Cerebrovascular Diseases最新文献

{"title":"Women in Stroke: A Conversation with Dr. Aleksandra Pikula on Prevention, Women's Health, Mentorship, and Leadership?","authors":"Ana Claudia de Souza, Aleksandra Pikula","doi":"10.1159/ced/accag016","DOIUrl":"https://doi.org/10.1159/ced/accag016","url":null,"abstract":"","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982098","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":"Advances in Stereotactic Hematoma Evacuation for Hypertensive Intracerebral Hemorrhage and the Value of Multimodal Monitoring.","authors":"Guojie Hu, Xing Yin, Cheng Zhang, Zhao Li","doi":"10.1159/ced/accag009","DOIUrl":"10.1159/ced/accag009","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive intracerebral hemorrhage (HICH) is a common spontaneous intracerebral hemorrhage with high morbidity and mortality. Early hematoma evacuation is critical to reduce secondary brain injury and improve neurological outcomes.</p><p><strong>Summary: </strong>Stereotactic hematoma evacuation has emerged as a minimally invasive, precise surgical approach, particularly for deep-seated hematomas. Randomized controlled trials provide high-level evidence of safety advantages compared with craniotomy in selected patient subgroups, and observational studies further confirm this benefit in broader populations. Advances in imaging, neuronavigation, endoscopic assistance, thrombolytic therapy, and robotic guidance enhance surgical accuracy and safety. However, treatment outcomes vary considerably across different technologies. Multimodal monitoring, which integrates clinical scales, serum biomarkers, neuroimaging, intracranial pressure, cerebral perfusion, and brain oxygenation, enables a dynamic and quantitative assessment that guides surgical decision-making, perioperative management, and prognostic evaluation. Presently, the available evidence is largely theoretical and observational, with a notable absence of high-level evidence.</p><p><strong>Key messages: </strong>The combination of stereotactic hematoma evacuation and multimodal monitoring enables individualized risk stratification, optimized intervention timing, and real-time evaluation of treatment efficacy, representing a promising precision-based strategy to improve prognosis in HICH patients.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Dynamics of Circulating Syndecan-1 in Acute Ischemic Stroke and Their Association with Recanalization Therapy and Functional Outcomes.","authors":"Mayara Thays Beckhauser, Carlos Henrique Miranda, Rui Kleber do Vale Martins Filho, Millene Camilo, Renato Arruda, Tainã Paulo Zanata Trombetta, Marcelo de Almeida Pinheiro, Trajano Aguiar Pires Gonçalves, Iago Blanco Bacchiega, Octavio M Pontes-Neto","doi":"10.1159/ced/accag023","DOIUrl":"https://doi.org/10.1159/ced/accag023","url":null,"abstract":"<p><strong>Background: </strong>and Purpose: The endothelial glycocalyx (EG) is a protective carbohydrate-rich layer lining the luminal surface of endothelial cells and a key component of the neurovascular unit, where it contributes to blood-brain barrier (BBB) integrity, vascular permeability control, and regulation of inflammatory and hemostatic responses. Disruption of the EG is increasingly recognized as an early marker of endothelial injury in acute vascular diseases. Syndecan-1, released during glycocalyx degradation, is a potential biomarker of endothelial dysfunction and may reflect vascular injury in acute ischemic stroke, although its temporal dynamics and clinical implications remain poorly understood.</p><p><strong>Methods: </strong>In this prospective observational cohort study, adults with first-ever AIS presenting within 12 hours of symptom onset were enrolled at a tertiary stroke center. Serum syndecan-1 concentrations were measured at admission, 24 hours, and 48 hours after stroke onset and compared with controls. Associations between syndecan-1 concentrations, clinical and imaging characteristics, recanalization therapy, and 90-day functional outcomes were analyzed.</p><p><strong>Results: </strong>Fifty-six patients with AIS and 73 controls were included. Compared with controls, syndecan-1 concentrations did not differ significantly at baseline (p=0.658) but were significantly higher at 24 and 48 hours (both p<0.001). In the linear mixed-effects model, there was an overall effect of time (p=0.032), with a significant increase at 24 hours relative to baseline (p=0.008), but not at 48 hours (p=0.135). Lower 48-hour syndecan-1 concentrations were associated with unfavorable 90-day functional outcome in the unadjusted analysis (p=0.005), although this association was not independently maintained in the overall multivariable model (p=0.064). Exploratory descriptive analyses showed different numerical patterns according to recanalization therapy, but no formal between-group longitudinal difference was established. Among patients receiving recanalization therapy, syndecan-1 concentration at 48 hours was inversely associated with unfavorable 90-day outcome in an exploratory multivariable analysis (OR 0.94, 95% CI 0.90-0.99; p=0.03).</p><p><strong>Conclusions: </strong>Circulating syndecan-1 concentrations vary during the acute phase of AIS. Concentrations were significantly higher than those of controls at 24 and 48 hours, whereas the within-patient increase relative to baseline was statistically significant only at 24 hours. The data do not establish different temporal trajectories according to recanalization therapy, and the subgroup prognostic finding should be considered hypothesis-generating. These findings do not directly demonstrate cerebral glycocalyx degradation or blood-brain barrier injury but support further investigation of syndecan-1 as a time-dependent circulating marker in AIS.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905257","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":"The Safety of Early Intravenous Tirofiban in Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.","authors":"Chengli Tian, Liangke Tu, Jun Wan, Yuyang Liu, Yuning Feng, Xiang Yuan, Lu Jia, Yu Zhang","doi":"10.1159/ced/accag020","DOIUrl":"10.1159/ced/accag020","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate the hemorrhagic and mortality risks associated with early intravenous tirofiban in patients with acute ischemic stroke.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane, from inception to December 23, 2025, evaluating the safety outcomes of tirofiban in acute ischemic stroke patients. The primary outcome was symptomatic intracranial hemorrhage.</p><p><strong>Results: </strong>Eleven studies (3,635 patients) were included, with data availability varying by specific safety outcomes. Tirofiban was associated with a significant increase in the risk of any intracranial hemorrhage (risk ratios (RRs), 1.19; 95% CI, 1.02-1.38). However, there was no significant difference in the risk of the primary outcome, symptomatic intracranial hemorrhage (RR, 1.12; 95% CI, 0.56-2.22), systemic bleeding (RR, 1.20; 95% CI, 0.79-1.83), or mortality (RR, 0.93; 95% CI, 0.67-1.27). Subgroup analysis for symptomatic intracranial hemorrhage stratified by initial treatment strategy revealed no significant interaction (p = 0.29).</p><p><strong>Conclusion: </strong>Early intravenous tirofiban is associated with a significantly increased risk of any intracranial hemorrhage. Although no statistically significant increases in symptomatic intracranial hemorrhage or mortality were detected, the wide confidence intervals preclude the definitive exclusion of clinically meaningful harm.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905219","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":"Prevalent Stroke, Fatigue, and Incident Dementia Risk in the UK Biobank.","authors":"Keyu Bian, Xingqi Zhao, Xiangling Yuan, Xiaoli Feng, Zhifeng Yang, Wen Sun, Gelin Xu, Huafeng Jin","doi":"10.1159/ced/accag021","DOIUrl":"10.1159/ced/accag021","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major risk factor for dementia, and fatigue is common among stroke survivors. Whether self-reported fatigue is associated with dementia risk among individuals with prevalent stroke remains unclear.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of 484,749 UK Biobank participants without dementia at baseline. Participants were classified into four groups according to prevalent stroke and self-reported fatigue: neither exposure, fatigue only, prevalent stroke only, and prevalent stroke with fatigue. The primary outcome was incident all-cause dementia. Secondary outcomes were Alzheimer disease and vascular dementia. Cox proportional hazards models used age as the time scale and adjusted for demographic, socioeconomic, lifestyle, and cardiometabolic factors. Sensitivity analyses included landmark, competing-risk, extended-adjustment, stroke-subtype, and time-updated stroke analyses.</p><p><strong>Results: </strong>Of 484,749 participants, 60,379 had fatigue only, 5,706 had prevalent stroke only, and 1,697 had both prevalent stroke and fatigue. Compared with participants with neither exposure, adjusted hazard ratios for all-cause dementia were 1.51 (95% CI, 1.42-1.60) for fatigue only, 1.94 (95% CI, 1.74-2.17) for prevalent stroke only, and 2.79 (95% CI, 2.32-3.35) for prevalent stroke with fatigue. For participants with both prevalent stroke and fatigue, hazard ratios were 1.86 (95% CI, 1.32-2.62) for Alzheimer disease and 4.33 (95% CI, 3.24-5.80) for vascular dementia. Among participants with prevalent stroke, fatigue was associated with all-cause dementia after adjustment for time from recorded stroke occurrence to baseline assessment (HR, 1.36; 95% CI, 1.10-1.70), whereas the associations with Alzheimer disease and vascular dementia were not statistically significant.</p><p><strong>Conclusions: </strong>Prevalent stroke with self-reported fatigue was associated with the highest risk of incident dementia compared with neither exposure. Among participants with prevalent stroke, fatigue was associated with all-cause dementia but not clearly with Alzheimer disease or vascular dementia.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896628","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":"Acute Hyperglycemia after Intracerebral Hemorrhage Is Associated with 90-Day Cognitive Impairment.","authors":"Alvin S Das, John H Erdman, Hanna J Peterson, Elizabeth C Heistand, Vasileios-Arsenios Lioutas, Corey R Fehnel, Jason Yoon, Sandeep Kumar, Robert W Regenhardt, M Edip Gurol, Long H Ngo, Bruno A Benitez, Magdy H Selim","doi":"10.1159/ced/accag022","DOIUrl":"10.1159/ced/accag022","url":null,"abstract":"<p><strong>Introduction: </strong>Admission hyperglycemia (glucose >140 mg/dL) after ischemic stroke is associated with poor clinical outcomes, including cognitive impairment. Although hyperglycemia is commonly observed following intracerebral hemorrhage (ICH), it remains unclear whether its presence is also associated with reduced cognitive performance.</p><p><strong>Methods: </strong>In this post hoc analysis of the ICH Deferoxamine Trial, admission hyperglycemia and other baseline characteristics were compared between patients with and without cognitive impairment (90-day Montreal Cognitive Assessment score <26) using univariable and multivariable models.</p><p><strong>Results: </strong>Among 293 patients with spontaneous, supratentorial ICH (aged 60 ± 12 years, 38% female), 132 had hyperglycemia and 134 met criteria for cognitive impairment. Patients with cognitive impairment were older (61 ± 12 vs. 57 ± 11 years, p = 0.02), more likely to be female (46% vs. 28%, p = 0.02), had less coronary artery disease (6% vs. 16%, p = 0.06), higher hemorrhage volumes {19.5 mL (interquartile range [IQR] 9.3-32.7) vs. 12.2 mL [IQR 6.1-18.3], p < 0.01}, and more lobar hemorrhages (25% vs. 13%, p = 0.05). When these variables were entered into a multivariable logistic regression model, age (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI; 1.01-1.07]), coronary artery disease (aOR 0.33, 95% CI [0.11-0.97]), hyperglycemia (aOR 2.03, 95% CI [1.03-3.97]), and ICH volume (aOR 1.03, 95% CI [1.01-1.06]) were independently associated with impaired cognition.</p><p><strong>Conclusion: </strong>The association between admission hyperglycemia and cognition indicates that acute hyperglycemia may identify patients at heightened risk of cognitive decline, underscoring the need for further studies to determine whether aggressive glycemic control mitigates post-ICH cognitive impairment.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879245","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":"Wearable Ultrasound for Autoregulation-Guided Hemodynamic Management after Endovascular Thrombectomy: A Digital Revolution for Post-Stroke Care.","authors":"Anton Peled, Karol P Budohoski, Sarah T Menacho, Vijay Krishnamoorthy, Jennifer Juhl Majersik, Nils Hermann Petersen, Ramesh Grandhi","doi":"10.1159/ced/accag019","DOIUrl":"10.1159/ced/accag019","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamic management after endovascular thrombectomy (EVT) for patients with acute ischemic stroke from large vessel occlusions (LVOs) is a critical and unsolved challenge: four major randomized controlled trials that applied fixed systolic blood pressure (SBP) targets yielded neutral or harmful results, and the 2026 American Heart Association guideline cautions against aggressive SBP reduction below 140 mm Hg in the early post-EVT period. Independent physiological data demonstrate that cerebral autoregulation is profoundly and heterogeneously impaired after LVO stroke, suggesting that population-level fixed thresholds may be intrinsically mismatched to the biological diversity of autoregulatory states across individual patients.</p><p><strong>Summary: </strong>Continuous, personalized monitoring of cerebral autoregulation offers a precise alternative to uniform blood pressure targets. Current post-EVT hemodynamic management is reactive: blood pressure is measured intermittently, population-level thresholds are applied regardless of individual physiology, and clinical deterioration is often recognized only after secondary injury has occurred. Near-infrared spectroscopy-based computation of the cerebral oximetry index enables real-time derivation of each patient's optimal mean arterial pressure and autoregulatory limits, but current monitoring platforms are confined to specialized research settings. This review examines how recent advances in wearable ultrasound engineering, including conformal transcranial patches, wireless integrated systems, and low-cost disposable devices, create the technical foundation for portable, scalable cerebral hemodynamic monitoring with the potential to extend personalized autoregulation-guided care from specialized academic centers to community hospitals and broader stroke networks.</p><p><strong>Key messages: </strong>(1) The failure of four randomized trials to identify a uniform post-EVT blood pressure target, together with evidence of heterogeneous autoregulation impairment after LVO stroke, motivates a shift toward personalized, autoregulation-guided management. (2) Emerging wearable ultrasound technology offers a credible technical pathway to continuous transcranial hemodynamic monitoring, with an engineering profile suited to deployment in community hospitals and broader stroke networks beyond specialized research centers. (3) Integrating wearable sensing, computational autoregulation analysis, and digital health infrastructure could enable a proactive, precision-guided model of post-EVT care, contingent on prospective clinical validation.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872944","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":"Dynamic, Explainable Artificial Intelligence Framework for Sequential Prediction of Symptomatic Intracranial Hemorrhage after Reperfusion Therapy in Acute Ischemic Stroke.","authors":"Lin Yang, Xiaocui Fan, Aihua Xu, Juan Du","doi":"10.1159/ced/accag010","DOIUrl":"10.1159/ced/accag010","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic intracranial hemorrhage (sICH) remains a devastating complication undermining reperfusion therapy in acute ischemic stroke (AIS). Current prediction models rely on static baseline parameters, neglecting dynamic post-treatment physiological changes. We aimed to develop and validate a dynamic, explainable risk prediction framework integrating high-resolution temporal data.</p><p><strong>Methods: </strong>In this prospective multicenter study, 2,341 AIS patients with anterior circulation large vessel occlusion receiving reperfusion therapy were consecutively enrolled (January 2023-June 2024). High-frequency vital signs and serial laboratory tests were collected over 72 h post-treatment. Time-series features (trend, volatility, stability) were engineered, and XGBoost-based dynamic models were constructed at five timepoints (6, 12, 24, 48, 72 h). Performance was evaluated in a held-out validation cohort (n = 576) against a static baseline model. SHAP was applied for interpretability.</p><p><strong>Results: </strong>Of 2,158 analyzed patients, 218 (10.1%) developed sICH. The dynamic model consistently outperformed the static model across all timepoints (AUC 0.83-0.90 vs. 0.71-0.75; all p < 0.001). SHAP identified three core risk drivers: hemodynamic volatility (24-h SBP standard deviation ranked highest), metabolic-inflammatory trajectories, and early tissue injury markers. Unsupervised clustering revealed three risk phenotypes: persistent low-risk (71.5%, sICH 0.8%), early rapid-riser (18.2%, 52.3%), and delayed-riser (10.3%, 38.1%).</p><p><strong>Conclusion: </strong>This dynamic, explainable framework shifts sICH risk prediction from static snapshots to continuous, interpretable monitoring. Hemodynamic volatility emerged as the strongest modifiable predictor, offering clinically actionable insights for personalized post-procedural care in AIS.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886122","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":"Obesity and Subclinical Cerebral Small Vessel Disease Burden in Asymptomatic Japanese Adults: Mediation by Hypertension.","authors":"Takeshi Yoshimoto, Fusao Ikawa, Masaaki Chiku, Ryuji Kawata, Hirofumi Maruyama, Hiroshi Yamagami, Yuji Matsumaru","doi":"10.1159/ced/accag006","DOIUrl":"10.1159/ced/accag006","url":null,"abstract":"<p><strong>Introduction: </strong>Although obesity is associated with cerebral small vessel disease (CSVD), the extent to which hypertension (HTN) and diabetes mellitus (DM) statistically account for this association in Asian populations remains unclear.</p><p><strong>Methods: </strong>We analyzed asymptomatic Japanese adults enrolled in a Japanese Brain Dock registry between 2018 and 2024. The primary outcome was high CSVD burden, defined as a composite score ≥2 on a 0-4 scale based on the Standards for Reporting Vascular Changes on Neuroimaging criteria and incorporating moderate-to-severe white matter hyperintensities, lacunes, cerebral microbleeds, and pathologic basal ganglia perivascular spaces. Obesity was defined as a body mass index ≥25 kg/m2 according to Asian-specific criteria. We performed multivariable logistic regression, parametric mediation-decomposition analyses with bootstrap-derived 95% confidence intervals (CIs), and Karlson-Holm-Breen (KHB) decomposition.</p><p><strong>Results: </strong>Among 84,204 participants (45.7% women; median age, 50 years), obesity was associated with high CSVD burden (adjusted odds ratio [OR] 1.51 [95% CI 1.32-1.71]); this association attenuated to 1.24 (1.09-1.41) after adjustment for HTN and 1.21 (1.07-1.38) after additional adjustment for DM. In KHB decomposition, HTN and DM jointly accounted for 49.4% of the association (HTN, 91.9%; DM, 8.1%). The natural indirect effect was significant for HTN (1.27 [1.20-1.36]) but not for DM (1.00 [0.99-1.01]). A significant obesity × DM interaction was observed (p < 0.05).</p><p><strong>Conclusion: </strong>In this large Japanese brain-screening cohort, approximately half of the association between obesity and high subclinical CSVD burden was statistically apportioned to HTN and DM, predominantly through HTN. These cross-sectional decomposition findings should be interpreted as statistical, not mechanistic, mediation and support prioritizing blood-pressure assessment in obese adults undergoing brain screening.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863448","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":"Contextualized Clinical Practice Guidelines for Poststroke Motor Rehabilitation in India: Framework and Endorsement for Implementation.","authors":"Dorcas B C Gandhi, Rinita Mascarenhas, Elizabeth Lynch, Coralie English, Julie Bernhardt, Jeyaraj D Pandian, John M Solomon","doi":"10.1159/ced/accag013","DOIUrl":"10.1159/ced/accag013","url":null,"abstract":"<p><strong>Introduction: </strong>Existing Indian stroke rehabilitation clinical practice guidelines (CPGs) focus predominantly on physiotherapy and provide limited guidance on health system integration, care pathways, and implementation. This study aimed to develop an evidence-based, contextually relevant CPG for motor rehabilitation across the stroke continuum in India, identify priority recommendations, and assess implementation feasibility.</p><p><strong>Methods: </strong>A three-phase mixed-methods study was conducted across tertiary, secondary, and community-based rehabilitation settings in India. A scoping review, focus group discussions, and systematic synthesis of existing guidelines were undertaken. Participants included rehabilitation professionals with ≥10 years of experience, persons with lived experience of stroke, and key stakeholders. Recommendations were classified according to evidence strength and implementation feasibility.</p><p><strong>Results: </strong>Rehabilitation pathways were fragmented, with limited post-discharge access and no standardized referral systems. Sixty clinical questions were refined into nine PICO questions and two practice points. Eighty-four recommendations were synthesized from high-quality international guidelines meeting AGREE-II/AGREE-REX thresholds of ≥60%. Using a modified Alper tool, 50 recommendations supported interventions, 13 advised against routine use, and the remainder had limited or unclear evidence. Using the Adopt-Contextualize-Adapt framework, 39 recommendations were suitable for adoption, 32 required contextualization, and 13 required adaptation.</p><p><strong>Conclusion: </strong>A stakeholder-informed, contextually adapted stroke rehabilitation CPG was developed for India, addressing key evidence and implementation gaps and providing a scalable framework to improve rehabilitation quality, continuity, and accessibility.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}