Search Results for: Stroke

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

Stroke, Volume 56, Issue 7, Page e174-e177, 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 e172-e173, July 1, 2025.

Objective
To evaluate the prognostic ability of the haemoglobin-to-red blood cell distribution width ratio in predicting in-hospital mortality among elderly patients diagnosed with acute ischaemic stroke.

Design
Retrospective, longitudinal, observational study using a hospital-based database.

Setting
Claims data from 1 January 2014 until 31 January 2020 were extracted from the database of two hospitals affiliated with Nanjing University.

Participants
Patients aged ≥80 years who were diagnosed with acute ischaemic stroke, excluding those with cancers or other malignant diseases.

Outcome measures
Patients were stratified into three groups based on the tertiles of the haemoglobin-to-red blood cell distribution width ratio. The dose-dependent relationship between this ratio and in-hospital mortality risk was determined with robust locally weighted regression analyses and restrictive cubic spline on continuous variables. The primary endpoint was defined as all-cause mortality during the hospital stay, and the secondary endpoint centred on the duration of the hospital stay.

Results
A total of 606 patients constituted the dataset for the conclusive analysis (mean age, 84.6 ± 3.2 years; female, 40.3%). The haemoglobin-to-red blood cell distribution width ratio was categorised into three tertiles (T1, 8.34). After adjusting for relevant demographic and clinical variables, a statistically significant inverse correlation was observed between higher ratios and lower risk of in-hospital mortality, with HRs of 0.48 (95% CI, 0.34 to 0.68) for T2:T1 and 0.14 (95% CI, 0.08 to 0.23) for T3:T1. A dose-dependent relationship was evident between the haemoglobin-to-red blood cell distribution width ratio and in-hospital mortality risk. The sensitivity analysis indicated that no attenuation was observed in the HR in both non-anaemic and anaemic cases. The results also indicated that a shorter length of hospital stay was associated with a higher haemoglobin-to-red blood cell distribution width ratio.

Conclusions
A high haemoglobin-to-red blood cell distribution ratio may be an independent protective factor for in-hospital mortality and reduced length of stay in elderly patients suffering from acute ischaemic stroke.

Objective
To assess the association between educational level and cardiovascular age acceleration metric derived from ECG, and to determine whether this association is mediated by established cardiovascular disease (CVD) risk factors.

Design
Prospective population-based cohort study (the Tromsø Study).

Setting
General population of the Tromsø municipality, Norway.

Participants
The study sample consisted of 4367 participants of the Tromsø Study, who took part in both Tromsø6 (2007–2008) and Tromsø7 (2015–2016), had a 12-lead ECG obtained at Tromsø7 and did not report a history of heart attack, stroke or atrial fibrillation.

Primary outcome measures
-age, a biomarker of cardiovascular ageing, is defined as the difference (in years) between an individual’s ECG-predicted heart age and their chronological age. ECG-predicted heart age was estimated using a previously validated deep neural network.

Results
Our findings indicate an inverse association between education and -age, with a regression coefficient per increment increase in education of –0.24 (95% CI –0.41 to –0.07) in the overall sample, –0.38 (95% CI –0.59 to –0.16) for women and –0.04 (95% CI –0.31 to 0.23) for men. Participants with the highest level of education (university/college for 4 or more years) had the lowest estimated -age with a regression coefficient of –0.69 years (95% CI –1.23 to –0.16) compared with the group with primary education for the overall sample, –1.05 years (95% CI –1.73 to –0.37) for women and –0.15 years (95% CI –1.03 to 0.73) for men. CVD risk factors mediated up to 75% of the association between overall education and -age, and 80% of the association among those with the highest education level (university/college for 4 or more years). Among women, 50% of the effect of overall education on -age was mediated by CVD risk factors, rising to 53% in the category with the highest level of education. However, in the subsample of men, there was no significant association between education and -age, and the mediation analysis produced natural direct and indirect effects pointing in opposite directions.

Conclusions
Cardiovascular ageing is inversely associated with educational level, an effect that appears to be largely mediated through established risk factors.

In patients with low-to-moderate thromboembolic risk, 1-year stroke incidence was lower than the 2% threshold for guideline-recommended anticoagulation.

Stroke, Ahead of Print. BACKGROUND:Poststroke depression (PSD) affects ≈33% of individuals 1 year after a stroke. Blood-brain barrier (BBB) dysfunction in the nucleus accumbens (NAc), a hub for emotional processing, reward, and mood regulation, has been linked to stress-induced depressive-like behaviors in male mice. Neurovascular alterations were also observed in postmortem tissue samples from men with a diagnosis of major depression. Thus, we aimed to investigate if BBB changes in the NAc could contribute to PSD pathophysiology.METHODS:Stereotaxic injection of ET-1 (endothelin-1), a potent vasoconstrictor, was performed in the NAc of male mice to create a focal brain stroke, and then, infarct size and localization were assessed and quantified. We subsequently evaluated transcriptomic and morphological effects of the infarct on BBB-related genes and cells in the NAc, particularly those known to be altered after stress exposure in mice or human depression. BBB integrity was assessed with a dextran dye, and magnetic resonance imaging scans were conducted before versus after the injection of Gadovist, a contrast agent. Last, a battery of behavioral tests related to depressive- and anxiety-like behaviors was performed to determine if an infarct in the NAc is sufficient to induce a PSD-like phenotype.RESULTS:Following ET-1 injection, ≈50% of the total lesion was observed in the NAc leading to BBB hyperpermeability in this brain area. BBB gene expression was impacted by ET-1, and also surgery alone and profiles were differentially regulated throughout time up to 14 days. Gliosis in the NAc was observed with increased reactivity of astrocytes and microglia. The effect of ET-1 on PSD-like symptoms was limited. However, body weight, sociability, and activity were affected by surgery with a more pronounced impact of ET-1 on social interactions compared with naive animals.CONCLUSIONS:While no clear PSD phenotype was observed following an ET-1–induced stroke in the NAc of male mice, our study shed light on the technical complexity of focal lesions in deep brain structures, an understudied phenomenon occurring in humans. We provide technical insights for the development of a mouse model of deep brain lesions, characterize its impact at molecular, cellular, and behavioral levels, and highlight the need to control for vascular alterations when performing stroke surgeries.

Stroke, Ahead of Print. BACKGROUND:Defining the risk of developing major bleeding, especially intracranial hemorrhage (ICH), or ischemic stroke (IS) in patients receiving antithrombotic therapy is crucial. Existing risk prediction tools would inadequately assess the net clinical benefit of antithrombotic therapy. We aimed to develop novel risk scores incorporating covert vascular brain injury to personalize the risk assessment of major bleeding, ICH, and IS in patients receiving antithrombotic therapy.METHODS:The prospective, multicenter, observational study (BAT2 [Bleeding With Antithrombotic Therapy Study-2]) enrolled patients receiving oral antiplatelets or anticoagulants from 52 hospitals across Japan between 2016 and 2019. Multimodal brain magnetic resonance imaging was performed at baseline under prespecified conditions to determine cerebral small vessel disease (white matter hyperintensity, cerebral microbleed, lacune, enlarged perivascular space, and cortical superficial siderosis), nonlacunar infarct, and intracranial artery disease with central reading. Risk scores, collectively termed the BAT2 scores, were developed separately to evaluate the comparative risks of (1) major bleeding, (2) ICH, and (3) IS based on covariates from Cox proportional hazards models and clinical relevance. Model performance was assessed with the Harrell C-index and calibration slope adjusted for optimism via bootstrapping.RESULTS:Of 5378 patients enrolled, 5250 were analyzed (mean age, 71±11 years, 33% women); 93 experienced major bleeding, including 55 had ICH, and 197 had IS during a median follow-up of 2.0 years. Predictors for bleeding included age, underweight, renal impairment, hypertension, cerebral microbleed, lacune, and antithrombotic treatment type. Predictors for ICH further included deep white matter hyperintensity but not renal impairment. For IS, predictors included age, renal impairment, diabetes, atrial fibrillation, lacune, cerebral microbleed, nonlacunar infarct, and intracranial artery disease. Prediction performance showed optimism-adjusted C-index and calibration slope of 0.69 (95% CI, 0.64–0.74) and 0.82 (95% CI, 0.62–1.06) for bleeding, 0.75 (95% CI, 0.67–0.80) and 0.80 (95% CI, 0.56–1.02) for ICH, and 0.64 (95% CI, 0.60–0.68) and 0.92 (95% CI, 0.73–1.18) for IS.CONCLUSIONS:The BAT2 scores may help optimize the balance between risks and benefits of antithrombotic therapy.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT02889653. URL:https://www.umin.ac.jp/ctr; Unique identifier: UMIN000023669.

Stroke, Ahead of Print. BACKGROUND:It is unknown whether computed tomographic perfusion (CTP) parameters predict ischemic stroke in patients with symptomatic chronic carotid or middle cerebral artery occlusion.METHODS:A post hoc analysis of medically treated patients enrolled in the CMOSS trial (Carotid or Middle Cerebral Artery Occlusion Surgery Study; REGISTRATION: URL:https://www.clinicaltrials.gov; Unique identifier: NCT01758614), a randomized controlled trial conducted at 13 centers in China between June 2013 and March 2018. It aimed to compare extracranial-intracranial bypass surgery to medical therapy in patients with symptomatic carotid or middle cerebral artery occlusion and hemodynamic insufficiency. CTP-derived mean transit time and relative cerebral blood flow were collected. The primary outcome was defined as ischemic stroke in the territory of the qualifying artery within 2 years after randomization. The predictive value of CTP for the primary outcome was analyzed by a Cox regression model. Receiver operating characteristic curves were used to calculate optimal cutoff values of CTP parameters.RESULTS:All 165 per-protocol patients (median age=53.7 years, 81.2% males) treated with medical treatment alone were analyzed. Sixteen (9.7%) patients suffered the primary outcome during the 2-year follow-up. Cutoff values of mean transit time >6.5 seconds (symptomatic side) and relative cerebral blood flow ≤0.5 were associated with recurrent stroke. In multivariate Cox regression, mean transit time (adjusted hazard ratio, 3.50 [95% CI, 1.19–10.30];P=0.02) and relative cerebral blood flow (adjusted hazard ratio, 7.36 [95% CI, 2.27–23.85];P=0.001) were independently associated with the primary outcome.CONCLUSIONS:CTP-based hemodynamic parameters are predictive of recurrent ischemic stroke in symptomatic patients with chronic carotid or middle cerebral artery occlusion. CTP could be used in patient selection for stratified secondary prevention of stroke in future studies.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT01758614.

Stroke, Ahead of Print. BACKGROUND:Cerebral small vessel disease (SVD) causes up to 45% of dementias and 25% of ischemic strokes, but the understanding of vascular pathophysiology is limited. We aimed to investigate the contribution of pulsatility of intracranial arteries, veins, and cerebrospinal fluid (CSF) and cerebral blood flow to long-term imaging and clinical outcomes in SVD.METHODS:We prospectively recruited participants in Edinburgh/Lothian, Scotland, with lacunar or nonlacunar ischemic stroke (modified Rankin Scale score ≤2, as controls) and assessed medical and brain magnetic resonance imaging characteristics at baseline and 1 year (2018–2022). We used phase-contrast magnetic resonance imaging to measure flow and pulsatility in major cerebral vessels and CSF to investigate independent associations with baseline white matter hyperintensity (WMH) and perivascular space (PVS) volumes and their progression, as well as with recurrent stroke, functional, and cognitive outcomes at 1 year. We applied linear, logistic, and ordinal regression models in our analysis.RESULTS:We recruited 210 participants; 205 (66.8% male; aged 66.4±11.1 years) had useable data. In covariate-adjusted analyses, higher baseline arterial pulsatility was associated with larger volumes of baseline WMH (B=0.26 [95% CI, 0.08–0.44];P=0.01) and basal ganglia PVS (B=0.12 [95% CI, 0.04–0.20];P

Introduction
Balance and gait disorders represent the most frequent and disabling sequelae after stroke. Impaired body orientation with respect to gravity (lateropulsion) is one of the primary underlying mechanisms, increasingly investigated. After hemisphere stroke, lateropulsion is caused by an impaired internal representation of verticality, for which developing rehabilitation techniques has become a priority. Among various approaches, virtual reality appears to be a promising tool for modulating spatial reference frame. The objective of this study is to investigate the effects of immersion in virtual tilted reality (VTR) on the postural vertical (PV) as a primary outcome, as well as main secondary outcomes on the visual vertical (VV) and the active standing posture (body orientation with respect to gravity and weight-bearing (WB) distribution on lower limbs), both in healthy individuals and individuals exhibiting lateropulsion at the subacute phase after a hemispheric stroke. The cumulative effect of the VTR on the post-stroke lateropulsion will also be analysed.

Methods and analysis
This pilot study is a single-centre, within-person randomised trial conducted in the department of Physical and Rehabilitation Medicine of the University Hospital of Grenoble-Alpes (France). We will include 40 individuals from 18 to 85 years old, 20 healthy individuals and 20 individuals with lateropulsion tested 0.5 on the Scale for Contraversive Pushing), the study lasts 4 weeks: W1 for inclusion, randomisation, planning and conventional rehabilitation; W2 and W4 to collect clinical data and conventional rehabilitation; and W3 for the VTR intervention over four consecutive mornings at the same time: 2 to test the VTR effects on verticality perception (PV and VV) and 2 to test the VTR effects on active standing (body orientation and WB distribution on lower limbs). Immediate effects and post-effects of the VTR immersion are analysed by comparing results of the following time points: for verticality perception baseline, during and after VTR and for active standing at only baseline and during VTR immersion. Linear mixed-effect models will be run with different factors/covariates according to objectives. We will analyse the proportion and features of responders (PV modulation ≥2°). The cumulative effect of the 4 days of VTR sessions will be analysed by comparing scores of the SCAle for LAteropulsion assessed at the end of every week.

Ethics and dissemination
The study was approved by an institutional review board at the national level (Comité de Protection des Personnes Ile de France X; 2020-A02941-38, amendment 2024). All participants will provide written informed consent before enrolment. Findings will be submitted to peer-reviewed journals related to rehabilitation, stroke or neuroscience.

Trial registration number
ClinicalTrials.gov, NCT04911738.

Introduction
The treatment of paediatric AIS is particularly challenging due to its rarity, limited clinical awareness and absence of targeted treatment protocols and evidence-based data. This study aims to address these gaps by investigating the epidemiology, risk factors, aetiology and treatment of stroke in children in China and to observe the short-term and long-term functional outcomes of paediatric stroke and explore the factors that influence outcomes.

Method and analysis
The Chinese Paediatric Ischaemic Stroke Registry (CPISR) is a multicentre, prospective observational study that plans to consecutively recruit patients at 85 centres across 20 provinces in China. To streamline data collection, a WeChat-based programme has been developed to allow participating institutions to input standardised questionnaire data directly and upload electronic medical records. Comprehensive demographic, clinical, neuroimaging and laboratory data are collected and tracked for registered patients. All patients undergo detailed assessment at the time of admission and during scheduled follow-up visits.

Ethics and dissemination
Ethical approval has been obtained from the Ethics Committee of the First Affiliated Hospital of University of Science and Technology of China (2022KY071). The findings of this study will be disseminated through peer-reviewed journals, national and international conference presentations and reports to participating institutions and relevant stakeholders.

Trial registration number
ChiCTR2200059915.

Estupiñán-Romero F, Pinilla Dominguez J, BernalDelgado E, et al. Differences in acute ischaemic stroke inhospital mortality across referral stroke hospitals in Spain: a retrospective, longitudinal observational study. BMJ Open 2023;13:e068183. doi:10.1136/ bmjopen-2022-068183. This article has been corrected since it was published online. The funding statement has been updated from ‘This study was partially funded by grants from CONCEPT-STROKE: Effectiveness and efficiency of acute ischaemic stroke care pathways in five Spanish Regions (PI19/00154); REDISSEC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (RD16/0001/0007); and RICCAPS: Red de Investigación en cronicidad, atención primaria y promoción de la salud (RD21/0016/0023).’ to ‘This study was partially funded through the projects CONCEPT-STROKE: Effectiveness and efficiency of acute ischaemic stroke care pathways in five Spanish Regions (PI19/00154) REDISSEC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (RD16/0001/0007) and RICCAPS: Red de Investigación en cronicidad, atención primaria y promoción de la salud…

Tenecteplase pretreatment improved outcomes in patients treated within 4.5 hours.

Stroke, Ahead of Print. BACKGROUND:Understanding of sensorimotor reorganization following a stroke is still incomplete. This study examined how the neuromotor system of well-recovered patients with stroke achieves stable control of the redundant degrees of freedom in the upper limb through goal-directed reaching movements.METHODS:Thirteen right-handed individuals with left-hemispheric stroke and 13 age-, sex- and handedness-matched healthy controls participated in this cross-sectional study. Each participant performed 80 unconstrained reach-to-grasp movements with either arm while kinematic data were recorded at 200 Hz using an optoelectronic motion capture system. Two types of outcome measures were examined, contrasting healthy individuals with those who have had strokes: end point and proximal kinematics. End point kinematics analyzed spatiotemporal hand movement characteristics, including movement time, time-to-peak velocity (TTPVHD), time-to-peak acceleration (TTPAHD), and velocity peaks for trajectory smoothness. Proximal kinematics focused on interjoint and intrajoint coordination of the elbow and shoulder, examining angular velocities and their timing differences. Stroke effects were analyzed using linear mixed-effects models.RESULTS:No significant differences were observed in distal end point kinematics between groups (n=13 each) for movement time (control versus stroke, 0.92 versus 0.96 s;P=0.944), TTPVHD(40% versus 42% of movement time,P=0.358), TTPAHD(22% versus 21%;P=0.583), or smoothness (1.02 versus 1.15;P=0.057). However, stroke significantly affected proximal kinematics, altering interjoint coordination with differences in timing between elbow flexion and shoulder rotation (18% versus 14%;P=0.019) and intrajoint coordination with differences in timing between shoulder flexion and abduction (18% versus 11%;P=0.008) and between flexion and rotation (1% versus 10%;P=0.001).CONCLUSIONS:Arm motor control in this cohort of well-recovered patients with stroke showed near-complete restoration of distal end point kinematics but significant differences in the timing of proximal intrajoint and interjoint coordination. These findings suggest compensatory adjustments in shoulder and elbow movements to achieve functional goals like reaching. An enhanced understanding of these strategies can inform targeted interventions to improve upper limb capability poststroke.