Cerebrovascular Diseases最新文献

{"title":"Sudden Sensorineural Hearing Loss and Stroke: A Narrative Review of Pathophysiological Links, Clinical Evidence, and Diagnostic Implications.","authors":"Zhaoyang Li, Chenxi Li, Chen Li","doi":"10.1159/ced/accag033","DOIUrl":"https://doi.org/10.1159/ced/accag033","url":null,"abstract":"<p><p>Background Sudden sensorineural hearing loss (SSNHL) has long been hypothesized as a potential early warning sign of posterior circulation stroke, yet the causal association and clinical implications remain highly controversial. Summary This narrative review synthesizes current peer-reviewed evidence on the pathophysiological links, epidemiological associations, diagnostic strategies, and integrated management of SSNHL and stroke. Current findings demonstrate that anatomical and pathophysiological overlaps support the biological plausibility of this association, which is predominantly mediated by the vertebrobasilar circulatory system. Shared vascular and prothrombotic factors, including dyslipidemia, hyperhomocysteinemia, and MTHFR gene polymorphisms, may further contribute to the observed association. Clinically, SSNHL may present as an initial manifestation of posterior circulation infarction in a small subset of patients, particularly those with accompanying neurological symptoms or multiple vascular risk factors; however, existing epidemiological data are inconsistent, and there is insufficient evidence to define SSNHL as an independent predictor of stroke in the general population. Key Messages This review concludes that risk stratification and interdisciplinary collaboration between otolaryngologists and neurologists are critical in clinical practice: for high-risk SSNHL patients, timely neurovascular evaluation is warranted to enable early detection of cerebrovascular disease, and future large-scale prospective cohort studies and combined audiological-neurological assessment models are needed to clarify the causal relationship and optimize clinical pathways.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149285469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Try this at home: A systematic review of patient satisfaction with stroke telerehabilitation.","authors":"Aleksandra Rakic, Jamie L Fleet, Emma A Bateman","doi":"10.1159/ced/accag041","DOIUrl":"https://doi.org/10.1159/ced/accag041","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke rehabilitation improves patient outcomes, but requires timely delivery, sufficient intensity, and adequate participation in appropriate therapies for maximal effectiveness. Unfortunately, many patients experience barriers to accessing conventional in-person rehabilitation. Telerehabilitation may increase access to care and is increasingly used in clinical settings, particularly since the COVID-19 pandemic. However, little is known about patient satisfaction with telerehabilitation. The objective of this systematic review was to examine patient satisfaction with post-stroke motor telerehabilitation.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and PsycINFO databases were searched from database inception to July 2025 inclusive. Two independent reviewers screened articles using the following inclusion criteria: English-language, full-text articles, reporting patient satisfaction outcomes with telerehabilitation for persons with stroke receiving upper or lower limb motor rehabilitation. Studies reporting only caregiver, but not patient satisfaction, were excluded. Study quality was assessed using the PEDro rating scale where appropriate.</p><p><strong>Results: </strong>After removing duplicates, 225 unique articles were reviewed. Nineteen studies published between 2007-2025 met inclusion criteria, assessing 811 individuals (n= 4-188, median 24) across 13 countries. Most studies were conducted in the outpatient setting; three were in both outpatient and inpatient settings. Fourteen studies (74%) examined telerehabilitation in the chronic phase post-stroke, two in the acute phase, two in the subacute phase, and one in both acute and subacute. Ten studies used telerehabilitation for upper limb motor impairment, two for lower limb, and seven for both. Eight controlled trials (seven randomized control trials and one non-randomized control trial) were assessed for quality with PEDro scores ranging from 4-8 (median 6). Assessment tools for patient satisfaction varied significantly between studies. Eight unique validated satisfaction tools were used across studies. All studies reported high patient satisfaction ratings with virtual motor telerehabilitation.</p><p><strong>Conclusion: </strong>Although this review found that patient satisfaction ratings were high among studies of telerehabilitation for post-stroke motor impairment, there are few high-quality motor telerehabilitation studies, and none focused on satisfaction as their main outcome. Given the importance of telerehabilitation for removing barriers to care, future research should use standardized tools to explore patients' and providers' satisfaction in addition to evaluating efficacy.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149285533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Biologically Guided Vascular Repair in Neuroendovascular Therapy Extracellular Vesicles, Ultrasound Microbubbles, and Bioresorbable Scaffolds.","authors":"Clayton Rawson, Meriem Boukhiam, Brandon Lucke-Wold, Michael Karsy, Mehrdad Pahlevani","doi":"10.1159/ced/accag046","DOIUrl":"https://doi.org/10.1159/ced/accag046","url":null,"abstract":"<p><strong>Background: </strong>Neuroendovascular devices can achieve immediate angiographic success yet fail at the site that ultimately matters: the healing vessel wall. Durable therapeutic benefit depends on stable endothelialization, organized thrombus remodeling, and resolution of inflammation rather than progression to thrombosis, restenosis, or recanalization.</p><p><strong>Summary: </strong>This review reframes vascular healing as the primary therapeutic target and synthesizes evidence supporting three complementary strategies for biologically directed device integration. Among these, bioresorbable scaffolds and surface-modified implants currently have the strongest neurovascular device evidence, though this evidence derives from extracranial animal models, demonstrating improved hemocompatibility, more favorable vascular integration, and reduced long-term foreign material exposure. Extracellular vesicles, including exosomes, combined with ultrasound microbubble-mediated delivery represent promising approaches for concentrating pro-repair signals at the device interface. However, supporting evidence remains largely extracranial, and clinical translation will require rigorous control of vesicle identity and manufacturing standards, evaluation under clinically relevant antiplatelet conditions, standardized acoustic dosing, and careful assessment of branch vessel and perforator safety. No published intracranial platform has yet integrated a biological payload, focal delivery, and temporary scaffolding into a single therapeutic system. We therefore propose a stepwise translational framework that evaluates each component incrementally using endpoints aligned with clinically relevant failure mechanisms.</p><p><strong>Key messages: </strong>Future neuroendovascular therapies should be evaluated not only by immediate angiographic success but also by their ability to promote durable vascular healing. Key translational endpoints include surface thrombogenicity, endothelial coverage and function, quality of vascular remodeling, and preservation of branch vessel patency. A biologically directed approach to device integration may improve the long-term durability and safety of intracranial endovascular therapies.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Outcomes of the Solitaire™ and React™ Devices from India's First Multicenter Mechanical Thrombectomy Registry.","authors":"Mathew Cherian, Vikram Huded, Vipul Gupta, Uday Limaye, Arvinda Hanumanthapura Ramalingaiah, Santhosh Poyyamoli, Jayadevan Enakshi Rajan, Sapna Erat Sreedharan, Sajith Sukumaran, Suresh Giragani, Gaurav Goel, Anshu Mahajan, Rajsrinivas Parthasarathy, Rajeshwar Sahonta, Kaushik Sundar, Sabarish Sekar, Nishant Aditya, Anil Karapurkar, Manish Chugh, Hiren Patel, Jeyaraj D Pandian, Padmavathy Narayanan Sylaja","doi":"10.1159/ced/accag007","DOIUrl":"https://doi.org/10.1159/ced/accag007","url":null,"abstract":"<p><strong>Introduction: </strong>There is a low utilization of mechanical thrombectomy (MT) in India and lack of a nationwide registry or data. This registry aimed to study the systems of care, functional outcomes, and cost effectiveness of MT treatment in patients with acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>Patients were treated with Solitaire™ X and/or React™ catheter as the primary device/s. Subjects with AIS due to large vessel occlusion, within 24 hours of symptom onset with the Alberta Stroke Program Early CT Score (ASPECTS) score >5 and the National Institutes of Health Stroke Scale (NIHSS) ≥6 were included. An independent Core lab and clinical events committee assessed outcomes. Good functional outcome was defined as modified Rankin score of 0-2 at 90 days. Successful revascularization was defined as the modified Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b. Performance measures included door to needle time, door to groin puncture time, and groin puncture to recanalization time. A cost-effectiveness model was also developed.</p><p><strong>Results: </strong>Of the 200 patients screened, 190 (mean age, 59.6±14.35 years) were included. The mean baseline NIHSS score was 14.7 ± 5.38, median door to needle time was 50 (10-173) mins, door to groin puncture time was 99 (11- 478) mins, and groin puncture to revascularization time was 40 (10-170) mins. The first pass mTICI≥2b was 127 (66.8%) and the final pass mTICI≥2b was attained in 167 (87.9%). A good functional outcome was seen in 123 (65.8%) patients. Symptomatic intracranial hemorrhage occurred in 4 (2.1%). Device and/or procedure-related serious adverse events occurred in 27 (14.2%). Combined therapy of MT and Intravenous Tissue Plasminogen Activator [IV-tPA]was cost-effective compared with MT alone with an expected gain of 1.5 QALYs.</p><p><strong>Conclusions: </strong>This study results are comparable with global clinical registries and randomized clinical trials with favorable functional outcomes and excellent first pass and final recanalization. Combined therapy (MT + IV-tPA) was cost-effective compared to MT or IV-tPA alone.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of RapidAI® Implementation on Workflow Metrics and Access to Reperfusion Therapies in Acute Ischemic Stroke: A 10-Year Retrospective Analysis.","authors":"Pablo Enrique González, Pablo M Lavados, Alejandro M Brunser, Víctor Hugo Navia, Matías Cristobal Niedbalski, Carolina Andrea Vargas, Veronica V Olavarria","doi":"10.1159/ced/accag042","DOIUrl":"https://doi.org/10.1159/ced/accag042","url":null,"abstract":"<p><strong>Background and purpose: </strong>Artificial intelligence‑assisted perfusion imaging can support selection and coordination in acute ischemic stroke (AIS). This study assessed institutional changes in access to reperfusion therapies and workflow metrics before and after RapidAI® implementation.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive AIS admissions (July 2014-October 2024) at a single comprehensive stroke center, comparing pre‑implementation and post‑implementation periods (RapidAI® introduced June 2018). Primary outcomes were utilization of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), mRS 0-1 at discharge, and decompressive craniectomy (DC). Secondary outcomes were 90‑day mRS, door‑to‑needle (DTN) time, and hospital length of stay (LOS). Analyses were adjusted for key confounders and sensitivity analyses were made.</p><p><strong>Results: </strong>Among 2,144 patients, adjusted analyses showed no significant differences in IVT (adjusted OR 0.93; 95% CI 0.52-1.69; p = 0.822) or MT (adjusted OR 2.73; 95% CI 0.70-10.61; p = 0.147) between periods. Rescue decompressive craniectomy was lower in the post period (adjusted OR 0.15; 95% CI 0.03-0.82; p = 0.029) and hospital length of stay was reduced (adjusted B -2.33 days; 95% CI -3.62 to -1.03; p < 0.001). No significant adjusted differences were observed for door to needle time (B -0.56 minutes; 95% CI -32.44 to 31.32; p = 0.972), discharge mRS 0-1 (adjusted OR 1.47; 95% CI 0.90-2.39; p = 0.126), discharge mRS ordinal (B -0.29; 95% CI -0.62 to 0.05; p = 0.091), or 90 day mRS ordinal (B -0.26; 95% CI -0.64 to 0.12; p = 0.174). Sensitivity analyses after multiple imputation produced consistent results.</p><p><strong>Conclusions: </strong>RapidAI® implementation coincided with improved metrics in hospital length of stay and the need for decompressive craniectomy. Given low software utilization and potential secular trends, findings should be interpreted cautiously.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobile Stroke Units in Acute Ischemic Stroke: Thrombectomy Efficiency, Workflow Models, and Implementation Considerations: A Review.","authors":"Shemiele Lewis, Hunter Hutchinson, Maya Haghighi, Jerick Kim, Clayton Rawson, Brandon Lucke-Wold, Michael Karsy, Mehrdad Pahlevani","doi":"10.1159/ced/accag043","DOIUrl":"https://doi.org/10.1159/ced/accag043","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke (AIS) is a time-critical emergency in which the benefit of reperfusion depends not only on treatment speed but also on accurate large-vessel occlusion (LVO) recognition, destination selection, and coordination between prehospital and hospital teams. Mobile stroke units (MSUs) move imaging, laboratory testing, specialist assessment, and thrombolysis into the prehospital setting, but their effect on thrombectomy depends substantially on onboard vascular-imaging capability and local routing protocols.</p><p><strong>Summary: </strong>This narrative review evaluates MSUs through the broader construct of thrombectomy efficiency, encompassing LVO identification, destination accuracy, avoidance of secondary transfer and duplicate imaging, in-hospital parallel processing, puncture and reperfusion times, and downstream clinical outcomes. Evidence for earlier intravenous thrombolysis is retained as an important upstream benefit but is distinguished from thrombectomy-specific efficiency. The available literature indicates that non-contrast-CT-based MSUs can accelerate hospital workflows through early diagnosis and prenotification, whereas CTA-enabled models can additionally confirm LVO in the field and support direct routing to a thrombectomy-capable center or, in selected systems, direct-to-angiography pathways. The magnitude of benefit is therefore configuration- and system-dependent. Economic evaluations likewise show that value is highly sensitive to annual patient volume, catchment population, staffing model, operating hours, analytic time horizon, and baseline patient disability.</p><p><strong>Key messages: </strong>MSUs should not be treated as a uniform intervention. Their thrombectomy value is determined by how effectively prehospital imaging and specialist assessment are linked to destination decisions, interfacility-transfer avoidance, and receiving-center activation. CTA-enabled pathways provide the clearest mechanism for thrombectomy-specific time savings, while non-contrast-CT-based models may still improve in-hospital efficiency. Implementation is most defensible when local geography, case volume, workforce, dispatch integration, downstream thrombectomy capacity, and cost-effectiveness are considered together.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Thrombolysis Access and Treatment Times Before and After Telestroke Implementation in Matão, Brazil.","authors":"Leticia Januzi de Almeida Rocha, Cesar Minelli, Esther Maria Langui Chiozzini, Jussara Almeida de Oliveira Baggio, Octavio Marques Pontes Neto","doi":"10.1159/ced/accag034","DOIUrl":"https://doi.org/10.1159/ced/accag034","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous thrombolysis (IVT) rates for acute ischemic stroke (AIS) remain suboptimal in Brazil, largely due to limited access to specialized stroke teams. Telestroke (TS) has emerged as a potential strategy to overcome geographic and structural barriers to timely stroke care, particularly in countries with continental dimensions such as Brazil. However, robust evidence regarding the effectiveness and safety of telestroke in the country remains scarce. The primary aim was to compare access to IVT before and after the implementation of a mobile TS program in the municipality of Matão, São Paulo. Secondary objectives included comparing treatment metrics, safety outcomes-specifically, intracranial hemorrhage and mortality-and functional independence at 90 days.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of a prospectively collected stroke registry, using an uncontrolled before-and-after (pre/post-implementation) design at Carlos Fernando Malzoni Hospital (Matão-SP), including patients with confirmed AIS between September 1, 2016, and August 31, 2022. Patients were divided into two groups: pre-TS (36 months before implementation) and post-TS (36 months after implementation). The TS platform used was the JOIN® app (Allm Inc., Tokyo, Japan).</p><p><strong>Results: </strong>Of 379 patients diagnosed with AIS during the 72-month period, the mean age was 69.8 ± 13.6 years, and 59.1% were male. The most common risk factors were hypertension (76.8%), diabetes mellitus (38.5%), and smoking (26.1%). Although 65.4% of patients arrived within 4.5 hours from symptom onset, only 58 (15.3%) received IVT. Nevertheless, the number and proportion of patients receiving IVT increased from 11 (6.7%) in the pre-TS period to 47 (22.0%) in the post-TS period (p < 0.001). Among thrombolysed patients, median door-to-needle time was significantly reduced from 145.0 minutes (IQR 119.0-265.0) pre-TS to 92.0 minutes (IQR 66.0-129.0) post-TS (p = 0.004). There were no significant differences in symptomatic intracranial hemorrhage (p = 1.000), 90-day mortality (p = 0.729), or 90-day functional outcomes (p = 0.742). In multivariable analysis, post-TS period (OR 5.65; 95% CI 2.68-11.93; p < 0.001) and higher NIHSS score at admission (OR 1.05; 95% CI 1.02-1.08; p = 0.002) were independently associated with IVT.</p><p><strong>Conclusion: </strong>In this single-center before-and-after study, implementation of a mobile telestroke program was associated with higher rates of intravenous thrombolysis and shorter treatment times. No statistically significant differences were observed in symptomatic intracranial hemorrhage, 90-day mortality, or functional outcomes. These findings support further evaluation of mobile telestroke strategies in low- and middle-income settings.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring of Remote Ischemic Conditioning with a Tissue Reflectance Sensor: A Randomized Control Trial.","authors":"Gurpriya Bhangoo, Chetan Kashinkunti, Robert Joseph Sarmiento, Nabeela Khan, Radhika Kadangot Nair, Brian Buck, Michel Gauthier, Vivian Mushahwar, Ashfaq Shuaib, Martin Ferguson-Pell, Mahesh Kate","doi":"10.1159/ced/accag037","DOIUrl":"https://doi.org/10.1159/ced/accag037","url":null,"abstract":"<p><strong>Introduction: </strong>Remote ischemic conditioning (RIC) is delivered by a transient (5 min) pressure increase in the arm BP cuff by a variable 30-50 mmHg above systolic BP to a maximum of 200 mmHg. This inconsistency in pressure application may affect the fidelity of intervention delivery. We tested the hypothesis that monitoring remote ischemic conditioning (RIC) with an adjunct forearm skin tissue reflectance sensor (STRS) device may be feasible in patients with acute ischemic stroke (AIS) and cerebral small vessel disease (cSVD).</p><p><strong>Methods: </strong>We screened patients with AIS within 7 days of symptom onset for moderate-to-severe cSVD. Eligible patients were randomized 2:1 to receive intervention RIC or sham RIC. The primary outcome measure was a composite feasibility of the forearm STRS (patient-level comfort and technical aspects measured by IOx1 and IOx2). The secondary outcome was changes in forearm STRS-derived tissue reflectance responses during the pressure-on phase (5 min) and the early pressure-off phase (1 min) of RIC. Multivariable linear regression analysis assessed the relationship between IOx1 and intervention allocation. We also used receiver operating characteristic curve analysis to propose candidate thresholds for classifying the magnitude of the tissue oxygenation response to RIC.</p><p><strong>Results: </strong>Fifty-one [34 intervention (68 RIC sessions), 17 sham (29 RIC sessions)] patients with mean ± SD age of 69±12.8 years, 24(47.1%) were females, were enrolled at a median (IQR) 42(26-78) hours after symptom onset, and median baseline National Institute of Health stroke Scale of 5(3-7). STRS-derived median relative IOx1(β = 0.33, p = 0.002) and median relative IOx2 (β = 0.23, p = 0.04) slopes during the pressure-on phase were different in the intervention arm compared to the sham arm. A percent IOx1 change of 4- 13.7% can be considered a threshold to differentiate between intervention and sham treatment. The median Likert scale score was similar: 3.5 (3-4) in the intervention group and 4 (4-5) in the sham group.</p><p><strong>Conclusion: </strong>RIC monitoring with forearm STRS is feasible in patients with AIS. Clinical trials evaluating the efficacy of RIC interventions can use STRS to assess fidelity.</p><p><strong>Clinical trial registration number: </strong>ClinicalTrials.gov ID: NCT05408130 (https://clinicaltrials.gov/study/NCT05408130).</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic and clinical factors associated with seven domains of digital health literacy: A cross-sectional study (NORFAST).","authors":"Anne-Margrethe Linnestad, Marie Hamilton Larsen, Caryl L Gay, Ingrid Johansen Skogestad, Bent Indredavik, Jan Stubberud, Anners Lerdal","doi":"10.1159/ced/accag039","DOIUrl":"https://doi.org/10.1159/ced/accag039","url":null,"abstract":"<p><p>Introduction Due to limited digital health literacy (DHL), stroke survivors frequently face barriers in using digital health tools essential for post-stroke rehabilitation and self-management. DHL is a multidimensional construct, encompassing several distinct skill domains. Although sociodemographic and clinical characteristics may influence overall DHL, their associations with specific DHL domains remain poorly understood. This study therefore explores how individual DHL domains relate to patient characteristics in stroke survivors. Methods In this cross-sectional NORFAST study, stroke survivors aged 18-80 years with a first-ever stroke in 2021 or 2022 were recruited through the Norwegian Stroke Registry. Registry data included diagnosis, stroke type, aphasia, and scores on the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index for Activities of Daily Living. Cognitive function was assessed before inclusion using the Mini/5min MoCA, a brief telephone-administered cognitive screening tool. Participants also completed self-report questionnaires (telephone or electronic), assessing sociodemographics, self-rated health status (EQ-VAS) and fatigue interference (Fatigue Severity Scale, FSS-7). The primary outcomes were DHL dimensions, assessed with the 7-domain eHealth Literacy Questionnaire (eHLQ). Linear regression models examined unadjusted and adjusted associations between patient characteristics and each DHL domain. Results Among 177 stroke survivors (mean age 69), most had experienced minor strokes and cerebral infarction. Patients scored highest on the domain \"feel safe and in control\", and lowest on \"digital services that suit individual needs\". In multivariable regression models, older age was associated with lower scores on Using technology, Engage, Motivation, and Needs; female sex with lower scores on Motivation and Needs; college/university education with higher scores on Understanding, Engage, Motivation and Needs; and better health status with higher scores on domains Using technology, Understanding, Motivation, Access and Needs. Living alone, aphasia, cognitive function, and fatigue interference were not significantly associated with any DHL domain after multivariable adjustment. Conclusion This study demonstrates considerable variation in DHL across domains among stroke survivors. After adjustment, age, education level, and self-rated health status were the factors most consistently associated with DHL dimensions. These findings suggest that older stroke survivors, those without college or university education, and those with lower self-rated health may warrant particular attention when designing, implementing, and evaluating digital health interventions. Co-creation with stroke survivors, healthcare professionals, and technology designers may support the development of accessible and clinically meaningful digital solutions.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of plasma D-dimer and B-type natriuretic peptide levels with acute ischemic stroke mechanism, severity, and outcome.","authors":"Hyun-Wook Nah, Dae-Hyun Kim, Jae-Kwan Cha","doi":"10.1159/ced/accag040","DOIUrl":"https://doi.org/10.1159/ced/accag040","url":null,"abstract":"<p><strong>Background: </strong>We sought to evaluate the utility of D-dimer and BNP in relation to stroke mechanism, severity, and outcome in acute ischemic stroke.</p><p><strong>Methods: </strong>We retrospectively analyzed 1335 patients from our prospective stroke registry. D-dimer and BNP levels were compared among stroke subtypes. The associations of D-dimer and BNP with initial NIHSS, early neurological deterioration (END), and 3-month modified Rankin Scale (mRS) were investigated.</p><p><strong>Results: </strong>D-dimer levels were significantly different among stroke subtypes. Cardioembolism (CE) had the highest median D-dimer levels (1.03 ㎍/mL (0.51-2.54)) followed by undetermined negative (0.66 (0.37-1.26)), large artery atherosclerosis (LAA) (0.59 (0.38-1.14)), and small vessel occlusion (SVO) (0.45 (0.30-0.76)). Among the LAA, LAA steno-occlusion subgroup had higher D-dimer levels than LAA branch occlusive disease subgroup (0.66 (0.41-1.32) vs. 0.45 (0.32-0.66), p<0.001). BNP levels were higher in CE than all the other subtypes (233.9 pg/mL (103.5-478.3) vs. 30.9 (14.1-70.2), p<0.001) and the C statistic of BNP for predicting CE was 0.889. Multivariable regression analysis showed that NIHSS was associated with log D-dimer (B=3.556, p<0.001) and log BNP (B=0.799, p=0.010) along with short onset-to-sample time, atrial fibrillation, and no history of coronary disease. END was associated with D-dimer (OR, 1.048; 95% CI, 1.008-1.089; p=0.018), short onset-to-sample time, NIHSS, diabetes mellitus, LAA, and SVO. The mRS was associated with D-dimer (OR 1.093, 95% CI, 1.037-1.151; p<0.001), age, NIHSS, history of previous stroke, LAA, and SVO.</p><p><strong>Conclusion: </strong>D-dimer levels were different among stroke subtypes and associated with stroke severity, END, and mRS. BNP was useful for predicting CE, and associated with stroke severity but not independently with END or mRS.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}