Risultati per: Stroke

Objective
This study investigates the effects of dexmedetomidine on short-term and long-term survival rates in intensive care unit (ICU) patients with ischaemic stroke.

Design
This is a retrospective study.

Setting
Data were sourced from the Medical Information Mart for Intensive Care IV database.

Participants
This study analysed 2816 patients with ischaemic stroke from the US Intensive Care database.

Interventions
Dexmedetomidine administration during the ICU stay was defined as the exposure.

Methods
Patients were categorised into the dexmedetomidine group and the control group. Cox regression analysis was used to identify factors that may influence the 28-day mortality rate of patients with ischaemic stroke. High-risk factors were incorporated as covariates, and a 1:1 propensity score matching using the logit model was constructed to compare the prognosis between the two groups.

Primary and secondary outcome measures
The primary outcome was 28-day mortality. The secondary outcomes included in-hospital mortality, ICU length of stay, hospital length of stay, mechanical ventilation duration and 180-day mortality in discharged patients.

Results
A total of 2816 patients were included. Cox regression analysis revealed that dexmedetomidine use was associated with a reduced risk of 28-day mortality. Following propensity score matching, each group comprised 407 patients. Dexmedetomidine was found to improve 28-day mortality (27.8% vs 36.6%, p=0.007). However, it was also associated with the prolonged length of hospital and ICU stay (p=0.002). Among discharged patients, dexmedetomidine use was also associated with an improved 180-day mortality rate (p=0.0019).

Conclusion
The use of dexmedetomidine is associated with improved short-term and long-term prognosis in patients with ischaemic stroke and could potentially confer benefits in those receiving mechanical ventilation.

New England Journal of Medicine, Ahead of Print.

The stacked ML model incorporating TyG-BMI effectively predicts stroke risk, with the ISS score demonstrating strong performance across diverse populations. Further research is needed to assess its applicability in broader cohorts.

Objective
Understanding how patients access and experience long-term care after stroke, including the kind of medical support desired, in a qualitative interview study; analysis with a question-focused approach adapted from grounded theory methodology.

Setting
Recruitment in primary care and physical therapy practices in the metropolitan area of Berlin, Germany.

Participants
15 patients treated in general practice or physical therapy, whose last stroke occurred more than 2 years ago.

Results
‘Shaping relationships’ was the core category extracted from the data as a necessary component to receive appropriate long-term care after stroke. Care is embedded in relationships that must be managed primarily by the study participants and their proxies in the German setting. Study participants used different strategies to shape care relationships. This process is helped or hindered by healthcare institutions. Compared with concepts of patient-centred care, patients play a more active role in shaping relationships. To improve long-term care for chronic diseases, this needs to be taken into account.

Conclusion
Shaping relationships is a composite skill that includes engaging in and sustaining relationships, finding and using information and communication. This skill is essential for adequate long-term care after stroke.

Objectives
The inflammatory response from acute infection may trigger cardiovascular events. We aimed to estimate associations between microbiologically confirmed urinary tract infections (UTIs) and first acute myocardial infarction (MI) and stroke.

Design
We used a self-controlled case series, with risk periods 1–7, 8–14, 15–28 and 29–90 days after UTI. Included individuals experienced the outcome and exposure of interest and acted as their own controls.

Setting
We used individually linked general practice, hospital admission and microbiology data for the population of Wales held by the Secure Anonymised Information Linkage databank.

Participants
Included individuals were Welsh residents aged over 30 years with a record of a hospital admission for MI or stroke (outcomes) and evidence of a microbiologically confirmed UTI (exposure) during the study period of 1 January 2010 to 31 December 2020.

Main outcome measures
The primary outcome was acute MI or stroke identified using the International Classification of Disease V.10 codes from inpatient diagnoses recorded in the Patient Episode Database for Wales. We used Poisson regression to estimate incidence rate ratios (IRRs) and 95% CIs for MI and stroke during predefined risk periods, compared with baseline periods.

Results
During the study period, 51 660 individuals had a hospital admission for MI, of whom 2320 (4.5%) had 3900 microbiologically confirmed UTIs, and 58 150 had a hospital admission for stroke, of whom 2840 (4.9%) had 4600 microbiologically confirmed UTIs. There were 120 MIs during risk periods and 2190 during baseline periods, with an increased risk of MI for 1–7 days following UTI (IRR 2.49, 95% CI (1.65 to 3.77)). There were 200 strokes during risk periods and 2640 during baseline periods, with an increased risk of stroke for 1–7 days following UTI (IRR 2.34, 95% CI (1.61 to 3.40)).

Conclusions
UTI may be a trigger for MI or stroke. Further work is needed to understand mechanisms and test interventions to reduce the risk of cardiovascular events among people with UTIs in primary care.

Introduction
Direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prophylaxis in non-valvular atrial fibrillation. Yet, DOAC use is regarded as a contraindication for intravenous thrombolysis in acute ischaemic stroke. The stratification of patients into ‘on-therapy’ and ‘off-therapy’ categories based on their plasma DOAC concentrations is particularly crucial in the acute phase of stroke when decisions for thrombolysis or anticoagulation reversal are time-sensitive. The novel point-of-care DOAC dipstick assay (DOASENSE) rapidly assesses urine for clinically significant DOAC levels, potentially broadening eligibility for thrombolysis or targeted reversal therapy. This multicentre prospective observational registry study aims to evaluate the accuracy and clinical utility of DOAC dipstick testing compared with plasma DOAC assays in acute stroke management across regional Australian hospitals.

Methods and analysis
This multicentre, prospective, observational study will enrol participants presenting to hospitals across Victoria and Tasmania with acute ischaemic stroke or intracerebral haemorrhage with DOAC ingestion within 48 hours of presentation. Plasma DOAC concentrations measured by chromogenic assays will be compared with rapid urine dipstick results from DOASENSE testing. There is a target sample size of 146 participants. The primary outcomes are as follows: (1) proportion of ischaemic stroke participants with off-therapy plasma DOAC levels and (2) eligibility for reperfusion therapy based on DOASENSE and plasma DOAC concentrations. Secondary outcomes are follows: (1) ischaemic stroke aetiology for participants with on-therapy vs off-therapy DOAC levels; (2) proportion of participants meeting criteria for pharmacological DOAC reversal based on DOASENSE outcomes; (3) incidence of false-negative and false positive DOASENSE results in clinically significant DOAC plasma concentrations at a threshold of ≥30 ng/mL and (4) an exploratory analysis of any false negative DOASENSE assays to identify potential contributing factors.

Ethics and dissemination
Ethics approval has been granted by the Eastern Health Human Research Ethics Committee (reference number: 99628). Dissemination of findings will occur through peer-reviewed publications and academic conferences.

Objectives
Providing information about the process of poststroke recovery, and individuals’ likely outlook can be challenging for professionals, which may lead to avoidance of this important issue, leaving patients’ and carers’ needs unmet in relation to understanding their recovery. We aimed to understand professionals’ experiences and views of providing information about recovery in stroke units.

Design
Semistructured interviews were conducted as part of a wider ethnographic case study. A Framework approach to analysis was employed.

Setting
Two UK stroke units.

Participants
19 qualified stroke unit professionals with a range of experience levels participated, including doctors, physiotherapists, occupational therapists, speech and language therapists and a nurse.

Results
Three themes and seven subthemes were generated. Participants across disciplines perceived that discussing recovery could have important benefits, although many lacked guidance about their roles in this domain. Skills in predicting recovery and sharing these predictions were learnt experientially, and therapists reported a lack of preparatory training and confidence, resulting in perceptions of mixed experiences for patients. Many professionals were worried about the consequences of sharing personalised predictions, including the impact on patients’ hope and motivation, and their ability to manage patients’ and families’ emotional responses. These concerns could result in professionals experiencing negative psychological consequences, for which limited formal support was available.

Conclusions
Stroke unit professionals perceive that providing information about recovery, including individualised predictions, to patients and carers has important benefits; however, they require additional guidance, support and training to confidently engage in this important area of clinical practice.

Stroke, Ahead of Print. Microvascular reperfusion stands as a critical therapeutic objective in ischemic stroke management. Pericytes, specialized contractile mural cells enveloping cerebral capillaries, serve as master regulators of capillary tone and regional hemodynamics, exerting a profound influence on post-ischemic stroke blood flow dynamics. Despite their pivotal role in microcirculatory control, there are limited therapeutic targets specifically aimed at regulating their activity. Here, we summarize the multifaceted roles of pericytes in ischemic stroke and discuss various pericyte-related strategies for ischemic stroke. While these interventions offer some benefits, they also present notable limitations, including adverse reactions, structural instability, suboptimal efficacy, and challenges in clinical translation. Future efforts directed toward deciphering the spatiotemporal responses of pericytes across different ischemic phases and achieving their selective and effective regulation are expected to yield novel strategies for precision microcirculatory rehabilitation.

Stroke, Ahead of Print. Stroke significantly impacts mortality and long-term disability, necessitating effective rehabilitation strategies to enhance recovery. This review examines the roles of vagus nerve stimulation (VNS) and fastigial nucleus stimulation (FNS) in facilitating ischemic stroke recovery through brain-body interactions. VNS enhances ischemic stroke recovery by reprogramming microglia from proinflammatory (M1) to neuroprotective (M2) phenotypes, reducing neuroinflammation and promoting tissue repair via neurotrophic factors. It has shown promise in clinically improving chronic upper limb deficits when combined with rehabilitation therapies. Conversely, FNS provides cerebellar-mediated neuroprotection by mainly mitigating excitotoxic damage and inflammatory responses independent of cerebral blood flow alterations, as evidenced by preclinical models of middle cerebral artery occlusion. By integrating VNS-driven immunomodulation with FNS-mediated excitotoxicity suppression, this review highlights their synergistic potential to improve rehabilitation outcomes for ischemic stroke survivors. Biomarker-guided protocols: VNS for cortical/subcortical ischemic deficits and FNS for cerebellar network recovery are advocated to address postischemic disability via anti-inflammatory rewiring, neuroplasticity enhancement, and cerebellar-thalamocortical circuit stabilization. Critical gaps remain in hemorrhagic stroke, where FNS’s excitotoxicity suppression may destabilize clots, necessitating subtype-specific safety validations.

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.

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

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