Search Results for: Stroke

Stroke, Ahead of Print. BACKGROUND:Multiple recent randomized trials have demonstrated the benefit of thrombectomy over medical management alone in adult patients with large vessel occlusion (LVO) stroke and large infarct on baseline imaging. Cohort studies have also identified improved functional outcomes in pediatric patients who received thrombectomy. However, the role of thrombectomy in pediatric stroke with large baseline infarct remains uncertain.METHODS:A case-control study was undertaken using pooled data from 3 cohort studies of pediatric stroke (Save ChildS, Save ChildS Pro, Pediatric LVO Stroke Study). Pediatric patients of age 1 to 18 years with acute anterior circulation LVO stroke presenting within 24 hours since last seen well with an Alberta Stroke Program Early Computed Tomography (CT) Score of 0 to 5 on CT or magnetic resonance imaging were included. Isolated M2 occlusion or focal cerebral arteriopathy–inflammatory subtype cases were excluded. Thrombectomy-treated patients were compared with patients who received medical management alone. The primary clinical outcome was the pediatric modified Rankin Scale score at 90 days, compared between groups using ordinal logistic regression.RESULTS:Of 56 pediatric patients with anterior circulation LVO and low Alberta Stroke Program Early CT Score presenting between January 1, 2000 and August 31, 2023 from 45 centers across Europe, North America, and Australia, 40 patients were eligible for inclusion (female: n=14, 35.0%; mean age, 9.1 years; range, 1.5–17; SD, 5.27). Thrombectomy-treated patients (n=24) had significantly better pediatric modified Rankin Scale scores at 90 days than medical management alone patients (n=16; odds ratio, 3.68 [95% CI, 1.11–12.21];P=0.034). There was no significant difference between groups in the rate of symptomatic intracranial hemorrhage (P=0.806).CONCLUSIONS:In this multicentre case-control study, pediatric patients (age, 1–18 years) with anterior circulation LVO stroke and low Alberta Stroke Program Early CT Score who received thrombectomy had significantly better functional outcomes than those treated with medical management alone. Exclusion of pediatric patients from thrombectomy based on low Alberta Stroke Program Early CT Score alone may not be appropriate.

Objective
Prognostic nutritional index (PNI) is an index for assessing nutritional and immune status. The aim of this study is to investigate the predictive value of PNI for long-term major adverse cardiac and cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (T2DM).

Design, setting and participants
This retrospective cohort study analysed 1582 STEMI patients with T2DM who underwent percutaneous coronary intervention from January 2015 to June 2023 in Urumqi, China. Patients were followed up for MACCE.

Primary and secondary outcome measures
The primary endpoint was new-onset MACCE including all-cause death, non-fatal MI and non-fatal stroke.

Results
This study ultimately included 1582 patients for analysis with a median follow-up period of 48 months (IQR: 24–84 months) and 282 patients (17.8%) developed MACCE. Of them, 138 (8.7%), 84 (5.3%) and 60 (3.8%) patients developed all-cause death, a non-fatal MI and a non-fatal stroke, respectively. Incidences of MACCE and all-cause death conversely correlated with PNI. Kaplan-Meier curves showed a significant difference in all components of MACCE between PNI quartiles (p

Introduction
African, Caribbean and Black (ACB) communities experience disparities in health outcomes, with higher rates of chronic diseases, such as heart disease and stroke, and lower self-reported health status compared to their White counterparts. Barriers to timely access to healthcare services further exacerbate these inequities. Some studies link racialisation to surgical disparities and subpar surgical outcomes. However, the findings are diverse, and there is no synthesis of the evidence on disparities in surgical care for ACB patients in high-income countries with universal healthcare systems. The objective of the scoping review is to systematically describe, characterise and map the existing literature on disparities in the access to and quality of surgical care among ACB patients in high-income countries with universal healthcare systems, and to identify gaps in the literature on surgical access and quality of surgical care in ACB patients.

Methods and analysis
The scoping review will follow the Joanna Briggs Institute methodology and report according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The search strategy will be customised for each database (MEDLINE, Embase, CINAHL, APA PsycINFO and Cochrane Library) using terms for ACB and surgery. Grey literature and references from included studies will be searched for additional sources, with no limitations on publication date or language. All study designs will be eligible. Two independent reviewers will screen titles, abstracts and full texts in duplicate for eligibility. One reviewer will chart data, with a second reviewer validating the data charted. The findings will be synthesised, quantitatively summarised using descriptive statistics and qualitatively analysed through thematic analysis.

Ethics and dissemination
Ethics approval is not required as the study utilises published data. The dissemination of the findings will inform future research and improve understanding of the surgical care experiences of ACB patients. Dissemination will target academics and healthcare professionals through publications, presentations and workshops.

Circulation, Volume 151, Issue 25, Page e1096-e1096, June 24, 2025.

Circulation, Volume 151, Issue 25, Page e1095-e1095, June 24, 2025.

Stroke, Volume 56, Issue 7, Page 1947-1957, July 1, 2025. In the 2025 David G. Sherman Lecture, Jean-Claude Baron emphasizes the major role positron emission tomography played in the breakthroughs in ischemic stroke pathophysiology that took place in the last half-century and allowed major therapeutic advances. Based on his work using PET in both animal models and people with stroke spanning 4 decades, he details his main contributions to key milestones, including (1) the demonstration of the hemodynamic consequences of chronic carotid artery occlusion and the hemodynamic mechanism underlying some transient ischemic attacks; (2) the documentation of the existence of the ischemic penumbra in man and the formal validation, using stringent prespecified operational criteria, of the core/penumbra model; (3) the persistence of substantial penumbral volumes up to 17 hours after stroke onset in a substantial fraction of patients; (4) the demonstration that from early timepoints poststroke, a good fraction of patients do not show the extensive penumbral pattern but instead exhibit large cores or spontaneously reperfusion, indicating the importance of individual patient selection for trials and therapy based on physiological imaging instead of time since stroke onset; (5) the documentation that the salvaged penumbra may not be intact but is often affected by selective neuronal loss, which may impact functional outcome and represent a novel target for neuroprotection; and (6) the demonstration of remote metabolic effects of disconnection resulting in loss of excitatory input, such as crossed cerebellar diaschisis and thalamocortical diaschisis, which may represent additional targets for therapies aiming at adaptive plasticity.

Stroke, Volume 56, Issue 7, Page 1659-1659, July 1, 2025.

Stroke, Volume 56, Issue 7, Page 1914-1916, July 1, 2025.

Stroke, Volume 56, Issue 7, Page 1660-1661, July 1, 2025.

Stroke, Volume 56, Issue 7, Page e172-e173, July 1, 2025.

Stroke, Volume 56, Issue 7, Page e168-e169, July 1, 2025.

Stroke, Volume 56, Issue 7, Page e174-e177, July 1, 2025.

Stroke, Volume 56, Issue 7, Page e178-e181, July 1, 2025.

Stroke, Volume 56, Issue 7, Page e170-e171, July 1, 2025.

Stroke, Volume 56, Issue 7, Page 1965-1968, July 1, 2025. Poverty profoundly influences stroke risk, access to care, and recovery, yet remains largely invisible in hyperacute stroke trials. Despite growing awareness of health inequities, current research and clinical frameworks rarely capture socioeconomic data at the point of care—particularly during the hyperacute phase, when decisions are time sensitive. This commentary highlights the urgent need to incorporate measures of poverty and social vulnerability into hyperacute stroke care and research. We briefly review existing evidence on the relationship between socioeconomic status and acute stroke outcomes, identify gaps in current data collection practices, and explore why capturing such information has remained a challenge. To address this gap, we propose a practical, rapid-assessment approach using brief, validated tools to measure economic strain in emergency or prehospital settings. These tools can be embedded into clinical workflows with minimal disruption while providing critical context for interpreting outcomes and guiding resource allocation. We envision incorporating such tools into future randomized controlled trials to ensure that socioeconomic factors are systematically captured and analyzed—ultimately enabling more inclusive trial designs, equitable care delivery, and data-driven policy change.

Stroke, Volume 56, Issue 7, Page 1958-1964, July 1, 2025. The vast majority of patients with minor stroke achieve what are considered good or excellent outcomes on the modified Rankin Scale (0–1/0–2), yet many are dissatisfied with their outcomes. There is a need for a functional outcome measure tailored for minor stroke that better reflects the spectrum of clinical outcomes within this population. We developed the Canadian Outcome Scale for Minor Stroke (COSMOS) and performed an interrater and intrarater reliability study. COSMOS is a 7-point scale ranging from 0 (no symptoms) to 6 (loss of independence for an instrumental or basic activity of daily living or worse), which accounts for performance limitations and losses of a person’s hobbies or passions and of their employment, educational, service, or caregiving pursuits, besides just activities of daily living. One hundred test case vignettes were developed. Stroke physicians, fellows, and research nurses/staff were invited to review training materials and provide the COSMOS grade for 20 cases representing all COSMOS grades (0–6). After a minimum 2 weeks’ wash-out period, participants were asked to grade the same 20 cases again. Interrater and intrarater agreement were assessed using Cohen κ, weighted κ, percentage agreement, and intraclass correlation coefficient. Among 33 participants (18 attending physicians, 9 stroke fellows, and 6 research staff/nurses; median 12.5 years of experience), COSMOS had substantial interrater reliability (80.5% agreement [95% CI, 75.7%–85.3%]; Cohen κ, 0.77 [95% CI, 0.72–0.84]) and almost-perfect intrarater reliability overall (87.1% agreement [95% CI, 84.4%–89.7%]; Cohen κ, 0.85 [95% CI, 0.82–0.88]); weighted κ showed almost perfect agreement for both interrater (0.88 [95% CI, 0.85–0.92]) and intrarater reliability (0.92 [95% CI, 0.90–0.94]). The overall chance-adjusted simultaneous intrarater/interrater agreement using intraclass correlation coefficient was 0.95 (95% CI, 0.94–0.97). Results were similar with substantial to almost-perfect agreement when considering key subgroups based on position (attendings, fellows, research nurses/staff) and years of experience. In conclusion, the newly proposed COSMOS scale demonstrated substantial interrater and intrarater reliability. The scale merits further study in cohort studies and clinical trials of minor stroke.