Stroke (Hoboken, N.J.)最新文献

{"title":"Assessing Predictive Factors for Thrombectomy Necessity in Acute Ischemic Stroke: Insights From the Direct to Angio Suite Protocol.","authors":"Whitfield Lewis, Keiko A Fukuda, Shashvat M Desai, Cynthia L Kenmuir, Mohamed Shehab-Eldin, Mausaminben Y Hathidara, Ashutosh P Jadhav","doi":"10.1161/SVIN.124.001476","DOIUrl":"10.1161/SVIN.124.001476","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) has emerged as an effective treatment option. Unfortunately, interfacility transfers to thrombectomy-capable centers often delay treatment time. The direct to angio suite (DTA) pathway reduces interfacility transfer time by foregoing the emergency department at the thrombectomy-capable center and directing patients immediately to the angio suite. Up to 22% of patients transferred under the DTA pathway will not have a large vessel occlusion on cerebral angiography or will experience significant neurological improvement, obviating the need for EVT. This study evaluated predictive factors associated with EVT under the DTA protocol.</p><p><strong>Methods: </strong>A retrospective review was conducted on 2590 patients transferred to 2 comprehensive stroke centers from January 2015 to December 2020. Data from 407 patients transferred under the DTA protocol were analyzed to identify factors associated with undergoing EVT using multivariable logistic regression adjusted for age, sex, National Institutes of Health Stroke Scale (NIHSS) score on arrival at the comprehensive stroke center, Alberta Stroke Program Early Computed Tomography Score, decrease in NIHSS score from initial presentation to arrival at the comprehensive stroke center by ≥5 points (change in NIHSS score from referring hospital to comprehensive stroke center), intravenous thrombolytics, and computed tomography angiography-confirmed large vessel occlusion. Statistical analysis included the Mann-Whitney <i>U</i> test, the Fisher exact test, the Pearson χ<sup>2</sup> test, and the logistic regression analysis.</p><p><strong>Results: </strong>Of the 407 patients transferred under the DTA protocol (median age, 73 [interquartile range, 63-82] years; 50% female), 355 underwent EVT, while 52 did not. Among patients who did not undergo EVT, 12 demonstrated significant neurological improvement on arrival, obviating the need for intervention. Among the remaining 40 patients, diagnostic cerebral angiography demonstrated distal clot migration or patent vessels, precluding thrombectomy. Factors associated with EVT included comprehensive stroke center NIHSS score, large vessel occlusion on computed tomography angiography at the satellite hospital, change in NIHSS score from referring hospital to comprehensive stroke center score, intravenous thrombolytics, and Alberta Stroke Program Early Computed Tomography Score. Comprehensive stroke center NIHSS score ≥8 (odds ratio, 5.99) and large vessel occlusion on computed tomography angiography (odds ratio, 5.36) were associated with higher odds of EVT. In contrast, change in NIHSS score from referring hospital to comprehensive stroke center score (odds ratio, 0.38), intravenous thrombolytics (odds ratio, 0.41), and Alberta Stroke Program Early Computed Tomography Score ≥9 (odds ratio, 0.22) were associated with lower odds of EVT. Tenfold cross-validation demonstrated a sensitivity of 96.65%, posit","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e001476"},"PeriodicalIF":3.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990288","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":"Consensus Guidelines on Inferior Petrosal Sinus Sampling: A Guideline From the Society of Vascular and Interventional Neurology Guidelines and Practice Standards Committee.","authors":"Farhan Siddiq, Hunter Brooks, Esra Demirtas, Ibrahim A Bhatti, Sami Al Kasab, Adam de Havenon, Robin Novakovic, Ossama Y Mansour, Cynthia L Kenmuir, Ameer E Hassan, David Liebeskind, Thanh N Nguyen, Shahram Majidi, Waldo R Guerrero","doi":"10.1161/SVIN.125.002309","DOIUrl":"10.1161/SVIN.125.002309","url":null,"abstract":"<p><strong>Background: </strong>Bilateral inferior petrosal sinus sampling (BIPSS) is the gold-standard test to distinguish Cushing disease (CD) from ectopic adrenocorticotropic hormone (ACTH) secretion when biochemistry confirms ACTH-dependent Cushing syndrome and pituitary magnetic resonance imaging is equivocal. However, practice varies widely between centers, leading to false negatives, misinterpretation, sampling errors, and avoidable risk. Neurointerventionalists performing BIPSS have lacked dedicated, procedure-focused guidance.</p><p><strong>Methods: </strong>Using the Society of Vascular and Interventional Neurology Guidelines and Practice Standards framework, a multidisciplinary panel (endocrinology, interventional neuroradiology, and endovascular neurosurgery) performed a systematic review through August 2025 and developed recommendations graded by class of recommendation and level of evidence through a modified Delphi process.</p><p><strong>Results: </strong>The guideline standardizes (1) indications for BIPSS in biochemically confirmed ACTH-dependent Cushing with normal, equivocal, or <6 mm pituitary lesions; (2) technical approach, including bilateral IPS catheterization, heparinization, and stimulation with corticotropin-releasing hormone or desmopressin; (3) sampling protocol with 2 prestimulation draws and timed collections at 3, 5, 10, and 15 minutes; (4) lab handling, emphasizing prechilled EDTA tubes, rapid ACTH processing, and prolactin measurement as an internal control of venous effluent; and (5) interpretation, using ACTH inferior petrosal sinus to peripheral ratio cutoffs (≥2 prestimulation, ≥3 poststimulation) and techniques to identify potential false negatives. The document also defines operator/institutional competency benchmarks and quality-assurance metrics.</p><p><strong>Conclusions: </strong>When executed with standardized technique and interpretation, BIPSS offers very high sensitivity and specificity for localizing ACTH pathology. These consensus guidelines provide a practical playbook for neurointerventionalists to perform BIPSS safely, reproducibly, and with maximal diagnostic yield.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002309"},"PeriodicalIF":3.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847346","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":"Diagnostic Accuracy of Lateral Flow Blood Tests to Detect Large Vessel Occlusion Stroke.","authors":"Lisa Shaw, Rachel Binks, David Burgess, Anand Dixit, Edoardo Gaude, Clare Lendrem, Graham McClelland, Philip White, Gewei Zhu, Christopher I Price","doi":"10.1161/SVIN.125.002233","DOIUrl":"10.1161/SVIN.125.002233","url":null,"abstract":"<p><strong>Background: </strong>A rapid and accurate tool to identify large vessel occlusion stroke (LVO) for use by prehospital emergency medical services responders could support direct access to time-critical thrombectomy at regional Comprehensive Stroke Centers. This study evaluated the accuracy of D-dimer and GFAP (glial fibrillary acidic protein) detected by lateral flow tests (LFT) to identify LVO stroke.</p><p><strong>Methods: </strong>This hospital-based prospective observational cohort study recruited adults within 6 hours of onset of at least 1 face, arm, or speech test (FAST) symptom. The LFTs use fingerprick capillary blood and give an overall positive (ie, LVO stroke predicted) or negative LFT outcome. Independent adjudication of brain imaging and clinical data established LVO or non-LVO. Specificity, sensitivity, negative and positive predictive values were calculated for (1) LFT outcome for participants with >1 FAST symptoms (primary analysis population); (2) a combined decision rule where participants with 1 FAST symptom were rule negative, patients with >1 FAST symptoms rule positive or negative according to LFT outcome; (3) FAST symptoms alone split by 1 symptom versus >1 symptom.</p><p><strong>Results: </strong>The study involved 382 participants (age [mean], 72.4 years; female, 50.8%; National Institutes of Health Stroke Scale score [median], 6; time from onset to LFT [median], 130 minutes). Of 278 participants who met the primary analysis population, 202 of 278 had both LFT outcome and LVO/non-LVO assigned. Analysis gave specificity 79% (95% CI, 72%-85%), sensitivity 53% (95% CI, 39%-67%), negative predictive value 86% (95% CI, 79%-90%), and positive predictive value 42% (95% CI, 30%-55%). For 382 participants with 1 to 3 FAST symptoms, 290 of 382 had both a combined decision rule result and LVO/non-LVO assigned giving specificity 86% (95% CI, 82%-90%), sensitivity 51% (95% CI, 37%-65%), negative predictive value 90% (95% CI, 86%-93%), positive predictive value 42% (95% CI, 30%-55%). FAST symptoms alone (n=318) gave specificity 33% (95% CI, 27%-38%), sensitivity 96% (95% CI, 87%-99%), negative predictive value 98% (95% CI, 92%-99%), positive predictive value 23% (95% CI, 18%-29%).</p><p><strong>Conclusions: </strong>LFT outcome combined with FAST symptoms gave high specificity for LVO identification. This approach could be considered for facilitation of direct access to thrombectomy providers. However, further research is required to evaluate test performance in the prehospital setting and consider technological improvements to boost sensitivity without compromising specificity.</p><p><strong>Registration: </strong>URL: https://www.isrctn.com/; Unique identifier: ISRCTN12414986.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002233"},"PeriodicalIF":3.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847024","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":"Matched-Pair Analysis of Patients With Large-Vessel Occlusions Undergoing Thrombectomy Using Single-Plane Versus Biplane Angiography.","authors":"Diwas Gautam, Sarah E Nguyen, Sarah Dabb, Erin Peterson, Jackson Aubrey, Julian Brown, Philipp Taussky, Robert C Rennert, Craig Kilburg, Ramesh Grandhi, Karol P Budohoski","doi":"10.1161/SVIN.125.002173","DOIUrl":"10.1161/SVIN.125.002173","url":null,"abstract":"<p><strong>Background: </strong>The Mechanical Thrombectomy Global Access for Stroke study demonstrated that access to mechanical thrombectomy (MT) is <3% of demand, with severe disparities across urbanization and income levels. Although biplane angiography is the standard, single-plane systems may offer a cost-effective alternative. We conducted a propensity-matched analysis comparing the procedural and clinical outcomes of MT performed in single-plane versus biplane angiography suites.</p><p><strong>Methods: </strong>All consecutive stroke MT cases performed at 3 centers (2 single plane and 1 biplane) between 2018 and 2024 were included. Outcomes assessed included rates of first-pass effect (modified Thrombolysis in Cerebral Infarction score ≥2b on first pass), successful reperfusion (final modified Thrombolysis in Cerebral Infarction score ≥2b), time to reperfusion, complication rates, postprocedural symptomatic intracranial hemorrhage, and good clinical outcome (modified Rankin Scale score 0-2) at discharge, 30 days, and 90 days.</p><p><strong>Results: </strong>A total of 51 thrombectomies were performed in single-plane suites, and 367 were performed in biplane suites. After propensity matching, 100 patients (50 in each group) were included. In a multivariable analysis, the type of angiography suite was not significantly associated with successful reperfusion (odds ratio, 3.84 [95% CI, 0.22-68.4]; <i>P</i>=0.36) or good clinical outcome at 90 days (odds ratio, 0.94 [95% CI, 0.18-4.88]; <i>P</i>=0.94). There were no significant differences in reperfusion rates and clinical outcomes in the unmatched comparison. In the unmatched cohort, higher numbers of patients with medium- or distal-vessel occlusions and posterior circulation strokes were treated in the biplane suite.</p><p><strong>Conclusions: </strong>This propensity score-matched analysis comparing MT for large-vessel occlusion in single-plane versus biplane angiography suites demonstrated no statistically significant differences in procedural and clinical outcomes or safety measures. These results indicate that MT using single-plane angiography suites can serve as a viable alternative for treating proximal large-vessel occlusions within the anterior circulation in areas where establishing a full biplane suite is not feasible.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002173"},"PeriodicalIF":3.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990316","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":"Systematic Review of Large Language Models and Natural Language Processing in Stroke Care: Applications, Challenges, and Future Directions.","authors":"Kaue Tartarotti Nepomuceno Duarte, Abhijot Singh Sidhu, Maya Bakshi, Murilo Costa de Barros, Brij Karmur, Taha Aslan, Donghao Zhang, Mohamed AlShamrani, Wu Qiu, Bijoy K Menon","doi":"10.1161/SVIN.125.002261","DOIUrl":"10.1161/SVIN.125.002261","url":null,"abstract":"<p><p>Stroke, a leading cause of mortality, manifests as ischemic (87%) or hemorrhagic (13%), demanding rapid intervention to mitigate irreversible damage. Despite advances in artificial intelligence, systematic reviews addressing the integration of large language models and natural language processing into clinical stroke care remain limited. Such a review is critical given large language models' potential to overcome traditional natural language processing limitations, thereby enhancing risk prediction and decision support. We proposed a systematic review aimed to comprehensively analyze applications in stroke care. After searching 6 databases, 2991 records were screened, yielding 65 eligible studies. Results were structured quantitatively (impact factor trends, publication distribution) and qualitatively across 4 dimensions: Study Purposes (eg, risk modeling, decision support), Data Sets/Key Findings, Limitations, and Future Directions. Large language models demonstrated strong capabilities in automated data extraction from clinical notes (accuracies of 93.5%-95.1%) and report summarization. However, majority of studies (94%) lacked external validation. Most were limited by single-center, retrospective designs (62%) and used private data sets (85%), raising concerns about generalizability. Common failure modes included model hallucinations, performance degradation on external data, and infrastructural barriers to clinical integration. Future efforts must prioritize multicenter, prospective validation (82% of studies) to ensure model robustness and generalizability across diverse populations. Pathways for clinical translation include developing interpretability techniques to build clinician trust. Technical refinements for hallucination mitigation (98% of studies) and real-time integration of multimodal data are necessary to enhance predictive power. Addressing data heterogeneity and ethical concerns remains as gaps. This review highlights the potential of large language models in stroke care, encompassing tasks from risk prediction to workflow automation. Realizing this potential requires a shift from proof-of-concept studies to rigorously validated, clinically integrated systems. The field demands scalable, equitable, and transparent artificial intelligence solutions that are codeveloped with clinicians. These are needed to overcome existing methodological and translational barriers.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002261"},"PeriodicalIF":3.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990341","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":"Inside the Thrombus: Revealing the Microarchitecture of Intracranial Clots.","authors":"Leonardo Cruz-Criollo, Milad Arzani, Madhavan L Raghavan, Santiago Ortega-Gutierrez","doi":"10.1161/SVIN.125.002239","DOIUrl":"https://doi.org/10.1161/SVIN.125.002239","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002239"},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847282","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":"Accuracy of Distal Internal Carotid Artery Contrast Ratio to Infer Proximal Carotid Disease in the Mobile Stroke Unit.","authors":"James L Barker, Oshi Swarup, Hannah T Johns, Leonid Churilov, Anna H Balabanski, Cameron Williams, Bernard Yan, Peter J Mitchell, Vincent N Thijs, Andrew Bivard, Francesca Langenberg, Henry Zhao, Geoffrey A Donnan, Stephen M Davis, Bruce C V Campbell","doi":"10.1161/SVIN.125.002260","DOIUrl":"10.1161/SVIN.125.002260","url":null,"abstract":"<p><strong>Background: </strong>Extracranial internal carotid artery (ICA) stenosis is a common cause of ischemic stroke and transient ischemic attack. Cervical computed tomography (CT) angiography can rapidly diagnose carotid pathology but is not possible with current-generation CT scanners used in mobile stroke units. We assessed the diagnostic accuracy of the intracranial ICA contrast density ratio (CDR) to identify extracranial ICA stenosis.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients at 3 comprehensive stroke centers in Melbourne, Victoria, who received CT angiography on the mobile stroke unit CereTom CT scanner, with reference standard in-hospital CT angiography or digital subtraction angiography in the Melbourne mobile stroke unit database. The mean Hounsfield units at 4 segments of the intracranial ICA, both ipsilateral and contralateral to the symptomatic hemisphere, were measured. The CDR was calculated using the formula: CDR=contralateral mean Hounsfield units/ipsilateral Hounsfield units. Statistical analysis was completed with univariate analysis of CDR, and leave-one-out cross-validation with receiver operating characteristic area under the curve to determine CDR thresholds associated with stenosis or occlusion, to determine sensitivity and specificity of the test.</p><p><strong>Results: </strong>Of 151 patients included, 31 of 151 (20.5%) had extracranial ICA stenosis >50%, and the average CDR was higher in patients with >70% stenosis with threshold ratio of >1.24 (sensitivity, 80%; specificity, 88%; positive predictive value, 57%; and negative predictive value, 96%) or extracranial occlusion (sensitivity, 100; specificity, 82%; positive predictive value, 29%; and negative predictive value, 100%). The threshold of 1.18 for 50% to 99% and carotid occlusion had lower sensitivity (sensitivity, 78%; specificity, 95%; positive predictive value, 88%; and negative predictive value, 91%).</p><p><strong>Conclusions: </strong>Assessment of the intracranial ICA CDR may assist in ruling out high-grade extracranial stenosis in patients who are being considered for direct transfer for endovascular thrombectomy after head-only CT angiography.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002260"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392878","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":"Diagnostic Accuracy of Ischemia and Hemorrhage on Cone-Beam CT Immediately After Endovascular Thrombectomy.","authors":"Lovisa Landström, Henrik Andersson, Mattias Drake, Helena Mellander Oxholm, Emma Hall, Veronica Fransson, Björn M Hansen, Johan Wassélius","doi":"10.1161/SVIN.125.002211","DOIUrl":"10.1161/SVIN.125.002211","url":null,"abstract":"<p><strong>Background: </strong>Detection of ischemia and intracranial hemorrhage (ICH) directly after endovascular thrombectomy (EVT) could enable earlier diagnosis and treatment. We evaluated whether post-EVT Sine Spin cone-beam computed tomography (CBCT) on the Siemens ARTIS Icono biplane system at the end of the procedure can predict ischemia and ICH on subsequent follow-up computed tomography (FUCT) within 48 hours.</p><p><strong>Methods: </strong>Adult patients undergoing EVT in 2024 with available CBCT and FUCT were included. Two interventional neuroradiologists independently evaluated the CBCT examinations for ischemia, ICH (including Heidelberg classification), and image quality. FUCT, annotated by a neuroradiologist, was used as reference standard. Large ischemia was defined as ischemia involving ≥3 predefined vascular territories.</p><p><strong>Results: </strong>Of 331 patients with EVT, 225 had both CBCT and FUCT, of which 197 (88%) were successfully recanalized. Ischemia was observed in 127 (56%) and ICH in 64 (28%) of the FUCTs. For ICH, sensitivity was 75%/77% (reviewer 1/reviewer 2), specificity 85%/84%, and positive predictive value 67% for both reviewers, negative predictive value 92%/91%, and accuracy 84%/83%. Accuracy for large ischemia (n=24, 11%) was 78%/67%. Sensitivity for correctly located ischemia on CBCT was 48%/73%, with specificity of 87%/60%, positive predictive value of 82%/71%, negative predictive value of 56%/63%, and accuracy of 65%/68%. CBCT was rated overall nondiagnostic in 0%/1% of the cases. For the posterior fossa specifically, 6%/16% of examinations were rated nondiagnostic.</p><p><strong>Conclusions: </strong>Sine Spin CBCT on the Siemens ARTIS Icono biplane system after EVT showed high accuracy for predicting ICH and large ischemia on FUCT. CBCT may help identify patients needing closer monitoring or early neurosurgical intervention.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002211"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392876","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":"Transcending Social and Cultural Barriers to Transform Global Stroke Care: An SVIN Mission Thrombectomy Initiative.","authors":"Fawaz Al-Mufti, Mohamed Elfil, Hazem S Ghaith, Aarti Kishore Jain, Nimrod Gozum, Eric Feldstein, Ankita Jain, Eris Spirollari, Andre Calixte, Priyank Khandelwal, Victor C Urrutia, Nabeel A Herial, Pankajavalli Ramakrishnan, Gabor Toth, Mohammad El-Ghanem, Krishna Amuluru, Viktor Szeder, Jonathan R Crowe, Karol Budohoski, Zurab Nadareishvili, Kaustubh Limaye, Fazeel Siddiqui, Hamza Shaikh, Nishita Singh, Hesham Masoud, Sushanth R Aroor, Shashvat M Desai, Santiago Ortega-Gutierrez, Tareq Kass-Hout, Dileep R Yavagal, Kaiz S Asif","doi":"10.1161/SVIN.125.002243","DOIUrl":"10.1161/SVIN.125.002243","url":null,"abstract":"<p><p>Stroke is a leading cause of neurological disability and mortality worldwide, with acute ischemic strokes caused by large-vessel occlusions presenting significant health care challenges. While endovascular thrombectomy has emerged as a gold standard treatment, access to timely stroke care remains severely limited, especially in low- and middle-income countries. This review examines the multifaceted social, cultural, and systemic barriers that impede effective stroke care globally. We performed a comprehensive search of PubMed from 2004 to 2024, using keywords of acute stroke care, low-middle-income countries, social barriers, cultural barriers, and access. There are several recognized obstacles to stroke treatment, especially in the acute settings, including health fatalism, spiritual and religious beliefs that discourage medical intervention, and widespread lack of public awareness about stroke symptoms and urgency. Cultural misconceptions often lead individuals to delay or avoid seeking medical care, with some communities attributing stroke to supernatural forces or divine punishment. Language barriers, insufficient health care infrastructure, and socioeconomic challenges further compound these issues, particularly in regions such as sub-Saharan Africa and parts of Asia. Furthermore, there are critical infrastructural barriers to delivering acute stroke in a timely manner, including limited transportation to health care facilities and inadequate stroke centers in rural areas. A comprehensive strategy to address these challenges should focus on culturally sensitive education, community engagement, and infrastructure development. Recommendations include cooperating with religious and community leaders, developing targeted awareness campaigns, and creating inclusive health care approaches that respect local cultural contexts. Overall, addressing the global stroke burden not only requires technological interventions but also demands a holistic approach that bridges cultural understanding, challenges misconceptions, and empowers communities to recognize and respond to stroke as a critical medical emergency.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002243"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847270","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":"Case of Early Postpartum Ischemic Stroke: Timely Thrombolysis and Thrombectomy for Rapid Recovery.","authors":"Anthea Ferriggi, Marija Cauchi, Steve M Cordina","doi":"10.1161/SVIN.126.002351","DOIUrl":"10.1161/SVIN.126.002351","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002351"},"PeriodicalIF":3.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847277","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}