p><strong>Conclusions: </strong>In patients with acute ischemic stroke ineligible for recanalization therapies, early RIC was safe, feasible, and well tolerated but did not improve neurological outcomes or modify HIF-1α and HSP27 levels.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04400981.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002277"},"PeriodicalIF":3.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active Cerebrospinal Fluid Exchange Versus External Ventricular Drainage in IVH and SAH: A Meta-Analysis.","authors":"Amir Reza Bahadori, Albin Röblom, Mika Niemelä, Saif D Salman, Adnan Siddiqui, Rabih G Tawk, Babak Jahromi, William D Freeman, Sepide Kashefiolasl, Reza Dashti, Behnam Rezai Jahromi","doi":"10.1161/SVIN.125.002212","DOIUrl":"10.1161/SVIN.125.002212","url":null,"abstract":"<p><strong>Background: </strong>Intraventricular hemorrhage and subarachnoid hemorrhage are associated with neuroinflammation and increased morbidity and mortality. Rapid clearance of blood from the cerebrospinal fluid space may mitigate neuroinflammatory cascades and improve clinical outcomes. This systematic review and meta-analysis aimed to compare the clinical effectiveness of active cerebrospinal fluid exchange, including neuroendoscopic lavage and IRRAflow systems, versus external ventricular drainage in patients with intraventricular hemorrhage or subarachnoid hemorrhage.</p><p><strong>Methods: </strong>The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and thoroughly assessed databases, including PubMed, Embase, Scopus, Cochrane, and Web of Science, up to September 18, 2025. Statistical analysis, both fixed-effect and random-effect model analyses, was performed by the Comprehensive Meta-Analysis software. In addition, the Cochran Q test was conducted to determine the statistical heterogeneity. In terms of low heterogeneity, the fixed-effect model is reported.</p><p><strong>Results: </strong>This review included 7 studies with a total sample size of 834. Our analysis showed that active cerebrospinal fluid exchange was associated with significantly higher hematoma clearance (odds ratio, 2.72 [95% CI, 1.22-6.08]; <i>P</i>=0.015), better functional outcomes (odds ratio, 1.66 [95% CI, 1.12-2.48]; <i>P</i>=0.012), lower shunt dependency (odds ratio, 0.22 [95% CI, 0.10-0.50]; <i>P</i><0.001), and reduced infection rates (odds ratio, 0.22 [95% CI, 0.12-0.42]; <i>P</i><0.001). Subgroup analysis showed that neuroendoscopic lavage was most effective for hematoma clearance, while IRRAflow reduced infection rates. Also, younger patients had better neurological recovery.</p><p><strong>Conclusions: </strong>Active cerebrospinal fluid exchange techniques demonstrated superior outcomes over external ventricular drainage in managing intraventricular hemorrhage and subarachnoid hemorrhage, particularly in clot resolution and neurological recovery. Large-scale trials are warranted.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002212"},"PeriodicalIF":3.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durability of Drug-Eluting Balloon-Mounted Stents in Symptomatic ICAD: A Propensity-Matched Landmark Analysis of RO-ZES Versus Wingspan or Medical Management Beyond 24 Months.","authors":"Omid Shoraka, Oz Haim, Samantha Miller, Joanna M Roy, Vinay Jaikumar, Basel Musmar, Omar Tanweer, Jan-Karl Burkhardt, Pascal M Jabbour, Adnan H Siddiqui, Farhan Siddiq, Ameer E Hassan, Ramesh Grandhi","doi":"10.1161/SVIN.125.002204","DOIUrl":"10.1161/SVIN.125.002204","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic intracranial atherosclerotic disease can be managed with medical therapy, risk factor control, angioplasty, and stenting. The Wingspan stent demonstrated limited efficacy and higher adverse outcomes than medical management in the SAMMPRIS trial (Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis). Drug-eluting stents, including the Resolute Onyx Zotarolimus-eluting stent, have demonstrated superior outcomes beyond 1 year. This study assessed outcomes at ≥24 months after stenting.</p><p><strong>Methods: </strong>This retrospective multicenter study compared patients diagnosed with severe symptomatic intracranial atherosclerotic disease who underwent Resolute Onyx Zotarolimus-eluting stent stenting between March 2018 and May 2021 with patients from the percutaneous angioplasty and stenting and the aggressive medical management arms of the SAMMPRIS trial. Individuals who remained alive, stroke-free, and under follow-up at 24 months were included. Propensity score matching was used to align the 3 arms, and landmark analysis using inverse probability weighting, accounting for differential survival to 24 months, was used as complementary sensitivity analysis. The primary outcomes measured were postlandmark (ie, 24 months) stroke recurrence, intracranial hemorrhage, and all-cause mortality.</p><p><strong>Results: </strong>After applying the 24-month landmark and propensity score matching, 204 patients (68 per arm) were eligible (median follow-up, 36 months). Unweighted rates of stroke (<i>P</i>=0.147), intracranial hemorrhage (<i>P</i>=0.362), and mortality (<i>P</i>=0.168) did not differ significantly among groups. Weighted multivariable logistic and Cox regression analyses, adjusting for residual postmatch differences, similarly showed no significant differences in stroke recurrence. Kaplan-Meier analysis did not demonstrate a significant difference in overall survival across the 3 arms (log-rank <i>P</i>=0.139).</p><p><strong>Conclusions: </strong>Although previous studies have demonstrated the superiority of the Resolute Onyx Zotarolimus-eluting stent compared with the Wingspan system and aggressive medical management for the treatment of severe symptomatic intracranial atherosclerotic disease, the present landmark analysis suggests that these benefits may not consistently extend beyond 24 months. One speculative explanation is that the drug elution-related benefit of the Resolute Onyx Zotarolimus-eluting stent may attenuate over time, but this was not directly assessed in the present study. Prospective, controlled trials are necessary to confirm the implications of our long-term findings.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002204"},"PeriodicalIF":3.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tandem Lesion Strokes: To Stent or Not to Stent, Insights From a Decade of Experience at a Comprehensive Stroke Center in Argentina.","authors":"Julieta Rosales, Alejandro González-Aquines, Nicolás Pérez, Manuel Chasco, Matías Lopez, Juan Cirio, Carlos Bleise, Iván Lylyk, María Julieta Russo, Pedro Lylyk","doi":"10.1161/SVIN.126.002337","DOIUrl":"10.1161/SVIN.126.002337","url":null,"abstract":"<p><strong>Background: </strong>Tandem lesion strokes, defined by the coexistence of an intracranial large- or medium-vessel occlusion and a cervical internal carotid artery stenosis or occlusion, represent a challenging subtype of acute ischemic stroke. Optimal endovascular management remains controversial, particularly regarding the role of emergent carotid artery stenting (eCAS) during mechanical thrombectomy (MT). We aim to compare the safety and efficacy of eCAS versus MT alone in patients with anterior circulation tandem lesion strokes treated at a comprehensive stroke center.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study of consecutive adult patients with anterior circulation tandem lesion strokes treated with MT within 24 hours of symptom onset between January 2015 and July 2025. Patients were categorized according to treatment strategy: eCAS performed during thrombectomy or MT alone. The primary efficacy outcome was the ordinal shift in the 90-day modified Rankin Scale score. Secondary efficacy outcomes included excellent outcome (modified Rankin Scale score of 0-1), functional independence (modified Rankin Scale score of 0-2) at 90 days, and successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b). Primary safety outcomes included symptomatic intracranial hemorrhage, in-hospital mortality, and 90-day mortality.</p><p><strong>Results: </strong>A total of 111 patients were included (mean age, 71.2±12.6 years; 68.5% male), of whom 74 (67%) underwent eCAS, and 37 (33%) received MT alone. Ordinal logistic regression demonstrated a nonsignificant trend toward better functional outcomes with eCAS. This subgroup achieved higher rates of successful recanalization (97.3% versus 78.4%; odds ratio, 13.26 [95% CI, 2.13-82.49]; <i>P</i>=0.006) and excellent functional outcomes at 90 days (41.9% versus 12.5%; odds ratio, 6.80 [95% CI, 1.35-34.20]; <i>P</i>=0.020). Rates of symptomatic intracranial hemorrhage, early neurological deterioration, and mortality did not differ significantly between groups.</p><p><strong>Conclusions: </strong>In this single-center experience, emergent eCAS was associated with higher reperfusion rates and improved functional outcomes, without an increased risk of symptomatic hemorrhage or mortality. Prospective randomized controlled trials are warranted to establish standardized management guidelines for this complex stroke subtype.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002337"},"PeriodicalIF":3.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}