International Journal Of Stroke[JOURNAL]
Sun
200 papers
Can immunization prevent stroke?
Markus HS
Int J Stroke · 2026 Apr · PMID 41873867 · Publisher ↗
Abstract loading — click title to view on PubMed.
Stroke and climate change: A World Stroke Organization scientific statement.
Saad A, Khan M, Estol C … +13 more , Wasay M, Kameda T, Ullberg T, Béjot Y, Ozturk S, Collantes ME, Zavaleta-Cortijo C, Kang J, Macmillan A, Kingston DG, Stephenson J, Reis J, Ranta A
Int J Stroke · 2026 Jul · PMID 41833557 · Full text
BACKGROUND: Climate change poses an escalating threat to global brain health and is increasingly linked to stroke incidence, outcomes, and inequities in prevention and treatment. This World Stroke Organization scientific...
BACKGROUND: Climate change poses an escalating threat to global brain health and is increasingly linked to stroke incidence, outcomes, and inequities in prevention and treatment. This World Stroke Organization scientific statement summarizes current evidence on the associations between stroke and the environmental variables exacerbated by climate change, with a focus on risk and outcomes. METHODS: We systematically identified and reviewed published studies assessing associations between stroke and environmental variables, including extreme temperatures, temperature variability, humidity, barometric pressure, wildfires, dust and sandstorms, and compound weather events. Air pollution, unrelated to wildfire exposure, was excluded, as a subsequent statement will focus on this. Paired reviewers screened titles and abstracts. Full texts were evaluated for study design, sample size, geographic context, and strength of evidence, with attention to impacts on vulnerable populations where data were available. Study type, exposure assignment, and strength of evidence were further confirmed by a team member with Master's level qualification in epidemiology. RESULTS: Most of the included studies were based on ecological designs. Cold exposure, temperature variability, and extreme thermal events were most consistently associated with increased stroke risk. Although cold effects were generally stronger than heat effects, heat effects have been increasing over time. Increased stroke incidence was also associated with low or varying barometric pressure, rapid humidity shifts, and exposure to wildfire smoke, dust, and sandstorms, particularly among older adults and those in low- and middle-income countries. Compound weather events, such as concurrent heat and humidity extremes, showed additive or synergistic effects on stroke incidence and mortality. Despite heterogeneity in definitions and methods and most evidence supporting associations rather than proving causation, the overall direction of evidence across exposures was positive, coherent, and biologically plausible. RECOMMENDATIONS: Advancing mitigation efforts that reduce greenhouse gas emissions is essential, since limiting further climate change directly decreases the environmental drivers of stroke risk and protects long-term population brain health, along with broader climate-related health risks. Stroke professionals and organizations can meaningfully contribute through local, regional, and global advocacy. Climate-related environmental variables already meaningfully increase stroke risk and exacerbate existing health inequities. To further counter these trends, stroke prevention and care systems should integrate climate risk awareness, patient education, and early-warning mechanisms into clinical practice and health system planning. Priority areas include targeted protection for vulnerable groups, standardized exposure metrics, longitudinal surveillance, systematized education on climate change's impact on brain health, and expansion of research in underrepresented regions. Strengthening global collaboration and embedding climate resilience into stroke systems of care are critical for reducing both stroke-related morbidity and the wider health impacts of a climate-impacted world. This scientific statement has been reviewed and approved by the WSO Executive.
Stroke during pregnancy and the postpartum period: A nationwide population-based study in South Korea.
Chung D, Ahn BR, Bushnell CD … +5 more , Lee JY, Mo H, Park HK, Rha JH, Yoon CW
Int J Stroke · 2026 Mar · PMID 41833554 · Publisher ↗
BACKGROUND: Pregnancy-associated stroke (PAS) is a rare but clinically important complication of pregnancy. Despite its clinical significance, nationwide data on PAS are lacking in South Korea, a representative country w...
BACKGROUND: Pregnancy-associated stroke (PAS) is a rare but clinically important complication of pregnancy. Despite its clinical significance, nationwide data on PAS are lacking in South Korea, a representative country with advanced maternal age. AIMS: This study aimed to investigate the incidence, temporal trends, and risk factors of PAS in South Korea. METHODS: We retrospectively analyzed nationwide data from the Korean National Health Insurance Service (NHIS) to identify women of reproductive age (15-49 years) who delivered between 2014 and 2021. PAS was defined as an ischemic or hemorrhagic stroke occurring during pregnancy or within 6 weeks postpartum. Multivariable logistic regression analysis was performed to identify independent predictors of PAS. RESULTS: Of 2,000,110 deliveries between 2014 and 2021, 909 first-ever strokes occurred during pregnancy or within 6 weeks postpartum, including 500 ischemic (55%) and 409 hemorrhagic (45%) strokes. The overall incidence of PAS was 45.6 per 100,000 deliveries (95% confidence interval (CI), 42.7-48.6) and increased from 41.5 in 2014 to 51.0 in 2021 (p = 0.049), mainly driven by ischemic stroke. PAS occurred predominantly during the postpartum period (p < 0.0001) and among older women (p for trend < 0.0001). In multivariable analysis, advanced maternal age (odds ratio [OR] per year, 1.02; 95% CI, 1.01-1.05), hypertension (OR, 2.04; 95% CI, 1.37-3.04), migraine (OR, 1.33; 95% CI, 1.02-1.74), gestational hypertension (OR, 1.49; 95% CI, 1.04-2.12), pre-eclampsia/eclampsia (OR, 5.00; 95% CI, 3.59-6.96), and peripartum cardiomyopathy (OR, 14.26; 95% CI, 4.48-45.42) were identified as independent predictors of PAS. CONCLUSION: The incidence of PAS is increasing in South Korea, with advanced maternal age, vascular risk factors, and pregnancy-related complications serving as independent predictors. These findings emphasize the importance of clinical awareness and the identification of women at high risk of PAS.
Endovascular thrombectomy for acute ischemic stroke with large infarct in randomized trials versus clinical practice: Comparison of the TENSION trial and the German Stroke Registry.
Winkelmeier L, Flottmann F, Thomalla G … +14 more , Bendszus M, Kniep H, Bechstein M, Heitkamp A, Geest V, Jungnitz M, Meucci L, Schlicht F, Hanning U, Schell M, Fiehler J, Heitkamp C, TENSION Investigators, GSR-ET Investigators
Int J Stroke · 2026 Mar · PMID 41833549 · Publisher ↗
BACKGROUND: Randomized trials have shown that endovascular thrombectomy improves functional outcomes in patients with acute ischemic stroke and large infarct. However, there is continued debate about the generalizability...
BACKGROUND: Randomized trials have shown that endovascular thrombectomy improves functional outcomes in patients with acute ischemic stroke and large infarct. However, there is continued debate about the generalizability of these results to routine clinical practice. AIMS: To investigate whether functional outcomes reported in the randomized TENSION trial can be achieved in routine clinical practice. METHODS: TENSION was a prospective, multicenter, randomized trial that enrolled patients with acute ischemic stroke and large infarct at 41 centers across Europe and Canada. Patients were randomized to endovascular thrombectomy or best medical treatment. The main inclusion criteria of TENSION were defined as pre-stroke mRS 0-2, randomization within 11 hours of symptom onset, occlusion of the intracranial ICA or M1 segment of the MCA, ASPECTS 3-5, and baseline NIHSS score 0-25. Patients from the thrombectomy arm of TENSION (TENSION-RCT) were compared to patients from the German Stroke Registry meeting the main inclusion criteria of TENSION (TENSION-GSR) using 1:1 propensity score matching. Primary outcome was the 90-day mRS score (shift analysis). RESULTS: Of 308 patients who met the inclusion criteria, 198 were matched (median age, 74 [IQR, 64-81]; 98 [49.5%] female; median 90-day mRS, 5 [IQR, 3-6]). There was no significant shift in 90-day mRS scores between TENSION-RCT and TENSION-GSR (acOR, 1.19; 95% CI, 0.70-2.02; = 0.52). The proportions of independent ambulation (90-day mRS 0-3; 33.3% vs 31.3%, = 0.76) and severe disability or death (90-day mRS 5-6; 50.5% vs 52.5%, = 0.78) did not differ between TENSION-RCT and TENSION-GSR. CONCLUSION: Functional outcomes of the TENSION thrombectomy arm are achievable within comprehensive stroke centers in Germany. These findings support endovascular thrombectomy for acute ischemic stroke with large infarct and its broad implementation in routine care. DATA AVAILABILITY: The data that support the findings of this study are available upon reasonable request after approval of the steering committees of the TENSION trial and the GSR-ET.
Estimated lithium exposure in drinking groundwater and stroke risks in the United States.
Luo J, Jin Z, Yang Y … +4 more , Olopade CS, Ahsan H, Pinto JM, Aschebrook-Kilfoy B
Int J Stroke · 2026 Mar · PMID 41775701 · Publisher ↗
BACKGROUND: Lithium, a naturally occurring element in drinking water, has demonstrated beneficial effects for stroke in prior research, yet its relationship with stroke risk in the general population remains uncertain. A...
BACKGROUND: Lithium, a naturally occurring element in drinking water, has demonstrated beneficial effects for stroke in prior research, yet its relationship with stroke risk in the general population remains uncertain. AIMS: To evaluate the association between environmental lithium exposure and stroke risk. METHODS: We assessed environmental lithium exposure across the United States using monitoring data of 4700 wells for drinking groundwater from the US Geological Survey. Ecological and individual-level analyses were conducted. Ecological associations between county-level lithium concentration and stroke mortality (2015-2019) were evaluated in 3108 counties using multivariable linear regression adjusted for county-level socioeconomic factors. Individual-level associations were examined in 303,153 adults (⩾35 years old) from the All of Us Research Program with electronic health records followed up through 1 October 2023 using stratified Cox models adjusted for individual-level sociodemographic, behavioral, and clinical factors. Lithium was analyzed per interquartile range (IQR) increase and by quartiles. RESULTS: In ecological analysis, each IQR increase in lithium exposure corresponded to 8.2 fewer stroke deaths per 100,000 population (95% confidence interval (CI) = -9.8, -6.5). Compared with the lowest quartile (⩽ 6.6 µg/L), the highest quartile (> 23.3 µg/L) showed 22.6 fewer deaths per 100,000 (95% CI = -27.4, -17.8); middle quartiles were not associated. In All of Us, each IQR increase was associated with a 23% lower incident stroke risk (hazard ratio (HR) = 0.77, 95% CI = 0.66, 0.90). The highest exposure quartile (> 17.7 µg/L) had a 52% lower risk (HR = 0.48, 95% CI = 0.34, 0.67) versus the lowest; the second (HR = 1.23, 95% CI = 0.73, 2.09) and third (HR = 0.92, 95% CI = 0.50, 1.69) quartiles showed non-significant associations. Results were robust to alternate exposure windows and residential stability restrictions. CONCLUSION: Higher naturally occurring lithium concentrations in US groundwater are associated with reduced stroke mortality and incidence, whereas low-to-moderate levels confer no benefit.
Prevalence, time-course and predictors of depression after transient ischemic attack: A systematic review, meta-analysis, and validation.
McColl AJ, Pendlebury S, Rothwell PM
Int J Stroke · 2026 Mar · PMID 41775680 · Publisher ↗
BACKGROUND: Depression is common after stroke and is associated with increased mortality. However, there are few data on the prevalence after transient ischemic attack (TIA), and it is unclear whether TIA can trigger dep...
BACKGROUND: Depression is common after stroke and is associated with increased mortality. However, there are few data on the prevalence after transient ischemic attack (TIA), and it is unclear whether TIA can trigger depression and, if so, what factors might suggest susceptibility in an individual. METHODS: We completed a systematic review (Medline/PsycINFO/EMBASE searched to 20 March 2025) of published cross-sectional or cohort studies that reported the prevalence of depression at any time point after a TIA and validated the findings in a population-based cohort (Oxford Vascular Study; OXVASC). Pooled prevalence rates were calculated, risk factors reported and regression analyses were used to determine the proportion of between-study heterogeneity that could be accounted for by study methodology. RESULTS: The search identified 26 studies; 23 reported data at a uniform time point after the TIA but the prevalence rates of depression were highly heterogeneous at each time point studied ( < 0.001 at <1, 1-6 and 12 months). However, among studies with serial assessments (196 patients from four published longitudinal studies and 478 from OXVASC) there was less heterogeneity and the pooled prevalence of depression fell from 20.1% (16.9%-23.4%; = 0.35) at 0-1 month to 14.1% (11.5%-16.7%; = 0.40) at 3-12 months ( = 0.004). In the few studies that reported risk factors for depression after a TIA, younger age was the only consistent predictor, but this was similarly validated in the OXVASC population. On regression analysis for heterogeneity, 83% of the variance in prevalence rates between studies was explained by assessment method (postal questionnaire: 5.6%, 95% CI 3.1-8.1 vs face-to-face interview 17.7%, 13.7-21.7; < 0.001), the screening tool used, TIA definition and exclusion criteria. A model, based on these study methods in published studies, predicted a prevalence rate of 22.1% in OXVASC, which was close to the observed rate of 20.7% at 1 month validating the findings. CONCLUSIONS: Depression affects about 1-in-5 patients early after a TIA but prevalence falls with time, suggesting that it may be triggered by the event in some cases, but further work is required to identify risk factors. In addition, when planning future research, investigators must remain cognizant of the significant influence that study design has on the observed prevalence rates.
Long-term risk of bleeding events in patients taking antithrombotic agents for cerebrovascular or cardiovascular disease.
Yoshimura S, Miwa K, Koga M … +18 more , Tanaka K, Yagita Y, Nagakane Y, Hoshino H, Terasaki T, Shiozawa M, Iguchi Y, Arakawa S, Fujimoto S, Okada Y, Ihara M, Takahashi S, Doijiri R, Sasaki M, Yakushiji Y, Hirano T, Toyoda K, for BAT2 Investigators
Int J Stroke · 2026 Feb · PMID 41757707 · Publisher ↗
BACKGROUND: Antithrombotic agents are essential for preventing cerebrovascular and cardiovascular diseases; however, bleeding complications remain a major concern, particularly among elderly patients and those receiving...
BACKGROUND: Antithrombotic agents are essential for preventing cerebrovascular and cardiovascular diseases; however, bleeding complications remain a major concern, particularly among elderly patients and those receiving combination therapy. AIMS: We designed the Bleeding with Antithrombotic Therapy 2 (BAT2) Study, a prospective multicenter registry involving hospitals from a clinical research network in Japan, to clarify the risk of bleeding events in patients taking antithrombotic agents for cerebrovascular and cardiovascular diseases in recent clinical settings. METHODS: This prospective, multicenter, observational study followed bleeding and ischemic events for up to 2 years in patients with cerebrovascular and cardiovascular diseases. The primary outcome was major bleeding, and secondary outcomes included intracranial hemorrhage (ICH). RESULTS: The 5250 patients enrolled comprised 3134 (70 ± 11 years; male, 66.6%; HASBLED ⩾ 3, 32.8%) treated with single antiplatelet therapy (SAPT), 551 (71 ± 11 years; 25.8%; 40.8%, respectively) with dual antiplatelet therapy (DAPT), 870 (75 ± 10 years; 37.1%; 39.8%, respectively) with direct oral anticoagulant (DOAC) alone, 433 (72 ± 12 years; 34.2%; 41.4%, respectively) with warfarin alone, 143 (76 ± 8 years; 16.8%; 42.7%, respectively) with DOAC plus antiplatelet agents (AP), and 119 (73 ± 12 years; 18.5%; 47.5%, respectively) with warfarin plus AP. During follow-up (median, 1.98 years), 93 patients experienced major bleeding, and 55 developed ICH. Compared with the SAPT group (37 events, 0.63%/year), the DOAC (18 events, 1.12%/year; adjusted hazard ratio (aHR) = 1.94, 95% confidence interval (CI) = 1.09-3.46), warfarin (16 events, 2.02%/year; 3.44, 1.90-6.23), and DOAC plus AP groups (six events, 2.24%/year; 3.07, 1.28-7.35) exhibited significantly higher risks of major bleeding after multivariable adjustment. DAPT (aHR 2.47, 95% CI = 1.11-5.48), warfarin (5.38, 2.65-10.92), and DOAC plus AP (3.86, 1.30-11.47) had significantly higher risks of ICH than SAPT. The DAPT (2.28, 95% CI = 1.65-3.14), DOAC plus AP (1.96, 1.08-3.56), and warfarin plus AP (2.83, 1.62-4.92) groups showed significantly higher risks of ischemic events than the SAPT group. CONCLUSION: Oral anticoagulant alone and DOAC with antiplatelet therapy were associated with higher risks of major bleeding events than SAPT in long-term follow-up for patients with stroke and cardiovascular disease.
Sex, gender, and stroke and early neurological deterioration after stroke.
Markus HS
Int J Stroke · 2026 Mar · PMID 41736466 · Publisher ↗
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Climate change and cerebrovascular diseases: A narrative review with Brazilian regional analysis.
Rodrigues DLG, Andrade JBC, Santos JPND … +2 more , Russo AC, Sampaio Silva G
Int J Stroke · 2026 Feb · PMID 41731311 · Publisher ↗
BACKGROUND: Climate change is reshaping environmental exposures, which in turn influence cerebrovascular diseases. Brazil's continental dimensions and climate diversity offer a unique opportunity to examine climate-strok...
BACKGROUND: Climate change is reshaping environmental exposures, which in turn influence cerebrovascular diseases. Brazil's continental dimensions and climate diversity offer a unique opportunity to examine climate-stroke associations within a unified healthcare system. Such regional analyses may inform adaptation strategies for other low-and middle-income countries facing similar environmental challenges. METHODS: A literature search was conducted across the PubMed, Scopus, and Web of Science databases, covering publications from January 2000 through August 2025 linking climate exposures to cerebrovascular outcomes. To examine climate-stroke associations, we analyzed national mortality data (DATASUS, 2020-2023) for Brazil's five geographic regions, yielding 127,424 stroke deaths (I61-I62, I63 + I65-I66). FINDINGS: Global evidence consistently demonstrates nonlinear, asymmetric associations between temperature extremes and stroke risk (relative risk (RR) = 1.06-1.18 for extreme heat/cold, p < 0.05), with PM conferring both short-term (RR = 1.01, 95% confidence interval (CI) = 1.004-1.012 per 10 µg/m) and long-term risks (hazard ratio (HR) = 1.11-1.21, p < 0.001). Brazilian analysis revealed climate-dependent patterns: cooler southern temperate regions showed higher ischemic-to-hemorrhagic stroke ratios (2.28:1, 70% ischemic) compared to hotter tropical regions (1.28:1 in Centro-Oeste, 56% ischemic). Both ischemic (Pearson r = -0.70, p = 0.001) and hemorrhagic (Pearson r = -0.65, p = 0.002) stroke deaths demonstrated negative associations with peak temperatures across pooled observations. INTERPRETATION: Stroke should be recognized as a climate-sensitive non-communicable disease. Global evidence demonstrates robust associations between temperature and stroke, while preliminary Brazilian regional patterns suggest potential climate influence on the distribution of stroke subtypes. Key priorities include establishing linkages between daily weather observations and atmospheric pollutant measurements, establishing multi-center surveillance networks, strengthening climate-resilient stroke care systems, and reducing PM through environmental regulation as a stroke-prevention strategy.
High ambient temperature, humidity, heat index, and stroke risk in a Mediterranean region.
Negev M, Paz S, Vered S … +2 more , Kloog I, Weinstein G
Int J Stroke · 2026 Feb · PMID 41731310 · Publisher ↗
BACKGROUND: Studies assessing the relationship between high ambient temperatures and stroke risk yielded conflicting results, while potential associations of humidity and heat stress with stroke risk remain underexplored...
BACKGROUND: Studies assessing the relationship between high ambient temperatures and stroke risk yielded conflicting results, while potential associations of humidity and heat stress with stroke risk remain underexplored. OBJECTIVE: To explore the association of ambient temperature, humidity, and heat index (HI) with the risk of total stroke (combined ischemic-intracerebral hemorrhage [ICH]), ischemic stroke (IS), ICH, and transient ischemic attack (TIA) among older adults during the warm season in the Mediterranean region. METHODS: In this time-stratified case-crossover study, we utilized data from the Israeli National Stroke Registry. We included all first stroke and TIA events among individuals aged ⩾18 years that occurred during the warm season (2014-2019). Temperature and relative humidity were assessed using high-resolution satellite-based models and monitoring stations, respectively, based on patients' residential addresses. A heat index (HI) was calculated based on a combination of temperature and relative humidity data. Conditional logistic regression models with Distributed Lag Non-Linear Models (DLNMs) were used with adjustment for potential confounders, including air pollution. The HI models were stratified by participants' demographic and health characteristics. RESULTS: The sample included 22,269 individuals with a first stroke (mean age 72 ± 14 years; 55% males) and 8728 individuals with a first TIA (mean age 69 ± 14 years; 52% males) during the warm season. Higher temperature (32°C vs. 27°C), particularly on the stroke event date, was associated with increased risk of total stroke (odds ratio (OR) = 1.32; 95% confidence interval (CI) = 1.23-1.41). The strongest association for relative humidity (90% vs. 70%) was observed 2 days before the stroke event (OR = 1.09; 95% CI = 1.06-1.12). An HI of 100°F was associated with an approximately 40% higher risk of total stroke compared to HI of 80°F on the event day (OR = 1.39; 95% CI = 1.32-1.47). Associations were slightly weaker for ICH, possibly reflecting its relatively smaller sample size, whereas associations with TIA were similar in magnitude to those observed for IS. No evidence of effect modification was observed across subgroups defined by sociodemographic characteristics or comorbidities. SIGNIFICANCE: High temperatures combined with high humidity are associated with an immediate increase in the risk of stroke and TIA, even in a region where the population is acclimatized and most buildings are air-conditioned. Preparedness and prevention strategies may be crucial for reducing stroke risk during periods of heat stress.
Association of acute kidney injury with in-hospital outcomes among patients hospitalized for stroke: A nationwide study.
Xie S, Pruijm M, Marques-Vidal P
Int J Stroke · 2026 Feb · PMID 41731307 · Publisher ↗
BACKGROUND: Acute kidney injury (AKI) is a common and serious complication in hospitalized patients and an important determinant of outcomes in stroke. However, evidence from long-term, nationwide studies in this populat...
BACKGROUND: Acute kidney injury (AKI) is a common and serious complication in hospitalized patients and an important determinant of outcomes in stroke. However, evidence from long-term, nationwide studies in this population remains limited. AIMS: To examine temporal trends, factors associated with AKI, and clinical outcomes among patients hospitalized for stroke in Switzerland from 1998 to 2022. METHODS: We analyzed nationwide Swiss hospital discharge data from 1998 to 2022, covering over 98% of all hospitals. Stroke and AKI were identified using ICD-10 codes. Multivariable logistic and linear regression models were used to assess factors associated with AKI and its associations with intensive care unit (ICU) admission, length of stay, ICU duration, and in-hospital mortality. RESULTS: Among 439,465 stroke hospitalizations, 7674 (1.7%) were coded with AKI. The prevalence of coded AKI increased from below 1% in 1998 to approximately 4% in 2022, while overall in-hospital mortality declined from 10.4% to 5.1%. In multivariable regression, factors independently associated with AKI included older age, emergency admission, diabetes, hypertension, atrial fibrillation, heart failure, and chronic kidney disease, whereas female sex was associated with lower odds of AKI. AKI was associated with higher odds of ICU admission (OR 1.62; 95% CI 1.53-1.71), longer hospital stay (coefficient 0.12; 95% CI 0.11-0.14), and prolonged ICU duration (coefficient 0.33; 95% CI 0.28-0.37). In-hospital mortality was more than twice as high in patients with AKI (OR 2.40; 95% CI 2.25-2.56). The association between AKI and adverse in-hospital outcomes was stronger among male, younger, and non-CKD patients. Outcomes were worst among hospitalizations involving dialysis, with AKI associated with a markedly higher adjusted predicted probability of in-hospital mortality (0.47 vs 0.15 without dialysis). CONCLUSION: AKI was associated with greater ICU use, longer hospital stay, and higher in-hospital mortality among patients hospitalized for stroke.
Validation and simplification of the MR PREDICTS @24H model for outcome prediction after endovascular thrombectomy for acute ischemic stroke.
Li X, Roozenbeek B, van Walsum T … +8 more , Bos D, van der Worp HB, Emmer BJ, Majoie CB, van Oostenbrugge RJ, Dippel DW, Lingsma HF, ICAI Stroke Lab
Int J Stroke · 2026 Feb · PMID 41731306 · Publisher ↗
BACKGROUND: Outcome prediction after endovascular thrombectomy (EVT) for ischemic stroke is important for patient counseling and rehabilitation planning. MR PREDICTS @24H, a nine-predictor model, showed excellent perform...
BACKGROUND: Outcome prediction after endovascular thrombectomy (EVT) for ischemic stroke is important for patient counseling and rehabilitation planning. MR PREDICTS @24H, a nine-predictor model, showed excellent performance in predicting functional outcome at 90 days of patients with acute ischemic stroke. With the expanding treatment indications, we validated the model for patients receiving EVT within 24 hours after stroke onset and simplified it for easier clinical implementation. METHODS: We used individual patient data from the Dutch MR CLEAN Registry (2014-2018), a prospective observational cohort enrolling patients treated with EVT, and three randomized controlled trials MR CLEAN-MED, MR CLEAN-NOIV, and MR CLEAN-LATE (2018-2022). We included patients with an intracranial large-vessel occlusion in the anterior circulation treated with EVT within 24 hours of symptom onset or last seen well. We assessed the effect of predictors on functional outcome (modified Rankin Scale [mRS]) at 90 days with ordinal logistic regression. Predicted probabilities of functional independence (mRS 0-2) and survival (mRS 0-5) were derived from the model formula. We evaluated predictive performance with discrimination (C statistic) and calibration (intercept, slope). The model was simplified by excluding predictors based on the Akaike information criterion (AIC). We applied leave-one-study-out cross-validation to evaluate heterogeneity in model performance between the cohorts. RESULTS: The validation cohort included 6154 patients: 4737 from the Registry and 1417 from the trials. External validation of the original model showed excellent discrimination in predicting functional independence (C statistic 0.91, 95% CI 0.90-0.92) and survival (C statistic 0.90, 95% CI 0.89-0.91). The simplified model, comprising four predictors-NIHSS at 24 hours after EVT, age, pre-stroke mRS, and symptomatic intracranial hemorrhage-performed comparably (functional independence C statistic 0.91, 95% CI 0.90-0.92; and survival 0.89, 95% CI 0.88-0.90). Cross-validation revealed heterogeneity between LATE and the other cohorts, with the model overestimating the probability of functional independence in LATE (observed 39.1% vs predicted 44.2%), whereas the observed and predicted probability of survival was similar (75.5% vs 75.7%). CONCLUSIONS: A simplified version of MR PREDICTS @24H including only four predictors performed as good as the full model, providing a practical tool that can be applied one day after EVT for reliable outcome estimation. Further validation and updating of the model are needed for patients treated in the late time window (6-24 h).
Atrial fibrillation detection after embolic stroke of undetermined source: Development and validation of the CATCH-AF score.
D'Anna L, Favruzzo F, Baracchini C … +36 more , Pes A, Mag Uidhir F, Rosin D, Valente M, Gigli GL, Zhang L, Leung N, Sohal M, Sacco S, Ornello R, De Santis F, Coppola U, Prandin G, Romoli M, Tudisco V, Sepe FN, Guan J, Barnard A, Jeffrey L, Dagan J, Dolkar T, Syed I, Banerjee S, Edwards S, Safak C, Avila R, Cruz J, Laurie A, Desai G, Haneef M, Idian A, Chandratheva A, Lim PB, Merlino G, Foschi M, Simister R
Int J Stroke · 2026 Feb · PMID 41721212 · Publisher ↗
BACKGROUND: Embolic stroke of undetermined source (ESUS) accounts for up to one quarter of ischemic strokes, with occult atrial fibrillation (AF) as a key underlying cause. Implantable cardiac monitors (ICMs) markedly im...
BACKGROUND: Embolic stroke of undetermined source (ESUS) accounts for up to one quarter of ischemic strokes, with occult atrial fibrillation (AF) as a key underlying cause. Implantable cardiac monitors (ICMs) markedly improve AF detection but are limited by cost and resource demands. Existing AF-prediction models show modest accuracy and lack longitudinal validation. We developed and validated the CATCH-AF score to provide a simple, clinically applicable tool for stratifying early and long-term AF risk after ESUS. METHODS: We analyzed 543 consecutive ESUS patients systematically monitored with ICMs. Variable selection used LASSO-penalized Cox regression. Model performance was assessed with time-dependent ROC curves, restricted mean survival time (RMST) analysis, and 10-fold cross-validation. To evaluate geographic generalizability, internal-external cross-validation was performed across seven participating centers, estimating discrimination and calibration for each held-out cohort. Based on the final multivariable model, a point-based score was derived including age, coronary artery disease, heart failure, and prior transient ischemic attack or ischemic stroke. RESULTS: During 1558.5 patient-years of follow-up, 118 patients (22%) developed new AF. The CATCH-AF score showed excellent discrimination (AUC 0.85, 95% CI 0.82-0.89), stable over 4.5 years (0.84-0.87). Compared with low-risk patients (0-2 points), those at high risk (⩾5 points) had a 19-fold higher hazard of AF detection (HR 19.2, 95% CI 9.4-39.4; < 0.001) and 918 fewer AF-free days (95% CI -1080 to -757). CONCLUSIONS: The CATCH-AF score provides a robust, interpretable, and easily applicable tool for predicting AF after ESUS, supporting targeted and cost-effective rhythm monitoring.
Long-term outcomes and complications of cerebral venous sinus thrombosis: Findings from the Vellore CVT registry.
Aaron S, Miraclin T A, Sulthana M … +19 more , Gowri M, Asokan P, Bal D, Ninan GA, Selvaganesan S, Jasper A, Vanjare HA, Mannam P, Babu K B S, Keshava NS, Nair S, Abhilash KPP, Nair AV, Mani AM, Iqbal Ahmed SA, Benjamin RN, Mathew V, At P, Sivadasan A
Int J Stroke · 2026 Feb · PMID 41700644 · Publisher ↗
BACKGROUND: Although short-term outcomes are generally favorable in Cerebral venous sinus thrombosis (CVT), there are limited data on long-term complications and sequelae. METHODS: This ambispective study is from the Vel...
BACKGROUND: Although short-term outcomes are generally favorable in Cerebral venous sinus thrombosis (CVT), there are limited data on long-term complications and sequelae. METHODS: This ambispective study is from the Vellore CVT Registry, the largest single-center CVT registry in the world. Two thousand four hundred and eighty-four adults with CVT enrolled between 2000 and 2024 were analyzed for functional status and complications with follow-up up to 12 years. RESULTS: Of 2484 patients, 2380 (95.8%) survived the acute phase, with a mean follow-up of 3.2 years (range, 0-12 years). During follow-up, 41 patients (1.7%) died, the majority being within 1 year. Excellent functional outcomes (mRS ⩽ 2) were achieved by 92% of patients within 2 years. Complications were observed in 799 (33.5%) at follow-up, of whom 405 (50.6%) required rehospitalization. More than half (55.1%) of these complications occurred more than 2 years after the initial diagnosis of CVT. Common complications were seizures (9.6%) and headaches (7.7%). Bleeding events occurred in 3.9% of cases, predominantly due to anticoagulant use. Recurrent CVT developed in 1.3%, and other thrombotic events in 2.4%. Occurrences of malignancies (1%) and secondary dural arteriovenous fistulas (dAVFs) (0.6%) were significant complications that occurred after 2 years. Of the 108 pregnancies that occurred during follow-up, thrombotic events occurred in 2.7% in the absence of antithrombotic prophylaxis. CONCLUSIONS: Most patients with CVT achieve long-term functional independence, yet one-third develop delayed complications. These findings underscore the importance of long-term surveillance in CVT survivors and give important insights into the natural history of CVT.
Efficacy and safety of intravenous anticoagulation for noncardioembolic stroke: An analysis of data from the Japan Stroke Data Bank.
Itabashi R, Yoshimura S, Koga M … +14 more , Nakai M, Wada S, Miyamoto Y, Matsumoto K, Yagita Y, Inaba M, Katayama M, Yazawa Y, Hatano T, Yoshida Y, Kamiyama K, Ogasawara K, Toyoda K, Minematsu K
Int J Stroke · 2026 Feb · PMID 41700624 · Publisher ↗
BACKGROUND: The benefits of parenteral anticoagulation in noncardioembolic stroke are still unclear. AIMS: The aim of this study was to clarify the association between intravenous anticoagulation (IVAC) and clinical outc...
BACKGROUND: The benefits of parenteral anticoagulation in noncardioembolic stroke are still unclear. AIMS: The aim of this study was to clarify the association between intravenous anticoagulation (IVAC) and clinical outcome in patients with acute noncardioembolic stroke. METHODS: The study had an observational design and analyzed data from the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database. A total of 33,184 patients were identified to have presented with acute noncardioembolic stroke between 2017 and 2020. After exclusion of patients with incomplete IVAC data, those with a premorbid modified Rankin Scale (mRS) score of 3-5, those who received thrombolysis or endovascular therapy, and those with atrial fibrillation, we examined the association between IVAC and clinical outcomes, including mRS score at discharge and the frequency of severe bleeding episodes during hospitalization. RESULTS: In total, 8967 patients were enrolled. The mean age was 71.8 ± 12.3 years, 64.9% were male, and the median initial National Institutes of Health Stroke Scale score was 2. Of these 8967 patients, 5708 (63.7%) received IVAC, 6425 (71.6%) had mRS score of 0-2 at discharge, and 33 (0.4%) experienced severe bleeding. In multivariable logistic regression analysis, IVAC was associated with lower odds of mRS 0-2 at discharge (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.73-0.94) but not with severe bleeding (OR 0.94, 95% CI 0.45-1.99). In subgroup analysis, a significant interaction (p < 0.001) indicated effect modification by dual antiplatelet therapy (DAPT) status, with a stronger association between IVAC and reduced odds of mRS 0-2 in patients not receiving DAPT. CONCLUSIONS: In this Japanese cohort, although assessed at discharge, IVAC was associated with lower odds of favorable early outcome after noncardioembolic stroke, likely influenced by selection bias, and the safety findings were inconclusive due to the small number of events.
Aneurysm treatment within 24 h versus 24-72 h after aneurysmal subarachnoid hemorrhage.
An X, Che S, Zhang L … +9 more , Wang R, Wang Z, Wang B, Zhang H, Guo Y, Yang X, Li S, Sun X, Guo F
Int J Stroke · 2026 Feb · PMID 41700617 · Publisher ↗
BACKGROUND: High-quality evidence comparing surgical strategies within 0-24 h and 24-72 h after aneurysmal subarachnoid hemorrhage (aSAH) remains limited. This study aimed to systematically evaluate surgical safety and l...
BACKGROUND: High-quality evidence comparing surgical strategies within 0-24 h and 24-72 h after aneurysmal subarachnoid hemorrhage (aSAH) remains limited. This study aimed to systematically evaluate surgical safety and long-term outcomes across these two critical time windows. METHODS: Patients with aSAH undergoing aneurysm surgery within 72 h were consecutively enrolled from 12 tertiary centers in northern China between January 2017 and December 2020. A 1:1 propensity score matching (PSM) adjusted for intergroup differences, and a generalized estimating equation (GEE) model accounted for hospital-level clustering. Outcomes were compared between the 0-24 h and 24-72 h groups. Kaplan-Meier curves assessed survival, Cox models identified mortality risk factors, and logistic regression determined predictors of 2-year dependency. RESULTS: A total of 3560 patients were included. After PSM, 1329 patients in the 0-24 h group were matched with 1329 in the 24-72 h group. There were no significant differences in 2-year mortality (12.3% vs 10.8%, p = 0.49), dependency at discharge (21.0% vs 18.4%; adjusted odds ratio (OR) = 0.815, 95% confidence interval (CI) = 0.649-1.024, p = 0.079), or 2-year dependency (10.6% vs 9.3%; adjusted OR = 0.896, 95% CI = 0.636-1.264, p = 0.533). Compared with the 0-24 h group, the 24-72 h group had lower in-hospital mortality (3.8% vs 1.1%; adjusted OR = 0.503, 95% CI = 0.349-0.723, p < 0.001), rebleeding (3.6% vs 1.9%; adjusted OR = 0.489, 95% CI = 0.299-0.801, p = 0.004), and stress ulcer bleeding (8.7% vs 4.9%; adjusted OR = 0.811, 95% CI = 0.713-0.922, p = 0.001). Risk factors for mortality and 2-year dependency differed between groups. CONCLUSION: Surgery within 24 h of onset showed similar long-term outcomes compared with treatment at 24-72 h, but in-hospital mortality and some hemorrhage-related complications differed. Risk factor analysis may provide guidance for individualized treatment strategies.
Stroke and HIV: Emerging mechanisms and management in a changing epidemic.
Phiri TE, Holroyd KB, Bernard Healey SA … +2 more , Mallon DH, Benjamin LA
Int J Stroke · 2026 Feb · PMID 41644514 · Publisher ↗
BACKGROUND: Stroke is increasingly recognized as an important cause of morbidity and mortality in people living with HIV (PLWH). Although advances in antiretroviral therapy (ART) have transformed HIV into a chronic condi...
BACKGROUND: Stroke is increasingly recognized as an important cause of morbidity and mortality in people living with HIV (PLWH). Although advances in antiretroviral therapy (ART) have transformed HIV into a chronic condition, cerebrovascular complications remain common and often underrecognized. AIMS: This review summarized current understanding of the pathogenesis, clinical features, investigations, and management of stroke in PLWH, highlighting knowledge gaps and priorities for future research. SUMMARY OF EVIDENCE: HIV-associated stroke is multifactorial. Mechanisms include HIV-associated vasculopathy, opportunistic infections, immune reconstitution inflammatory syndrome (IRIS), and traditional vascular risk factors accelerated by HIV and ART. Clinical presentations may resemble those in HIV-negative individuals but occur at a younger age, with distinct subtype distributions and a higher frequency of concomitant infection. Investigation requires a tiered approach: standard stroke imaging and cardiac work-up, supplemented by cerebrospinal fluid analysis and advanced vessel wall imaging in patients with suspected inflammatory or infectious etiology. Reperfusion therapies appear feasible in stable HIV disease, but evidence remains limited. Outcomes are shaped by immune status, access to care, and comorbidities, with higher recurrence and cognitive decline reported in several cohorts. Real-world challenges include stigma, clinician awareness gaps, and inequities in diagnostics and treatment, particularly in low-resource settings. CONCLUSIONS: Stroke in PLWH is an emerging global health challenge. Clinicians should maintain a high index of suspicion in younger patients and those with advanced disease or recent ART initiation. Multidisciplinary care pathways and equitable access to diagnostics and secondary prevention are essential. Future research must address unresolved questions around vasculopathy, IRIS, small vessel disease, and long-term cognitive outcomes to guide evidence-based management.
Lesion network mapping for post-stroke cognitive impairment.
Zhou Y, Wang Y, Jing J … +5 more , Li J, Liu H, Wang Y, Liu T, Li S
Int J Stroke · 2026 Feb · PMID 41644505 · Publisher ↗
BACKGROUND: While infarcts and white matter hyperintensities (WMHs) are critical determinants of post-stroke cognitive impairment (PSCI), their comprehensive network disconnection mechanisms remain poorly characterized....
BACKGROUND: While infarcts and white matter hyperintensities (WMHs) are critical determinants of post-stroke cognitive impairment (PSCI), their comprehensive network disconnection mechanisms remain poorly characterized. AIMS: This study aimed to systematically map the functional and structural network disconnection patterns underlying PSCI, elucidate the relationship between network disconnection and cognitive status-particularly the mediating role of WMH-and identify potential neuromodulation targets based on the disconnection maps. METHODS: In a cohort of 376 mild-to-moderate first acute ischemic stroke patients without pre-stroke dementia, we employed connectome-based lesion-symptom mapping (CLSM) to construct comprehensive disconnection maps derived from infarct and WMH lesions. The distinctiveness was validated against an independent cohort of 78 cerebral small vessel disease patients. CLSM-derived lesion impact scores were analyzed using regression models to assess their domain-specific cognitive relationships and using mediation modeling to quantify the mediating effects of WMH. Potential neuromodulation targets were subsequently identified based on the disconnection patterns. RESULTS: Results revealed that spatially heterogeneous infarcts and WMH converge on functionally/structurally coherent disconnection patterns through distinct pathological mechanisms, with attention and processing speed (APS) deficits emerging as the most sensitive domain. Lesion impact scores were significantly correlated with cognitive deficits and demonstrated greater predictive contribution for 3-month cognitive outcomes than traditional volumetric measures. WMH-induced disconnections significantly mediated the relationship between infarct and PSCI/APS deficits. The left temporo-parieto-occipital junction could be considered a potential neuromodulation target for PSCI. CONCLUSION: This study establishes a network-level pathophysiological framework for PSCI, demonstrating distinct yet synergistic roles of acute and chronic vascular lesions.
Net water uptake (NWU) in stroke imaging: A review of applications in patient selection for emerging neuroprotective therapies.
Broocks G, Minnerup J, Kemmling A
Int J Stroke · 2026 Feb · PMID 41641798 · Publisher ↗
Net water uptake (NWU) is an emerging quantitative imaging biomarker for assessing cerebral edema in acute ischemic stroke. By quantifying the increase in brain water content within ischemic regions on computed tomograph...
Net water uptake (NWU) is an emerging quantitative imaging biomarker for assessing cerebral edema in acute ischemic stroke. By quantifying the increase in brain water content within ischemic regions on computed tomography (CT), NWU offers a direct assessment of edema formation and its temporal evolution. Unlike conventional imaging markers such as infarct volume or ASPECTS, NWU provides specific information about the degree of tissue injury, which is a key determinant of clinical outcome. Observational studies have demonstrated that higher NWU is associated with malignant edema, hemorrhagic transformation, and worse functional outcomes, and that lower NWU may identify patients more likely to benefit from reperfusion and anti-edema therapies. This narrative review, based on a structured PubMed search of CT-based NWU studies in acute ischemic stroke, summarizes the technical methods for measuring NWU, its pathophysiological basis, and its potential clinical applications. We discuss the use of NWU for predicting outcomes, identifying patients at risk for malignant edema and hemorrhagic transformation, and selecting patients for emerging neuroprotective therapies. We also highlight the potential role of NWU in extending treatment windows and monitoring treatment response. Finally, we address the practical limitations of NWU, including situations in which reliable quantification is not feasible, and outline future directions for validation in multi-center cohorts and clinical trials before NWU-based thresholds can be adopted for routine decision-making.
Sex differences in the clinical and surgical management after intracerebral hemorrhage: A post hoc analysis of the INTERACT3 clinical trial.
Allende MI, Carcel C, Muñoz-Venturelli P … +21 more , Harris K, Ouyang M, Ma L, Chen X, Billot L, Li Q, Malavera A, Li X, de Silva A, Nguyen TH, Wahab KW, Pandian JD, Wasay M, Pontes-Neto OM, Abanto C, Arauz A, You C, Hu X, Song L, Anderson CS, INTERACT3 Investigators
Int J Stroke · 2026 Feb · PMID 41641790 · Publisher ↗
INTRODUCTION: As the management of intracerebral hemorrhage (ICH) shifts from historical inertia to more proactive, evidence-based care, ensuring sex-equitable access to best-practice stroke care is increasingly importan...
INTRODUCTION: As the management of intracerebral hemorrhage (ICH) shifts from historical inertia to more proactive, evidence-based care, ensuring sex-equitable access to best-practice stroke care is increasingly important. Data on sex differences in access to care for ICH remains limited and often conflicting. More robust evidence is required to understand where disparities may exist to inform targeted interventions. AIMS: We aimed to determine sex differences in the clinical and surgical management of patients with acute ICH who participated in the third Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3). METHODS: We performed a post hoc analysis of INTERACT3, an international stepped-wedge, cluster-randomised trial undertaken in 121 hospitals across 9 low- to middle-income countries and 1 high-income country. The trial aimed to evaluate a care bundle composed of intensive blood-pressure lowering, rapid correction of hyperglycemia, fever control, and reversal of anticoagulation; in adults presenting within 6 h of ICH onset. We used mixed-effects logistic regression to evaluate sex differences in access to surgical interventions, admission to an intensive care unit or acute stroke unit, assisted feeding, physiotherapy, occupational therapy, withdrawal of care, and use of pharmacological therapies (antiepileptic drugs, mannitol, dexamethasone, and statins). Patterns of care were further evaluated using latent class analysis, with sex differences analyzed using the same regression framework. RESULTS: Of 7036 patients with ICH, 2533 (36%) were female. Females were older and had more severe neurological deficits. Overall care provision was similar across sexes. However, females were more likely to receive assisted feeding (odds ratio [OR] 1.15, 95% CI = 1.02-1.31), and were less likely to withdraw from active care (OR 0.41, 95% CI = 0.19-0.87) than males. Surgical interventions were accessed at similar rates among sexes, a finding that persisted in analyses restricted to supratentorial ICH with hematoma volumes ⩾ 30 mL. Three distinct care classes were identified: high-intensity, high-rehabilitation, and low-intensity, with females and males having comparable distributions within the classes. CONCLUSION: Following acute ICH, females generally receive similar active acute care interventions as males, except for observed differences in access to assisted feeding and decision to withdraw from active care. These findings suggest that equal access to ICH interventions for females and males is feasible and exists in some settings. However, disparities in certain key interventions remain and present actionable opportunities for improvement. Further research is needed to explore not only access but also the timing and frequency of these interventions.Data access statement:Individual, de-identified participant data used in these analyses will be shared on request from any qualified investigator after the approval of a protocol and signed data access agreement via both the trial steering committee and the research office of The George Institute for Global Health (Sydney, NSW, Australia).
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