Risultati per: Stroke

Circulation, Volume 150, Issue Suppl_1, Page A4141163-A4141163, November 12, 2024. Background:The rising incidence of stroke among young adults is partly explained by underdiagnosis of risk factors such as hypertension. Current blood pressure cutoff values for hypertension diagnosis in adolescence are not based on cardiovascular outcomes and lack specificity for sex, even though female adolescents have lower blood pressure values.Methods:A nationwide, population-based, retrospective cohort study including data of all Israeli adolescents (16-19 years) who were evaluated prior to mandatory military service in 1985 through 2013. The medical evaluation included routine measurements of height, weight, and blood pressure. The primary outcome was the first occurrence of a stroke at a young age (≤52 years) as documented in the National Stroke Registry. Cox proportional hazard models were applied separately for males and females and adjusted for adolescent body mass index and sociodemographic variables. Diabetes status in adulthood, as documented in the National Diabetes Registry, was also accounted. Several sensitivity analyses were conducted, including the evaluation of ischemic stroke cases only as the outcome and stroke occurrence at a very young age (≤45 years).Results:The cohort comprised 1,897,048 adolescents (42.4% females). During 11,355,476 person-years of follow-up, there were 1,470 first stroke events, 1,233 (83.8%) cases were of ischemic etiology. In male adolescents, a diastolic blood pressure of ≥80 mmHg was associated with an adjusted hazard ratio (aHR) for stroke at a young age of 1.28 (95% confidence interval 1.05-1.58) (Image 1). In male adolescents with blood pressure of 70-79 mmHg, the aHR was comparable to that of the reference group (

Circulation, Volume 150, Issue Suppl_1, Page A4142210-A4142210, November 12, 2024. The importance of transesophageal echocardiogram (TEE) to exclude left atrial (LA) and left atrial appendage (LAA) thrombus prior to cardioversion for atrial fibrillation (AF) has been debated in patients who are anticoagulated prior to cardioversion. Despite comprehensive anticoagulation protocols, discrepancies in pharmacologic responses due to patient-specific factors such as adherence to anticoagulation, renal function, and genetics suggest that imaging studies may still be critical for patient safety. Although anticoagulation prior to cardioversion is thought to be adequate to prevent thromboembolic disease after cardioversion, there are studies to suggest imaging is always associated with lower incidence of stroke (Palla, et al., 2023). This study evaluates the impact of TEE before cardioversion on stroke reduction in a contemporary cohort of patients with persistent AF, regardless of adequate anticoagulation time.Question:Do patients with newly diagnosed persistent AF who receive a TEE prior to cardioversion have lower incidence of transient ischemic attack /ischemic stroke compared to those who are anticoagulated for at least four weeks without interruption and cardioverted without thrombus exclusion?Method:This single-center, retrospective observational study involved 454 patients ( >18 years) with newly diagnosed persistent AF undergoing cardioversion. Patients were divided into two groups: those who underwent TEE before cardioversion (n=382) and those who did not receive TEE after a four-week period of uninterrupted anticoagulation. Primary outcomes measured were the incidence of stroke within one-year post-cardioversion. Secondary outcome was mortality.Results:The incidence of stroke was significantly lower in the TEE group, with a hazard ratio of 0.1358 (95% CI 0.06531-0.2824; p < 0.0001). Mortality rates within a year did not differ significantly between the two groups. There was no significant difference in age, race, CHADS2VASc score, INR, GFR and platelet count between the two groups based on multivariate analysis.Discussion:TEE prior to cardioversion in patients with newly diagnosed persistent AF significantly reduces the risk of stroke compared to cardioversion after anticoagulation alone. In aligning with the results found in earlier trials such as ACUTE and AFFIRM, this study supports the paradigm that pre-cardioversion imaging to rule out LA/LAA thrombus could be beneficial even amongst patients who have been adequately anticoagulated.

Circulation, Volume 150, Issue Suppl_1, Page A4142467-A4142467, November 12, 2024. Background:Despite profound disparities in stroke mortality, there is limited research on geographic variation across and within US racial and ethnic populations.Research Question/Hypothesis:Do geographic trends in stroke mortality vary across and within racial and ethnic populations living in the US? We hypothesized that changes in county-level stroke mortality would vary across and within racial and ethnic groups.Methods:We applied validated small-area estimation methods to US National Vital Statistics System death certificates to estimate stroke mortality rates by county (N=3110) and race and ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic or Latino [Latino], and White) from 2000-19. Mortality estimates were corrected for race and ethnicity misclassification on death certificates and age-standardized to the 2010 Census.Results:In 2019, age-standardized county-level stroke mortality rates per 100,000 ranged from 10.9 to 170.6 among AIAN, 11.8 to 96.9 among Asian, 17.4 to 179.7 among Black, 6.5 to 114.3 among Latino, and 14.5 to 139.7 among White populations. Despite stroke mortality declining nationally among all racial and ethnic populations, there were counties where mortality increased (AIAN: 15/474; Asian: 46/667; Black: 11/1488; Latino: 154/1478; White: 46/3051),Fig. Among these counties, median absolute increases were 3.5 (IQR 1.9-5.3; max: 26.8) among AIAN, 4.1 (1.1-5.4; max: 12.2) among Asian, 7.1 (1.0-10.2; max: 52.5) among Black, 2.4 (1.3-4.6; max: 18.3) among Latino, and 5.6 (1.9-12.3; max: 47.5) among White populations. Increased stroke mortality largely occurred in the Carolinas, Florida, and Georgia (72.4% of counties with increases) for all racial and ethnic groups except AIAN, which were mostly in Oklahoma (n=9). Geographic and temporal trends also varied across stroke type.Conclusions:Stroke mortality increased in over 200 counties nationally, with differential effects by race and ethnicity. Most increases occurred in the lower South Atlantic states. These findings underscore the importance of understanding drivers of stroke mortality disparities, as well as creating prevention and treatment strategies that target populations and places at high risk.

Circulation, Volume 150, Issue Suppl_1, Page A4142338-A4142338, November 12, 2024. Background:Atrial fibrillation (AF) has been known as a main cause of embolic stroke. Well-chosen candidate to be anticoagulated should be critical for secondary prevention in patients with embolic stroke with undetermined source (ESUS). Atrial mechanical remodeling presenting cardiomyopathy could lead to not only occur atrial fibrillation but also increase risk of thromboembolism.Objective:To investigate association of LA strain, and newly detected AF in patients with ESUS.Methods:A total of 45 patients diagnosed ESUS with implantable loop recorder (ILR) who were prospectively enrolled and clinically followed for newly developed AF for secondary prevention in the 3 referral centers. Transthoracic echocardiography including LA strain analysis were performed.Results:11 patients (24%) among all (mean age 67 years, 58% male) have developed newly AF and others have maintained sinus rhythm within 2 years. The mean age, proportion of hypertension and diabetes were similar between sinus rhythm and newly AF patients. LA diameter (36.3 ± 6.6 mm vs. 39.3 ± 6.0 mm) and E of E’ (11.0 ± 4.5 mm vs. 9.2 ± 1.1 mm) were also similar between two group. Even though peak and pump LA strain in the newly AF were lower than those in sinus rhythm without statistically significance (24.7 ± 6.4 vs. 22.3 ± 8.8 and 10.8 ± 3.8 vs. 9.2 ± 4.9). Pump LA strain (cut-off value9.1) was significantly associated with developing newly AF during follow-up (hazard ratio=4.8, 1.27-18.3, p=0.02)Conclusion:Our data demonstrated that the pump LA strain was significantly associated with developing newly AF in the ESUS. This result suggests that atrial mechanical remodeling could be predictable for newly developed AF in patients with ESUS

Circulation, Volume 150, Issue Suppl_1, Page A4146671-A4146671, November 12, 2024. Background:Xe-liposome therapy has shown cerebroprotection in adult stroke animals. This study aims to validate the Xe therapeutic effect by MRI in adult rats and the therapeutic effect in an aged animal.Method:A 2-hour MCAO was induced in adult rodents. The MCAO animals were then divided into two groups: one receiving no treatment and the other receiving Xe-liposomal treatment (3 doses within 2-6 hours after stroke followed by 1 dose per day). Diffusion-weighted MRI conducted at 2, 6, and 24 hours post-MCAO, were analyzed by our image center. For aged rats (14 rats, 74 weeks old, male and female), MCAO (1.5 hours) was induced and then divided into two groups: stroke without treatment (n=5) and stroke with Xe-liposome treatment (n=9) and given 3 doses at day one and once per day for following days. Neurological function was tested by Limb placement and rotarod, and infarct volumes were measured two days post-stroke/treatment.Results:MRI (Fig.) demonstrated that infarct volume growth ratio was lower in the Xe-treated animals than those without treatment, indicating a protective effect of Xe against ischemic injury. MCAO induced 25% ± 5.4% infarct volume in the aged animals. Xe- reduced the infarct size to 6.7% ± 3.4%. Xe treatment demonstrated improved neurological functional recovery in these aged stroke animals.Conclusions:Xe-liposomal treatment reduces ischemic core growth in adult rats and has a therapeutic effect in aged stroke animals. These results support further development of Xe-based therapies for stroke.

Circulation, Volume 150, Issue Suppl_1, Page A4137989-A4137989, November 12, 2024. Background:A bimodal P wave in lead II reflects left atrial remodeling and is described as a notched P wave. A notched P wave is usually defined as a dip over the smallest unit of electrocardiography (ECG) recording paper, 40 ms, but automated analysis of ECGs has shown that even a notch of 20 ms is associated with cardiovascular events. A notched P wave is also known to predict atrial fibrillation (AF) after catheter ablation. However, the relationship between automatically assessed notched P waves and new-onset AF and ischemic stroke in patients without documented AF has not been clarified.Hypothesis:A notched P-wave by digital ECG analysis was associated with both new-onset AF and ischemic stroke.Methods:We enrolled 4,216 subjects from the Cardiovascular Prognostic Coupling Study in Japan (Coupling Registry) who had one or more cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M shape was calculated automatically using a 12-lead ECG analysis system. We compared two definitions: P-waves defined as “notched” at the the peak-to-peak (“M shape”) distance in lead II of ≥20 ms or ≥40 ms. New-onset AF was confirmed through routine medical care as well as annual ECGs. We defined the primary endpoint as new-onset AF and the secondary endpoint as ischemic stroke.Results:The mean follow-up period was 53 ± 17 months, during which 17 AF cases developed. When a notched P-wave was defined as ≥20 ms (n = 319), it was a significant predictor of both new-onset AF (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.41–6.01, p=0.004) and ischemic stroke (HR 3.02, 95% CI 1.56–5.83, P=0.001). A notched P-wave defined as ≥40 ms (n = 63) was also a predictor of new-onset AF (HR 4.57; 95% CI:1.42–14.71, p = 0.011) and ischemic stroke (HR 3.84, 95% CI 1.20–12.29, P=0.024).Conclusions:A notched P-wave by digital ECG analysis was associated with ischemic stroke as well as the new-onset AF.

Circulation, Volume 150, Issue Suppl_1, Page A4141154-A4141154, November 12, 2024. Background:Acute ischemic stroke (AIS) is one of the leading causes of death and disability in adults worldwide, and effective treatments are still lacking. Cold-inducible RNA-binding protein (CIRP) is up-regulated in response to various stress conditions. Previous studies have indicated that CIBP could potentially influence the development of various diseases.Research questions:Nevertheless, the specific role and molecular mechanism of CIBP after AIS remain unclear.Methods:The levels of serum CIRP and other brain injury markers such as NSE, S100β, GSDMD, and NLRP3 were measured by ELISA to explore the relationship between CIRP and AIS. Additionally, middle cerebral artery occlusion models (MCAO) in rats were established to investigate its localization in brain tissue using immunofluorescence staining. Additionally, the CIRP knockout MCAO rat model was established, and evaluate the effect of CIRP deficiency on the neurological function of rats. while the role of CIRP was investigated through RNA sequencing and Western Blot analysis. Additionally, the potential protective effect of the CIRP inhibitor C23 on neural injury following AIS was examined.Results:(1) Compared to the healthy control group, the serum levels of CIRP and other brain injury markers (NSE, S100β) in AIS patients and MCAO rats were significantly elevated, and the elevated levels were positively correlated. (2) In the MCAO rat model, the CIRP was mainly located in neurons and microglia. (3) Compared with wild-type MCAO rats, CIRP knockout MCAO rats improved neurological function scores. (4) RNA-seq analysis revealed that genes differentially expressed between wild-type MCAO rats and CIRP knockout MCAO rats were enriched in inflammation-related pathways. (5) The expression of pyroptosis-related proteins (NLRP3, Caspase-1, GSDMD, and ASC) and inflammatory factors (IL-1β, TNF-α, etc.) decreased in CIRP knockout MCAO rats. (6) The CIRP inhibitor C23 significantly alleviated brain injury and improved neurological function. C23 treatment significantly decreased the expression levels of pyroptosis-related proteins and inflammatory factors.Conclusions:This study shows that CIRP plays an important role in AIS development. The levels of CIRP in AIS patients and MCAO rats are significantly increased and are positively correlated with nerve damage markers. Thus, supporting CIRP as a potential target for the treatment of AIS. This discovery provides new strategies for the treatment of AIS.

Circulation, Volume 150, Issue Suppl_1, Page A4146152-A4146152, November 12, 2024. Background:Exploring the risk of young-onset stroke (YOS) in Asian Americans and Pacific Islanders (AAPIs), our study helps fill a critical gap in medical literature. By identifying unique risk factors and trends, the findings can guide early identification and targeted interventions for young AAPI individuals at high risk of stroke.Method:AAPIs aged 18-44 with and without YOS hospitalization were retrospectively identified from the National Inpatient Sample (2016-2020). Study population, comorbidities, and outcomes were queried using ICD-10-CM codes. All-cause in-hospital mortality (ACIHM) was the primary outcome and secondary outcomes were measures of healthcare resource utilization. Multivariable regression analysis was performed to analyze cardiovascular disease risk (CVD) factors as predictors of YOS and associated all-cause in-hospital mortality (ACIHM). Linear-by-linear trend analysis was performed. Statistical significance was defined at p

Circulation, Volume 150, Issue Suppl_1, Page A4143074-A4143074, November 12, 2024. Introduction:Atrial fibrillation (AF) is a risk factor for the development of ischemic stroke. Left atrial (LA) function has been described as a predictor of AF, however, atrial stiffness has been little studied.Objectives:To determine if there is a difference in left atrial stiffness between patients with ischemic stroke who presented AF and those who did not, the association of stiffness with AF and the stiffness cut-off points.Methods:An analytical, cross-sectional, single-center study was conducted. Patients older than 18 years with a diagnosis of cryptogenic ischemic stroke who were in sinus rhythm, had no history of atrial fibrillation and underwent an echocardiogram and a 24-hour rhythm Holter during hospitalization were included in the study.The echocardiograms were performed using a Siemens ACUSON SC 2000 machine with a 2.5 MHz sectorial 4v1c transducer. The reservoir LA strain (LASr) was determined using the VVI technique. The left atrial stiffness was obtained through the ratio E/e’ between the LASr.Variables were analyzed using chi-square or Student’s t-test. ROC curves were used to determine the cutoff points for predicting AF. The association of variables with the development of AF was analyzed using logistic regression.Results:A total of 96 patients were obtained, of which 35 had documented AF, 16 women and 19 men. Two groups were formed, Group 1: patients with ischemic stroke and AF (35), Group 2: with ischemic stroke without AF (61), which were used as control (Table 1). Among patients with AF, we found they were older and had a higher prevalence of diabetes mellitus, higher E/e’ value, LA indexed volume, and greater LA stiffness as well as lower LASr values. LA stiffness ( >0.29) and LASr (

Circulation, Volume 150, Issue Suppl_1, Page A4147422-A4147422, November 12, 2024. Background:Left ventricular thrombus (LVT) has been associated with an increased risk of cardioembolic stroke. However, it has not been established if coronary angiography (CAG) or percutaneous intervention (PCI) would enhance that risk. This study aims to determine the risk of cardioembolic stroke among patients with LVT who underwent CAG or PCI.Methods:This retrospective study includes patients diagnosed with LVT between June 1st, 2017, and May 31st, 2023 across the Yale New Haven Health System. The data was retrieved using ICD-10 and CPT codes, followed by manual review of the patients’ charts. The patients were divided into two groups, those who had a stroke versus those who did not. The data retrieved includes patient demographics, pre-existing medical conditions, LV function as assessed by echocardiogram, along with the findings on CAG and PCI. The statistical analyses were performed using t-test, ANOVA, and Fisher’s exact test.Results:A total of 1,104 charts were manually reviewed, of which 311 patients met the inclusion criterion of a confirmed LVT. Among these, 54 patients (17.4%) experienced an ischemic stroke. The mean age of these patients was 65.3 ± 14.8 years, with 219 patients (70.4%) being male, of whom 39 had a stroke. Among all the studied parameters (Table 1), only CAG was found to be associated with a significantly increased risk of stroke in these patients (RR: 1.47, 95% CI: 1.04-2.09, P = 0.014). There was no significantly increased risk of stroke among those patients who underwent PCI.Conclusion:Coronary angiography appears to carry a significantly increased risk of cardioembolic stroke among patients with LVT in a 6-month follow-up period, that is independent of subsequent percutaneous coronary intervention. Clinicians should carefully weigh the benefits and risks of CAG in patients with LVT and consider alternative diagnostic and therapeutic strategies when appropriate. Further studies are recommended to identify specific patient populations that might benefit from more targeted stroke prevention strategies post angiography.

Circulation, Volume 150, Issue Suppl_1, Page A4119303-A4119303, November 12, 2024. Introduction:Conscious sedation during cerebrovascular interventional surgery can shorten the time of vascular recanalization and bring significant benefits to patients, but patients are often difficult to cooperate, which affects the operation of interventional surgery. This study aims to develop a novel cerebral vascular intervention strait-jacket and explore its safety and effectiveness in emergency cerebral vascular intervention surgery.Methods:Using the convenient sampling method, patients with acute large artery occlusion stroke who underwent emergency mechanical thrombectomy in Zhongnan Hospital of Wuhan University from September 2018 to March 2021 were selected as the research objects. The control group was treated with conventional restraint belt, and the experimental group was treated with new cerebrovascular interventional surgery strait-jacket. The first reperfusion time, total operation time, modified Rankin score (mRS) at 30 days, intraoperative limb prolapse rate, average surgical cost, and safety indicators were compared between the two groups. The t test, Mann-Whitney U test or Fisher exact test were used for comparison between groups according to the data type. A p

Circulation, Volume 150, Issue Suppl_1, Page A4147434-A4147434, November 12, 2024. Background:Tirofiban is a GP IIb/IIIa inhibitor, an anti-platelet drug that is used after ischemic episodes like stroke or acute coronary syndromes. We are assessing the safety and efficacy of the drug in patients who have suffered an acute ischemic stroke.Methods:A comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to April 2024 yielded randomized controlled trials (RCTs) comparing Tirofiban and control in patients with acute ischemic stroke. We assessed the risk of bias using the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0). We analyzed the outcomes using RevMan 5.4, with risk ratio (RR) as the effect measure.Results:A total of eight RCTs with 3678 patients were included in our meta-analysis. According to our meta-analysis, the Tirofiban group was associated with a statistically significant increase in the patients showing functional independence at 90 days, measured by patients with Modified Rankin Score (mRS) of 0-2 (RR 1.14; CI = 1.05-1.25; I2= 38%). We found no difference between the two groups regarding excellent outcome (mRS score 0-1) at 90 days (RR 1.15; CI = 0.99-1.33; I2= 51%) and mortality (RR 0.86; CI = 0.50-1.46; I2= 56%). The tirofiban group did not increase the incidence of both intracranial hemorrhage (ICH) (RR 1.23; CI = 1.04-1.46; I2= 0%) and symptomatic ICH (RR 1.41; CI = 0.93-2.14; I2= 0%).Conclusion:According to our analysis of acute ischemic stroke patients, Tirofiban increased the number of patients with functional independence with no increase in adverse events as compared to the control group. Large-scale RCTs are needed to better ascertain the role of Tirofiban in acute ischemic stroke.

Circulation, Volume 150, Issue Suppl_1, Page A4139504-A4139504, November 12, 2024. Background:Atrial fibrillation (AF) outcomes are strongly associated with continuous measures of AF burden.Objectives:To assess the association between changes in maximum daily AF duration (MDAFD) and the combined endpoint of ischemic stroke and mortality among patients with cardiac implantable electronic devices (CIEDs) capable of continuous AF detection.Methods:The Optum®de-identified electronic health record (EHR) (2007-2021) was linked with the Medtronic CareLink®heart rhythm database for this study. CIED patients with healthcare activity recorded in the EHR >12 months pre- and >6 months post-CIED implant were included, excluding those with oral anticoagulation (OAC) prescription. MDAFD was assessed during the first 30 days post-implant (baseline period) and the 30 days prior to censoring or an event. Associations between change in MDAFD and the combined endpoint were evaluated, adjusting for the individual components of CHA2DS2-VASc, baseline MDAFD category and chronic kidney disease (CKD).Results:Of 26,400 patients (68±13 years; 60% male; follow-up 2.6±1.6 years) analyzed, 2,544 (9.6%) had AF during baseline. In all patients, increased (vs. stable or decreased) MDAFD in follow-up was associated with a higher adjusted rate of stroke and mortality (HR 1.80 [1.61-2.01]). There was no association between decreased MDAFD in follow-up and the combined endpoint. Subgroup analysis by baseline MDAFD category demonstrated that increased MDAFD in follow up was associated with a greater risk of stroke or mortality among patients with no AF at baseline, and decreased MDAFD in follow-up was associated with a lower adjusted risk of stroke or mortality among patients with baseline MDAFD 1hour-

Circulation, Volume 150, Issue Suppl_1, Page A4147279-A4147279, November 12, 2024. Background:Left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF), but the extent to which LA dysfunction impacts cardiac performance during exercise is unknown. Given the importance of the LA for ventricular filling, we assessed the relationship between LA compliance (LAc) at rest and during exercise and exercise stroke volume (SV) generation.Methods:We studied 50 adults with HFpEF during rest and upright cycle exercise (20W). LA volumes were calculated from two-dimensional, 4-chamber and 2-chamber echocardiographic views during both stages. LA pressures were derived from v-wave maximal amplitudes of corresponding pulmonary capillary wedge pressure tracings. LAc was calculated as LA volume divided by LA pressures (mL/mmHg).Results:LA volume increased by 3.5+1.4mL (p

Circulation, Volume 150, Issue Suppl_1, Page A4147143-A4147143, November 12, 2024. Introduction:In multiple recent studies, a higher coronary artery calcium score (CACS) has been associated with a higher risk of MACE and all-cause mortality. The relationship between coronary artery calcium (CAC) and the incidence of stroke is poorly defined.Method:Patients were obtained from the Sanford heart screening program from April 25, 2011 through June 23, 2023. The sample was limited to only those who underwent a CACS. A high CACS was deemed as anything greater than or equal to 300, whereas anything lower was identified as non-high CACS. The odds ratio was calculated via multiple logistic regression to analyze the data.Results:A total of 33249 patients with CACS were analyzed in this study. The average age of the patients is 56.19 (SD =9.97) and 46% of them are male. Among all the patients in the study, 3529 had a high CACS, of which 399 of them had stroke (11.3%). Our study shows that there is a positive effect between a high CACS and the incidence of stroke. The odds of having stroke are predicted to be 1.95 times larger in patients with high CACS (P-value < 0.001). In comparison to the patients who smoke frequently, the odds of developing a stroke shrink by a factor of about 0.53 and 0.48 for patients who do not smoke (P-value < 0.001) and patients who smoke occasionally (P-value=0.003), respectively. Furthermore, a five-year increase in age results in a 32% increase in odds of developing a stroke for patients with CACS less than 300 (P-value < 0.001), and a 17% increase in odds of developing a stroke for patients with high CACS (P-value = 0.006). However, for each additional year after CACS testing, the odds of stroke decreased by 18%, for patients with CACS less than 300 (P-value < 0.001), and 27%, for patients with high CACS (P-value < 0.001), likely due to interventions done.Conclusion:Our study showed that a high coronary artery calcium score predicts an increased incidence of stroke in our patient population.

Circulation, Volume 150, Issue Suppl_1, Page A4142559-A4142559, November 12, 2024. Introduction:It is recommended that blood pressure (BP) in patients with acute ischemic stroke should be monitored closely before and until 24 hours after thrombolysis. This study aimed to develop a BP monitoring protocol for acute ischemic stroke patients using smart wearable devices and investigate its feasibility and effectiveness.Methods:160 stroke patients in the emergency department of a designated advanced stroke center from were recruited from March to September 2023 (Fig.1). The intervention group received the BP monitoring protocol using smart wearable devices, while the control group received traditional bedside BP monitoring using standalone devices. Process evaluation indicators included feasibility, fidelity, and stakeholder acceptability. Outcome evaluation indicators included adherence to BP monitoring guidelines, time from admission to intravenous thrombolysis, National Institutes of Health Stroke Scale scores, modified Rankin Scale scores, and the incidence of symptomatic intracranial hemorrhage.Results:The implementation rate of BP monitoring guidelines from before intravenous thrombolysis to 24 hours after thrombolysis in the experimental group was 90.00 (87.50, 95.00) %, and that in the control group was 87.50 (82.50, 92.50) % (Table 1). The results of the process evaluation showed that the feasibility and intervention fidelity of this study were good. Interviews with stakeholders (11 nurses and 11 patients) revealed that the implementation of the intervention protocol was beneficial in improving nursing efficiency and timely detection of disease changes, but the protocol needed further improvement.Conclusion:The BP monitoring protocol for stroke patients undergoing intravenous thrombolysis based on smart wearable devices is scientifically sound and feasible. It can enhance adherence to BP monitoring guidelines and promote the implementation of evidence-based nursing practices.