International Journal Of Stroke[JOURNAL]
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200 papers
Efficacy of five strategies to improve stroke action awareness in Spanish-speaking adults: A randomized comparison.
Marquez-Romero JM, Sánchez-Ramírez KI, Pérez-Malagón CD … +4 more , Padilla-López J, Ford GA, Zhao J, Liu R
Int J Stroke · 2026 Mar · PMID 40884082 · Full text
BACKGROUND AND AIMS: Improving stroke action awareness is challenging in non-English-speaking populations. In this study, we evaluated the effectiveness of five Spanish-language educational tools in improving recognition...
BACKGROUND AND AIMS: Improving stroke action awareness is challenging in non-English-speaking populations. In this study, we evaluated the effectiveness of five Spanish-language educational tools in improving recognition and making an emergency response to stroke symptoms among Spanish-speaking adults in Mexico. METHODS: Spanish-speaking participants were recruited from public spaces. Individuals with a history of stroke were excluded. Participants were randomly assigned to receive an educational session tailored to one of five stroke awareness tools (RAPIDO, DALE, CAMALEON, CORRE, and ICTUS 911). Stroke knowledge was assessed using the Stroke Awareness Questionnaire before the educational intervention and after 6-9 days of follow-up. The primary outcome was the change in the proportions of correctly identified stroke symptoms. Secondary outcomes included changes in participants' achievement of adequate stroke knowledge in individual FAST domains and their understanding of the appropriate actions to take after identifying stroke symptoms. RESULTS: In data from 435 participants, all strategies improved stroke symptom recognition and risk factor awareness, although no statistically significant differences were observed in the primary outcomes. Changes ranged from 0.35 (DALE) to 0.49 (CAMALEON) for Facial Weakness, the symptom with the largest improvement, and from 0.00 (CAMALEON, CORRE, RAPIDO) to 0.15 (DALE) for Problems with Vision, the symptom with the smallest improvement. For the secondary outcomes, increases in adequate stroke knowledge ranged from 0.18 (CORRE, DALE) to 0.31 (ICTUS 911); between-group comparisons were statistically significant (p = 0.027). Improvements in appropriate action after symptom recognition ranged from 0.09 (RAPIDO) to 0.29 (ICTUS 911), with significant differences across groups (p = 0.034). CONCLUSIONS: This study shows that brief educational interventions can improve stroke symptom recognition and intended response in Spanish-speaking adults. Among five strategies, ICTUS 911 yielded the largest short-term gains, supporting its potential utility. Further research is needed to assess long-term effectiveness and broader applicability.
Natural history and outcomes of deep-seated brain arteriovenous malformations: A propensity score matched analysis using nationwide multicenter prospective registry data.
Wang C, Wang B, Han H … +15 more , Ma L, Li R, Li Z, Zhang H, Yuan K, Li A, Zhu Q, Su Y, Gao D, Jin H, Li Y, Sun S, Zhao Y, Chen Y, Chen X
Int J Stroke · 2026 Mar · PMID 40856357 · Publisher ↗
OBJECTIVES: This study aims to evaluate the natural history of deep-seated brain arteriovenous malformation (AVMs), as well as the risk-benefit outcomes of interventional treatment versus conservative management. MATERIA...
OBJECTIVES: This study aims to evaluate the natural history of deep-seated brain arteriovenous malformation (AVMs), as well as the risk-benefit outcomes of interventional treatment versus conservative management. MATERIALS & METHODS: Patients with deep-seated AVMs were selected from a nationwide prospective multicenter registry study in China (the MATCH study), and univariate and multivariate analyses were conducted to identify factors associated with AVM rupture. In the analysis of outcomes, propensity score matching (PSM) was performed between the interventional and conservative treatment groups, adjusting for baseline differences. The primary outcomes were hemorrhagic stroke or death, while the secondary outcomes focused on obliteration rates and neurological status. Subgroup and sensitivity analyses were conducted, incorporating various study designs to assess the robustness and consistency of the results. RESULTS: Among 4286 consecutive AVM cases registered from August 2011 to December 2021, 1057 (24.7%) were classified as deep-seated AVMs. The natural annualized rupture risk before the treatment decision is 5.58%. The independent risk factors for rupture included diffuse lesions (aOR: 1.79 [1.29-2.49]), single drainage (aOR: 1.88 [1.20-2.93]), and drainage stenosis (aOR: 2.33 [1.44-3.75]). In the analysis of outcomes, 883 cases maintained continuous follow-up (128 conservative management, 755 intervention). After PSM, there were 119 cases in each group. After a median follow-up duration of 4.34 (1.72, 7.23) years in the intervention group, 47.93% achieved complete obliteration, with an annualized rupture risk of 4.82%. Compared to conservative management, intervention was associated with a higher rate of hemorrhagic stroke or death (AR: 3.85 [1.84-5.86] per 100 person-year, < 0.001; HR: 4.862 [1.869-12.651] < 0.001) and higher obliteration rates (OR: 108.56 [14.57-809.01], < 0.001). No significant differences were observed in terms of neurological functional outcomes. In a further analysis stratified by interventional strategies, embolization and multimodality treatment significantly increased the risk of hemorrhagic stroke or death compared with conservative treatment (embolization: HR: 4.414 [95% CI, 1.642-11.867]; multimodality treatment: HR, 6.238 [95% CI, 2.146-18.136]), while microsurgical resection and stereotactic radiosurgery did not. Subgroup and sensitivity analyses showed consistent trends, though with slight differences in statistical power. CONCLUSION: This study indicates that in deep-seated AVMs, interventional treatment is associated with an increased risk of hemorrhagic stroke or death. However, the negative effect may result from the adverse effects of embolization and multimodality treatment, whereas microsurgical resection and stereotactic radiosurgery did not.
C-REGS2-A multinational, high-quality comparative effectiveness study of Cerebrolysin in moderate acute ischemic stroke.
Vosko MR, Sanak D, Do Y … +5 more , Vatanagul JS, Roushdy T, Bornstein NM, Vester JC, Brainin M
Int J Stroke · 2025 Oct · PMID 40851188 · Full text
BACKGROUND: The main objective of the Cerebrolysin REGistry Study in Stroke 2 (C-REGS2) was to systematically record the routine clinical use of Cerebrolysin in patients with moderate ischemic stroke (IS) following the p...
BACKGROUND: The main objective of the Cerebrolysin REGistry Study in Stroke 2 (C-REGS2) was to systematically record the routine clinical use of Cerebrolysin in patients with moderate ischemic stroke (IS) following the principles of a prospective controlled effectiveness study (CES) to compare its effectiveness in terms of functional recovery to patients treated with standard therapy alone. METHODS: C-REGS2 used an open-label, prospective controlled comparative effectiveness design aligning with the Target Trial Emulation Framework (TTEF) and the GRACE principles for high-quality observational studies based on the principles of high-quality comparative effectiveness research (HQCER) to capture treatment effects in clinical practice. The study was conducted in 16 countries worldwide between April 2018 and April 2024. Moderate IS was defined as baseline NIH Stroke Scale (NIHSS) score 8-15. Treatment modalities and concomitant medications were according to local standards. The methodology included rigorous pre-specified analysis and tight risk-based centralized monitoring, to ensure minimal enrollment bias, maximize data quality and overall reliability of trial results. The compared patient groups were standardized using a restricted cohort design and non-parametric multilevel stratification following the Good Research for Comparative Effectiveness (GRACE) principles. The primary endpoint was ordinal analysis of the modified Rankin Scale (mRS) at 90 days after stroke onset. Secondary endpoints were the ordinal NIH Stroke Scale (NIHSS) at day 21 and 90 after stroke onset, the ordinal mRS at 21 days after IS, the proportion of patients with excellent recovery (mRS 0-1) as well as the proportion of patients with functional independence (mRS 0-2) at 90 days after stroke onset and the ordinal analysis of Montreal Cognitive Assessment (MoCA) scale at 90 days after IS. RESULTS: Out of 1865 enrolled patients, the target population (TP) comprised 1769 patients (1021 Cerebrolysin-treated and 748 controls). The median NIHSS at baseline was 10.0. Median Cerebrolysin dose was 30 ml, median treatment duration was 10 days. Cerebrolysin was superior to standard therapy in the primary endpoint independently to prior thrombolysis (MW 0.6157; confidence interval (CI) 0.5910-0.6404; P < 0.0001) as well as in all secondary endpoints: mRS at day 21 (MW 0.6065, 95% CI 0.5811-0.6319, P < 0.0001), NIHSS at day 21 (MW 0.5792; 95% CI 0.5576-0.6008; P < 0.0001) and NIHSS at day 90 (MW 0.5781; CI 0.5561-0.6002; P < 0.0001). Additional pre-specified secondary endpoints (proportion of patients with excellent recovery and functional independence) showed moderate superiority for Cerebrolysin. The ordinal MoCA showed superiority for Cerebrolysin in the TP (MW 0.5530; CI 0.5282-0.5778; P < 0.0001) with more pronounced effects in the subgroup with cognitive impairments at baseline (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) ⩾ 3.3). No differences in safety measures were recorded. The study is notable for its robust data integrity, with valid entries of 90.9% for the primary 90 day mRS assessment with multilevel case mix standardization and an overall dropout rate to the final visit of only 5.7%. CONCLUSION: The results of the C-REGS2 study showed the effectiveness and safety of Cerebrolysin treatment for moderate acute IS in real-world clinical practice.
Multi-population genome-wide association study identifies multiple novel loci associated with asymptomatic intracranial large artery stenosis.
Liu M, Khasiyev F, Spagnolo-Allende A … +18 more , Sanchez DL, Andrews H, Yang Q, Beiser A, Qiao Y, Romero JR, Rundek T, Brickman AM, Manly JJ, Elkind MS, Seshadri S, Chen C, Del Brutto OH, Hilal S, Wasserman BA, Tosto G, Fornage M, Gutierrez J
Int J Stroke · 2026 Apr · PMID 40851121 · Publisher ↗
INTRODUCTION: Intracranial large artery stenosis (ILAS) is one of the most common causes of stroke worldwide and is associated with the risk for future vascular events. Asymptomatic ILAS is a frequent finding on neuroima...
INTRODUCTION: Intracranial large artery stenosis (ILAS) is one of the most common causes of stroke worldwide and is associated with the risk for future vascular events. Asymptomatic ILAS is a frequent finding on neuroimaging and shares many risk factors with atherosclerotic vascular disease. Whether asymptomatic ILAS is driven by genetic variants is not well-understood. METHODS: This study included 4960 participants from seven geographically diverse population-based cohorts (34% Whites, 16% African Americans, 22% Hispanics, 24% Asians, 5% native Ecuadorians). We defined asymptomatic ILAS as luminal stenosis >50% in any large brain artery using time-of-flight magnetic resonance angiography. RESULTS: A genome-wide association study revealed one variant in (rs75615271; odds ratio (OR), 1.22 (1.11-1.33); = 4.85×10) associated with global ILAS at genome-wide significance ( < 5×10). Gene-based association analysis identified a gene-set enriched in chr1q32 region, including , , , , and , in global ILAS ( = 1.34 ×10) and anterior ILAS ( = 1.77 ×10). DISCUSSION AND CONCLUSION: This study reveals one variant rs75615271 and a gene-set enriched in chr1q32 region associated with asymptomatic ILAS in a multi-population. Further functional studies may help elucidate the role that this variant plays in the pathophysiology of asymptomatic ILAS.
High-density lipoprotein cholesterol levels and their impact on outcomes in acute ischemic stroke patients treated with mechanical thrombectomy.
D'Anna L, Foschi M, Valente M … +12 more , Sacco S, Del Regno C, De Negri I, Toraldo F, Mare A, Sponza M, Gavrilovic V, Lobotesis K, Pirera E, Gigli GL, Banerjee S, Merlino G
Int J Stroke · 2026 Mar · PMID 40851120 · Full text
BACKGROUND: High-density lipoprotein cholesterol (HDL-C) is traditionally considered protective in cardiovascular disease, but its role in acute ischemic stroke (AIS) remains unclear, particularly in patients undergoing...
BACKGROUND: High-density lipoprotein cholesterol (HDL-C) is traditionally considered protective in cardiovascular disease, but its role in acute ischemic stroke (AIS) remains unclear, particularly in patients undergoing mechanical thrombectomy (MT). This study aimed to assess the association between HDL-C levels and clinical outcomes in AIS patients treated with MT for anterior circulation large vessel occlusion (LVO). METHODS: We conducted a multicentre, observational, post hoc analysis of AIS patients treated with MT between January 2016 and March 2023 across three stroke centers. HDL-C levels at admission were categorized, and outcomes included 90-day functional dependence (mRS: 3-6), symptomatic intracranial hemorrhage (sICH), hemorrhagic transformation, and 90-day mortality. We used logistic regression with restricted cubic splines to define an HDL-C threshold associated with increased risk and applied inverse probability weighting (IPW) to adjust for confounding. RESULTS: Among 2166 patients (median age: 71 years; 52.3% female), HDL-C levels > 1.33 mmol/L were independently associated with a higher risk of poor functional outcome at 90 days (risk ratio (RR): 1.72, 95% confidence interval (CI): 1.55-1.90), increased odds of sICH (RR: 2.3, 95% CI: 1.64-3.12), and higher mRS shift (OR: 2.10, 95% CI: 1.79-2.46). Subgroup analyses revealed significant sex-specific differences, with women at greater risk of adverse outcomes at higher HDL-C levels. CONCLUSION: Elevated HDL-C levels (>1.33 mmol/L) are associated with worse functional outcomes and increased hemorrhagic complications following MT for anterior circulation AIS.
Intracranial arterial calcification as a marker of stroke risk and worse stroke outcomes in adults: A systematic review and meta-analysis.
Elsheikh S, McKeever S, Irving GJ … +3 more , Hill AM, Lip GY, Abdul-Rahim AH
Int J Stroke · 2026 Mar · PMID 40847365 · Publisher ↗
BACKGROUND: Intracranial arterial calcification (ICAC) is common, but data on its impact on future stroke risk and outcomes remain limited. We conducted a systematic review and meta-analysis to investigate the associatio...
BACKGROUND: Intracranial arterial calcification (ICAC) is common, but data on its impact on future stroke risk and outcomes remain limited. We conducted a systematic review and meta-analysis to investigate the association of ICAC with stroke risk and outcomes. METHODS: We searched three multidisciplinary databases from inception to July 2025. We selected studies that investigated incidence of stroke and its outcomes in patients with ICAC. We assessed the studies' risk of bias using the Newcastle Ottawa Quality Assessment Scale. Statistical analysis was conducted using Cochrane Review Manager (RevMan 5.4). RESULTS: After reviewing 660 citations, we selected 94 studies for full-text screening. We extracted data from a total of 20 studies, reporting outcomes on 14,599 patients. Overall, the risk of bias was low. The included studies were heterogeneous, with varying outcomes assessed and differing measures of associations reported. ICAC was associated with an increased risk of ischaemic stroke, with a pooled odds ratio (OR) of 2.28 (95% confidence interval (CI): 1.39-3.73), and one study reported a hazard ratio (HR) of 1.49 (95% CI: 1.24-1.78). ICAC also showed a trend toward increased mortality, with a pooled OR 1.40 (95% CI: 0.96-2.05) and high heterogenicity across the studies (I² = 65%). The pooled HR per 1-standard deviation (1-SD) increase in ICAC was 1.25 (95% CI: 1.10-1.42), with low heterogenicity (I² = 1%) between 2 studies reporting the HR. CONCLUSIONS: ICAC is significantly associated with an increased risk of stroke as well as a trend toward increased mortality (PROSPERO ID: CRD42023414813).
Interaction of CYP2C19 with the effect of clopidogrel in secondary prevention of major ischemic events: Systematic review and meta-analysis.
Kremers FC, van den Biggelaar J, Lingsma HF … +3 more , van Schaik RH, Roozenbeek B, Dippel DW
Int J Stroke · 2026 Mar · PMID 40844153 · Full text
BACKGROUND AND AIMS: Clopidogrel may be a less effective antiplatelet agent for secondary prevention after cardiovascular events in carriers of the CYP2C19 Loss of Function (LoF) allele. Randomized controlled trials (RCT...
BACKGROUND AND AIMS: Clopidogrel may be a less effective antiplatelet agent for secondary prevention after cardiovascular events in carriers of the CYP2C19 Loss of Function (LoF) allele. Randomized controlled trials (RCTs) of clopidogrel in patients with known CYP2C19 carrier status have provided inconsistent results. This meta-analysis aims to pool evidence on the effect of different antiplatelet strategies on outcomes according to CYP2C19 LoF status. METHODS: We conducted a systematic review and meta-analysis of RCTs to evaluate the interaction of CYP2C19 LoF allele on clopidogrel versus placebo or other antiplatelet agents in patients with cardiovascular disease or transient ischemic attack (TIA) or ischemic stroke. Primary outcomes were major adverse cardiovascular events (MACEs) including ischemic stroke, with major bleeding events assessed as a safety outcome. Random effects analysis estimated pooled odds ratios for LoF carriers and non-carriers. RESULTS: Fifteen RCTs with 35,189 participants in total were included. When all interaction effects are pooled, the occurrence of MACE was 1.29 times higher in LoF variant carriers compared to non-carriers for clopidogrel treatment (p-interaction = 0.01). Risk of MACE was 1.20 times higher in LoF carriers compared to non-carriers when clopidogrel was compared to placebo (p-interaction = 0.13). In TIA or minor stroke patients, the interaction effect was 1.63 times larger (p-interaction = 0.02). Clopidogrel was less effective than prasugrel for MACE occurrence (1.57 times higher, p-interaction = 0.02) and ticagrelor (1.21 times higher, p-interaction = 0.19) in CYP2C19 LoF variant carriers. Bleeding outcomes were similar across groups. CONCLUSION: Clopidogrel is less effective in patients with CYP2C19 LoF genotype and cardiovascular disease, minor stroke, or TIA. The size and direction of the interaction warrant further research into the role of LoF genotypes and the cost-effectiveness of genetic testing. Prasugrel may be a more effective alternative for CYP2C19 LoF carriers.Registration-URL:https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021242993.
A scoping review of community-based stroke rehabilitation in low-resource settings.
Hardianto Y, Lynch E, Irwan AM … +9 more , Kandasamy T, Purvis T, Callisaya ML, Lindley RI, Gandhi D, Liu N, Abd Aziz NA, Pandian J, Cadilhac DA
Int J Stroke · 2026 Feb · PMID 40778608 · Full text
BACKGROUND: There is a need for accessible and affordable rehabilitation services in low-resource settings (low- and middle-income countries) to support the increasing number of survivors of stroke. AIMS: To synthesize e...
BACKGROUND: There is a need for accessible and affordable rehabilitation services in low-resource settings (low- and middle-income countries) to support the increasing number of survivors of stroke. AIMS: To synthesize existing literature on the delivery of community-based stroke rehabilitation programs in low-resource settings. SUMMARY OF REVIEW: We followed the PRISMA Scoping Review guidelines. Seven databases (including MEDLINE, PsycINFO, and CINAHL) were searched to identify relevant articles published between January 2012 and December 2024. Studies were considered if they included physical rehabilitation strategies as part of a community-based rehabilitation program for individuals with stroke aged ⩾18 years in low-resource settings. Titles, abstracts, and full texts were screened by multiple authors for inclusion. A predefined template that covered physical rehabilitation strategies, setting, providers, frequency, session duration, and program duration was used for data extraction. Results were synthesized narratively. After screening 2892 abstracts, 25 studies were included from 11 countries throughout Asia, Africa, and South America. Most studies were carried out in middle-income countries, with only one study taking place in a low-income country (Uganda). Over half of the studies (n = 16) were randomized controlled trials (RCTs). The physical rehabilitation programs were primarily delivered at home, in person, by a single healthcare professional, typically a physiotherapist or nurse. Session duration was not specified for more than half of the studies. Where reported, sessions were 1 h or less, usually occurring at least once weekly over a 2-to-3-month period. Over 36 different outcome measures were identified, with the Barthel Index being the most common (48%). Overall, 10 RCTs showed a statistically significant difference between intervention and control groups, while five RCTs had no significant difference at the post-intervention outcome evaluation. None of the included publications reported costs or cost-effectiveness data. CONCLUSION: Community-based rehabilitation programs in low-resource settings differ in their physical rehabilitation strategies and characteristics. While the evidence base in this field is growing, the lack of cost-effectiveness evaluations means there is limited guidance to inform investment in, or optimization of, these multi-component, community-based programs.
Clinical and safety outcomes following endovascular treatment for large ischemic core stroke with Alberta Stroke Program Early Computed Tomography Score 3-5 in the 12-to 24-h time window.
Nguyen TQ, Nguyen KV, Tran HTM … +28 more , Pham BN, Truong ALT, Le TQ, Duong HQ, Nguyen TT, Do BTT, Nguyen LC, Ha DT, Nguyen TTN, Bach DT, Nguyen NT, Tran VT, Le TVS, Do HQ, Nguyen HTB, Huynh HQ, Dang HQ, Chiem DN, Pham TNT, Doan HTM, Hoang DCB, Ngo TTK, Dang HM, Phan B, Chen Y, Nguyen TN, Nguyen TB, Nguyen TH
Int J Stroke · 2026 Feb · PMID 40778607 · Publisher ↗
INTRODUCTION: Although the efficacy and safety of endovascular treatment (EVT) for large-core ischemic stroke have been proven, most trials used perfusion imaging or included early-window patients, limiting generalizabil...
INTRODUCTION: Although the efficacy and safety of endovascular treatment (EVT) for large-core ischemic stroke have been proven, most trials used perfusion imaging or included early-window patients, limiting generalizability to the late window, particularly in developing countries. AIM: We aimed to evaluate the safety and functional outcomes of EVT in large-core stroke patients treated between 12 and 24 h (late window) from last known well (LKW). METHODS: We conducted a prospective, multicenter observational study across four comprehensive stroke centers in Vietnam, enrolling consecutive patients who underwent EVT within 24 h of symptom onset between August 2023 and September 2024. Large core was defined by an Alberta Stroke Program Early CT Score (ASPECTS) of 3 to 5 on non-contrast computerized tomography (NCCT) or diffusion-weighted magnetic resonance imaging (DWI-MRI). Patients who underwent EVT within 12-24 h after LKW were compared to those treated before 12 h (early window). Primary and safety outcomes were independent ambulation (90-day modified Rankin scale (mRS) = 0-3) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were 90-day mRS 0-2, ordinal mRS, successful reperfusion (modified Thrombolysis in Cerebral Infarction score ⩾2b, early neurological deterioration (END)), and 90-day mortality. RESULTS: Of 1872 patients receiving EVT, 343 with large ischemic cores (median age = 64.0 years, 33.8% female) were included, with 103 (30.0%) treated in the 12- to 24-h window. Compared to early-window patients, late-window patients had lower rates of intravenous thrombolysis (2.9% vs. 32.9%, p < 0.001), higher brain MRI use (51.5% vs. 16.2%, p < 0.001), and longer pre-treatment imaging-to-groin puncture times (106 vs. 77 min, p < 0.001). After adjusting for confounders, there were no significant differences in 90-day mRS 0-3 (56.3% vs. 55.0%, adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.39-1.28, p = 0.26), ordinal mRS (aOR = 1.21, 95% CI = 0.78-1.90, p = 0.39), and sICH (aOR = 1.12, 95% CI = 0.32-3.50, p = 0.85). Other secondary outcomes were also similar. CONCLUSION: In patients with anterior circulation large vessel occlusion stroke and low ASPECTS, EVT at 12-24 h versus <12 h from symptom onset showed no significant differences in clinical or safety outcomes. Larger trials are needed to confirm these findings, especially in developing regions.
Clinical features, including atypical symptoms, associated with acute cerebral ischaemia on DWI-MRI in suspected TIA and minor stroke.
Gallogly PC, Hassan J, Lee C … +5 more , Cousins J, Best J, Jäger HR, Werring DJ, Chandratheva A
Int J Stroke · 2026 Mar · PMID 40778605 · Publisher ↗
BACKGROUND AND AIMS: The diagnosis of transient ischaemic attack (TIA) and minor stroke can be challenging. Current diagnostic criteria for TIA disqualify atypical clinical presentations which may nevertheless be associa...
BACKGROUND AND AIMS: The diagnosis of transient ischaemic attack (TIA) and minor stroke can be challenging. Current diagnostic criteria for TIA disqualify atypical clinical presentations which may nevertheless be associated with objective cerebral ischaemia on diffusion weighted imaging-magnetic resonance imaging (DWI-MRI). We aimed to (1) ascertain the proportion of DWI-positive patients with atypical clinical presentations and (2) identify clinical factors predicting DWI positivity. METHODS: We retrospectively reviewed case notes of consecutive patients with suspected TIA or minor stroke undergoing MRI at our comprehensive stroke center. We identified clinical factors predicting DWI positivity using multivariable logistic regression. RESULTS: We included 1615 patients. Of 442 (27.4%) who were DWI-positive, 38.5% had atypical presentations; common symptoms included headache (present in 17%), unsteadiness (15%), positive sensory symptoms (11%), presyncope (10%), confusion (9%), and vertigo (8%). Symptoms independently associated with DWI positivity included weakness (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.01-1.67), dysarthria (OR: 2.05, CI: 1.56-2.70), and ataxia (OR: 3.76, CI: 2.27-6.21). Fluctuating symptoms (present in 21.5%) predicted DWI positivity (OR: 1.37, CI: 1.04-1.81), but sudden onset (80.1%) did not (OR: 1.05, CI: 0.80-1.38). Risk factors associated with DWI positivity included increasing age (OR: 1.02/year, CI: 1.01-1.02), hypertension (OR: 1.61, CI: 1.23-2.11), diabetes (OR: 1.40, CI: 1.04-1.90), and smoking (OR: 1.67, CI: 1.17-2.37). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p = <0.001). CONCLUSION: Over one-third of people with MRI-DWI-confirmed TIA or minor stroke present with atypical symptoms. MRI-DWI is essential to diagnose cerebral ischaemia in patients with atypical symptoms, particularly in those with vascular risk factors.
Associations between systolic blood pressure and infarct growth after thrombectomy for acute stroke: A retrospective observational study.
Sakamoto Y, Aoki J, Nishi Y … +10 more , Shoda S, Sakamoto M, Suzuki K, Katano T, Kutsuna A, Kimura R, Watanabe K, Sakuragi C, Shimoyama T, Kimura K
Int J Stroke · 2026 Feb · PMID 40762308 · Publisher ↗
BACKGROUND: The optimal blood pressure control strategy after mechanical thrombectomy (MT) is not well understood, especially for patients with successful recanalization. We hypothesized that low systolic blood pressure...
BACKGROUND: The optimal blood pressure control strategy after mechanical thrombectomy (MT) is not well understood, especially for patients with successful recanalization. We hypothesized that low systolic blood pressure (SBP) after MT is associated with infarct growth (IG), even in patients with successful recanalization. AIMS: The aim of the present study was to clarify the relationships between IG and SBP parameters in patients treated with MT. METHOD: Consecutive acute stroke patients who underwent emergent MT from September 2014 through December 2019 were retrospectively enrolled. Diffusion-weighted imaging (DWI) was performed on admission and approximately 24 h after the procedure. IG was calculated as the difference between infarct volume on 24-h DWI and initial DWI. SBP from recanalization to 24-h DWI was used. The associations between IG and SBP parameters, including maximum, minimum, and mean SBPs and coefficient of variation (CV) of SBPs, were evaluated with multiple regression analyses. RESULTS: A total of 377 MT cases (225 male (60%), median age = 76 (interquartile range (IQR) = 68-83) years, median National Institutes of Health Stroke Scale (NIHSS) score = 17 (10-23), median onset to initial DWI time = 131 (79-350) min) were enrolled in this study. Successful recanalization modified the association between SBP parameters and IG (p for interaction < 0.05). In cases with successful recanalization (n = 314), SBP was recorded 7007 times between recanalization and 24-h follow-up magnetic resonance imaging (MRI). Minimum SBP from recanalization to 24-h DWI (standardized coefficient = -0.144, 95% confidence interval (CI) -0.269 to -0.019, p = 0.024, i.e. low minimum SBP was associated with higher IG) and CV of SBP (0.122, 0.003 to 0.241, p = 0.045) were independently associated with IG, even after adjusting for various factors including age, sex, initial NIHSS score, baseline infarct volume, and symptomatic intracerebral hemorrhage. CONCLUSION: Minimum SBP and CV of SBP after recanalization were associated with IG in consecutive acute stroke patients who underwent successful MT. IG is a sensitive imaging marker for evaluating the effect of post-procedural SBP, and extremely low SBP after MT should be avoided to mitigate IG.
Estimating annual deaths from stroke in adults under 70 years of age in Freetown Sierra Leone: A comparative analysis of a hospital-based stroke register and a population-based verbal autopsy study.
Youkee D, Soley-Bori M, Deen GF … +7 more , Jha P, Assalif A, Wolfe C, Sackley C, Conteh Z, Fox-Rushby J, Marshall I
Int J Stroke · 2026 Jan · PMID 40762290 · Full text
BACKGROUND: In Sub-Saharan Africa (SSA), most stroke epidemiological data comes from hospital-based registers, which are prone to selection bias, and data may be unrepresentative of stroke burden at the population level....
BACKGROUND: In Sub-Saharan Africa (SSA), most stroke epidemiological data comes from hospital-based registers, which are prone to selection bias, and data may be unrepresentative of stroke burden at the population level. The degree of incompleteness and bias in hospital-based registers has been assessed in high-income countries but not in an SSA country. AIMS: The study describes and compares estimates of annual deaths from stroke under 70 years of age, from a hospital-based stroke register and a population-based verbal autopsy (VA) study. We describe the sociodemographic and clinical differences between patients captured and those missed by a hospital-based register and estimate the completeness of a hospital-based register in Sierra Leone. METHODS: We compared people under 70 years of age who died from stroke in the Stroke in Sierra Leone (SISLE) prospective longitudinal hospital-based register to the Healthy Sierra Leone (HEAL-SL) population-based VA study which sampled 2.5% of households in the Western Area. We included participants from SISLE and HEAL-SL who died within the same dates (1st May 2019 until 30th September 2021) and geographical area. We conducted data linkage using probabilistic matching and manual clerical review by two authors. To assess selection bias, we used univariable analysis to identify variables associated with capture by the hospital register. To estimate annual deaths from stroke, two-source capture-recapture analysis was conducted using the Lincoln-Petersen-Chapman estimator. Estimates of completeness were adjusted for undermatching and for the positive predictive value of VA for stroke diagnosis. Deaths rates from stroke were calculated as deaths per 100,000 individuals, with population estimates sourced from the 2021 Mid-term Population and Housing Census. RESULTS: A total of 345 participants were identified in the SISLE dataset, 46 in the VA dataset, and 4 in both datasets. Excluding individuals captured in both datasets, individuals identified by VA had a mean age of 58 years compared to 55 years in SISLE ( = 0.07), 59.5% were male compared to 50.7% in SISLE ( = 0.28), and 52.3% had no formal education compared to 39.0% ( = 0.09) in SISLE. Individuals identified by VA were more likely to be employed 36.7% vs 59.5% ( = 0.002), were less likely to have sought formal healthcare 48.5% vs 100% ( < 0.001), more likely to have died suddenly 14.3% vs 4.1% ( < 0.001), and less likely to have died in hospital 19.0% vs 67.5%. Estimates of annual deaths from stroke using capture-recapture methods ranged from 41 to 106/100,000. The completeness of SISLE register for fatal stroke ranged from 10.6% (95% CI: 9.6%-11.7%) to 27.2% (95% CI: 24.8%-30.0%). DISCUSSION: In this setting, a hospital-based stroke register underestimated deaths from stroke in adults younger than 70 years to a much greater degree than estimates from high-income country settings. For people who died from SISLE, employed people, people who did not seek formal healthcare, and people who died within 24 hours were less likely to be included in the hospital-based stroke register. Investment in routine death registration systems and population-based stroke surveillance is essential to provide accurate estimates of population-level stroke burden in our setting.
Decompressive craniectomy versus best medical treatment alone for spontaneous intracerebral hemorrhage: A systematic review and meta-analysis.
de Oliveira RR, Silva YP, Ansari YZ … +9 more , Maximiano MLB, Brenner LBO, Petry INS, Han ML, Monteiro JDS, Dias da Silva RL, Cavalcanti LNC, Gonçalves OR, Fagundes W
Int J Stroke · 2026 Feb · PMID 40762287 · Publisher ↗
BACKGROUND: While managing spontaneous intracerebral hemorrhage (sICH) has advanced, achieving favorable outcomes remains challenging. Recent studies suggest that decompressive craniectomy (DC) may offer benefits over co...
BACKGROUND: While managing spontaneous intracerebral hemorrhage (sICH) has advanced, achieving favorable outcomes remains challenging. Recent studies suggest that decompressive craniectomy (DC) may offer benefits over conservative treatment, consisting of the best medical treatment (BMT) in certain sICH cases. AIM: This study aims to compare DC to BMT alone for sICH regarding functional neurological outcomes, mortality, and length of hospitalization. METHODS: Randomized and observational studies were identified comparing surgery (DC) to conservative management alone for patients with sICH. The outcomes analyzed were modified Rankin Scale (mRS), mortality at 30 days, 90 days, and overall mortality, and length of hospital stay. The odds ratio (OR) and mean difference (MD) were calculated for binary and continuous outcomes. RESULTS: Our analysis included eight studies (n = 743), with 345 patients undergoing surgery and 398 undergoing conservative management. BMT alone was associated with a poor neurological function (mRS of 5-6) (OR = 0.44; 95% CI = 0.24-0.78; p-value = 0.005; I = 39.8%), while the rate of good neurological function (mRS = 0-4) was superior in the surgical cohort (OR = 2.29; 95% CI = 1.28-4.10; p = 0.005; I = 39.8%), despite the lack of statistical significance for mRS 0-2 (OR = 1.25; 95% CI = 0.47-3.33; p = 0.66; I = 0%) and mRS 0-3 (OR = 1.43; 95% CI = 0.82-2.51; p = 0.21; I = 0%). Conservative management was associated with higher mortality at 30 days (OR = 0.36; 95% CI = 0.19-0.66; p-value = 0.001; I = 0%), at 90 days (OR = 0.35; 95% CI = 0.14-0.86; p = 0.022; I = 68.7%), and at last follow-up (OR = 0.33; 95% CI = 0.21-0.52; p-value < 0.001; I = 34.8%). Length of hospital stay was superior in the DC cohort, but without statistical significance (MD = 16.05; 95% CI = -3.24 to 35.34; p-value = 0.1; I = 92.9%). CONCLUSIONS: In patients with sICH, decompressive craniectomy shows potential for reducing mortality and improving neurological function compared to BMT alone. Further randomized studies, with improved methods, are needed to increase the quality of evidence.
Racial/ethnic disparities among individuals with unruptured and ruptured cerebral aneurysms: Insights from the All of Us Research Program.
Roy JM, Musmar B, Piper K … +8 more , Ghanem L, Ritz C, Karadimas S, Koduri S, Tjoumakaris SI, Gooch MR, Rosenwasser RH, Jabbour P
Int J Stroke · 2026 Feb · PMID 40751574 · Publisher ↗
BACKGROUND AND OBJECTIVES: Race and ethnicity have been shown to affect healthcare outcomes among patients diagnosed with cerebral aneurysms. Our study analyzes baseline demographics, lifestyle, healthcare resource utili...
BACKGROUND AND OBJECTIVES: Race and ethnicity have been shown to affect healthcare outcomes among patients diagnosed with cerebral aneurysms. Our study analyzes baseline demographics, lifestyle, healthcare resource utilization, and perception of health status among patients with ruptured and unruptured cerebral aneurysms based on race and ethnicity. METHODS: This was a cross-sectional study that utilized survey data and electronic health record (EHR) data from the All of Us Research Program. Patients with unruptured and ruptured aneurysms were identified using ICD-9/10 codes. Cohorts were classified into three categories based on self-reported race/ethnicity: Black, Hispanic, or White. RESULTS: A total of 2975 patients with unruptured cerebral aneurysms and 1498 ruptured cerebral aneurysms were included. Black and Hispanic patients with cerebral aneurysms reported lower income, education, and employment rates, in addition to higher rates of daily cigarette smoking compared to White patients (P < 0.001). After adjusting for confounders, Hispanic patients reported higher odds of being unable to afford specialist care (odd ratio (OR) = 1.86 [1.02-3.37], P = 0.04) and follow-up care (OR = 2.76 [1.52-5.00], P < 0.001), while Black patients reported higher odds of being unable to afford prescription medications (OR = 1.55 [1.03-2.33], P = 0.03) compared to White patients. Black and Hispanic patients reported lower odds of feeling respected by their healthcare provider (OR = 0.45 [0.21-0.94], P = 0.03 and OR = 0.32 [0.15-0.67], P < 0.01), demonstrated lower confidence in completing medical forms independently (OR = 0.58 [0.37-0.89], P = 0.01 and OR = 0.31 [0.20-0.47], P < 0.001) and were more likely to consider their provider's race/religion important compared to White patients (OR = 2.09 [1.51-2.88], P < 0.001 and OR = 2.28 [1.56-3.34], P < 0.001). DISCUSSION: Our study identified disparities in baseline characteristics, healthcare access, and perception of health status among racial/ethnic minorities with unruptured and ruptured aneurysms. Future research could emphasize on addressing these disparities by ensuring more equitable access to healthcare.
Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study.
Guo ZN, Qu Y, Abuduxukuer R … +28 more , Jin H, Zhang P, Shen ZD, Zhang H, Zheng XY, Zhang Y, Chen YM, Zheng Y, Yuan ZM, Yao J, Wang YL, Zhang M, Li Y, Gu YQ, Zhao LL, Dong CP, Jiang Y, Pei ZR, Song WT, Shi ZH, Dong Y, Qi Y, Li YK, Li L, Sun X, Nguyen TN, Li C, Yang Y
Int J Stroke · 2026 Feb · PMID 40751573 · Publisher ↗
BACKGROUND: It remains unclear whether the serum levels of the brain injury biomarkers (glial fibrillary acidic protein [GFAP] and ubiquitin C-terminal hydrolase-L1 [UCH-L1]) can be used to quantitatively evaluate brain...
BACKGROUND: It remains unclear whether the serum levels of the brain injury biomarkers (glial fibrillary acidic protein [GFAP] and ubiquitin C-terminal hydrolase-L1 [UCH-L1]) can be used to quantitatively evaluate brain tissue injury and predict prognosis in patients with intravenous thrombolysis (IVT). AIM: This study investigates the association between serum GFAP and UCH-L1 levels with functional outcomes in patients receiving IVT. METHODS: Patients were prospectively enrolled from 16 hospitals. We measured serum GFAP and UCH-L1 levels 24 hours after IVT. Infarct volume, hemorrhagic transformation (HT), and short- and long-term prognostic indicators were evaluated. GFAP and UCH-L1 cutoff levels for predicting 3-month unfavorable outcomes were derived, and a biomarker-based model was established and subjected to internal and external validation. RESULTS: This study included 1028 patients. Higher GFAP and UCH-L1 levels were independently associated with larger infarct volume, HT, higher 24-hour and 7-day National Institutes of Health Stroke Scale scores, and 3-month modified Rankin Scale scores. The cutoff levels for GFAP and UCH-L1 (116 and 292 pg/mL, respectively) predicted patients with 3-month unfavorable outcomes with a specificity and positive predictive value (PPV) of 97.56% (95% confidence interval [CI], 94.51-99.00) and 88.68% (95% CI, 76.28-95.31), respectively, in the training cohort. In the testing and validation cohorts, specificity was 97.83% (95% CI, 91.62-99.62) and 96.90% (95% CI, 91.77-99.00), respectively, and PPV was 90.00% (95% CI, 66.87-98.25) and 75.00% (95% CI, 47.41-91.67), respectively. Furthermore, the biomarker-based nomogram model showed good predictability of 3-month prognosis in the different cohorts. CONCLUSIONS: Serum GFAP and UCH-L1 levels can be used to quantitatively evaluate brain tissue injury and predict the prognosis of patients with IVT.
Population attributable fractions of established, social-psychological, and reproductive risk factors for stroke among women: Evidence from UK Biobank.
Sun W, Hou L, Wu J … +2 more , Shan S, Song P
Int J Stroke · 2026 Feb · PMID 40751569 · Publisher ↗
BACKGROUND: Stroke is a leading cause of death and disability worldwide, with women facing unique risks due to a combination of well-established, under-recognized, and female-specific factors. AIMS: This prospective coho...
BACKGROUND: Stroke is a leading cause of death and disability worldwide, with women facing unique risks due to a combination of well-established, under-recognized, and female-specific factors. AIMS: This prospective cohort study aimed to quantify the population attributable fractions (PAFs) of stroke with distinct risk factor profiles and to explore disparities across age strata. METHODS: Data were from 239,200 women recruited in the UK Biobank. Following the framework established by the Lancet Women and Cardiovascular Disease Commission, stroke risk factors were sorted into three categories, including eight well-established risk factors, four social-psychological risk factors, and 11 reproductive factors. The Cox regression model with correction of multiple comparisons was used to assess their associations with incident stroke and its subtypes. PAFs were calculated to estimate the attributable stroke burden for individual risk factors, each risk factor category, and all risk factors combined. Age-stratified analyses were further conducted. RESULTS: During a median follow-up of 13.8 years, 4580 (1.9%) women developed incident stroke. Hypertension served as the leading individual risk factor (PAF 23.3%, 95% confidence interval [CI] = 20.1%, 26.4%). Under the assumption of multiplicative effect, well-established risk factors accounted for 32.8% of stroke cases, followed by social-psychological factors (15.2%) and reproductive factors (6.3%). The overall PAF (95% CI) of total stroke with all risk factors combined was 47.6% (47.6%, 47.7%) or 40.2% (40.1%, 40.2%) with multiplicative or additive effect. Across the age groups, the highest total stroke PAFs for overall risk factors (51.9%) and well-established risk factors (37.0%) were observed among women aged 60-65 years. For reproductive factors, the highest PAFs were observed among women aged 60-65 years (9.2%) and ⩾65 years (4.5%). CONCLUSION: While the conventional risk factors contributed to the greatest stroke burden, the potential benefit of addressing issues related to unfavorable social-psychological conditions and adverse reproductive profiles should not be neglected. Integrated and targeted prevention strategies are in urgent need to protect women's cardio-cerebrovascular health throughout the lifespan.
Blood pressure threshold and outcomes after successful endovascular thrombectomy.
Jung JW, Lee H, Heo J … +36 more , Kim YD, Kim BM, Kim DJ, Shin NY, Joo H, Ahn SH, Park H, Sohn SI, Hong JH, Yun J, Song TJ, Chang Y, Kim GS, Seo KD, Chang JY, Seo JH, Lee S, Baek JH, Cho HJ, Shin DH, Kim J, Yoo J, Baik M, Jung YH, Hwang YH, Kim CK, Kim JG, Lee IH, Choi JK, Jeon S, Lee HS, Kim KH, Kwon SU, Bang OY, Heo JH, Nam HS
Int J Stroke · 2026 Feb · PMID 40747963 · Publisher ↗
BACKGROUND: Several randomized clinical trials have indicated that intensive blood pressure (BP) lowering is associated with worse outcomes, leaving the optimal BP targets following endovascular thrombectomy (EVT) uncert...
BACKGROUND: Several randomized clinical trials have indicated that intensive blood pressure (BP) lowering is associated with worse outcomes, leaving the optimal BP targets following endovascular thrombectomy (EVT) uncertain. AIMS: This study aimed to investigate the relationship between specific systolic BP (SBP) thresholds, time spent outside these thresholds, and clinical outcomes. METHODS: This post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP) trial, included patients with successful EVT randomized to intensive (<140 mmHg) or conventional (140-180 mmHg) BP management. We analyzed SBP parameters, including mean, maximum, and minimum SBP during study period, as well as excursions beyond predefined SBP thresholds (<90, <100, <110, >170, >180, and >190 mmHg), and the cumulative and continuous durations of these excursions. Associations with 3 month modified Rankin Scale (mRS) and symptomatic intracerebral hemorrhage (sICH) were assessed using multivariable logistic and ordinal regression models. RESULTS: A total of 302 patients (median 75 years; 180 [59.6%] men) were analyzed with 11,461 BP measurements recorded during the first 24 hours after EVT. Prolonged hypoperfusion (SBP below 100 mmHg for continuous duration) was associated with worse mRS score (adjusted OR [aOR] 1.21 per hour, 95% CI [1.02-1.45]; P = 0.030) and increased sICH risk (aOR 1.49 per hour, 95% CI [1.15-1.97]; P = 0.004). SBP surges above 190 mmHg were linked to mRS worsening (aOR 2.60, 95% CI [1.05-6.53]; P = 0.039), but upper threshold-related parameters were not significantly associated with sICH. CONCLUSION: Prolonged hypoperfusion below 100 mmHg and extreme surges above 190 mmHg, rather than specific SBP parameters, were associated with poor functional outcomes. These findings highlight the need for a threshold-based BP management approach post-EVT to minimize prolonged hypotension and excessive surges.
Diagnosis and management of cerebral amyloid angiopathy: a scientific statement from the International CAA Association and the World Stroke Organization.
Cordonnier C, Klijn C, Smith EE … +15 more , Al-Shahi Salman R, Chwalisz BK, van Etten E, Muir RT, Piazza F, Schreiber S, Schreuder FH, Selim M, Shoamanesh A, Viswanathan A, Wermer M, Zandi M, Charidimou A, Greenberg SM, Werring D
Int J Stroke · 2025 Oct · PMID 40721902 · Publisher ↗
Cerebral amyloid angiopathy (CAA) is a well-recognized and challenging disease for neurologists and other clinicians caring for the rapidly aging worldwide population. CAA is a major cause of spontaneous lobar intracereb...
Cerebral amyloid angiopathy (CAA) is a well-recognized and challenging disease for neurologists and other clinicians caring for the rapidly aging worldwide population. CAA is a major cause of spontaneous lobar intracerebral hemorrhage (ICH), and can also cause transient focal neurological episodes, and convexity subarachnoid hemorrhage, CAA-associated ICH has a high mortality, morbidity, and recurrence rate. CAA can affect a wide range of clinical decisions including use of antithrombotic medications, safety for anti-β-amyloid peptide (Aβ) immunotherapy, and need for anti-inflammatory or immunosuppressive treatment. We present guidelines, intended to inform the approach to individuals with suspected CAA, written on behalf of the International CAA Association and the World Stroke Organization (WSO). We cover five areas selected for their relevance to practice: (1) diagnosis, testing, and prediction of intracerebral hemorrhage risk; (2) antithrombotic agents and vascular interventions; (3) vascular risk factors and concomitant medications; (4) treatment of CAA manifestations; and (5) diagnosis and treatment of CAA-related inflammation and vasculitis. The statement has been reviewed and approved by the Executive Committee of the WSO, and the International CAA Association.
Intravenous thrombolysis in acute ischemic minor stroke: A Danish nationwide cohort study.
Harsfort D, Hedegaard JN, Johnsen SP … +2 more , Musleh M, Modrau B
Int J Stroke · 2026 Feb · PMID 40721899 · Publisher ↗
BACKGROUND AND OBJECTIVES: In patients with minor stroke, intravenous thrombolysis is recommended only for those with disabling symptoms, yet no standardized definition exists, and the treatment decisions remain subjecti...
BACKGROUND AND OBJECTIVES: In patients with minor stroke, intravenous thrombolysis is recommended only for those with disabling symptoms, yet no standardized definition exists, and the treatment decisions remain subjective. This study aimed to evaluate the effect of thrombolysis in minor stroke using routine care registry data. PATIENTS AND METHODS: A Danish nationwide register-based cohort study included patients with minor stroke (Scandinavian Stroke Scale (SSS) ⩾ 45) from 2011 to 2021. Patients were categorized as having mild strokes (SSS 45-49, approximated National Institutes of Health Stroke Scale (NIHSS) = 5-6) or very mild strokes (SSS 50-58, approximated NIHSS 1-4) to pragmatically distinguish disabling from non-disabling symptoms. Return-to-work, use of homecare, typical stroke complications, recurrent stroke, and mortality were compared in patients treated with and without thrombolysis. Analyses were adjusted for vascular risk factors, demographics, and clinical characteristics using inverse probability of treatment weighting. RESULTS: Among 31,007 included patients, 1910 with mild strokes and 4052 with very mild strokes received thrombolysis. In patients with mild strokes, thrombolysis was associated with a higher rate of return-to-work (adjusted hazard ratio = 1.33), lower risk of pneumonia (adjusted relative risk (aRR) = 0.40), and lower mortality (aRR = 0.58, 0.50, and 0.50 at 30, 90, and 365 days, respectively). In patients with very mild strokes, thrombolysis was not associated with improved outcomes, except lower mortality at 365 days (aRR = 0.78). DISCUSSION: Intravenous thrombolysis was more often associated with better outcomes in patients with mild strokes than in patients with very mild strokes.
Differences in acute ischemic stroke treatment: A cross-sectional study from international Registry of Stroke Care Quality (RES-Q).
Mikulik R, Neto G, Sedani R … +45 more , Ameriso SF, Mammadova N, Marchenko S, Martins S, Milanov I, Constanzo F, Muñoz M, Budincevic H, Šrámek M, Ramos C, Zakaria MF, Kõrv J, Tsivgoulis G, Szapary L, Pandian J, Nulkhasanah A, Batayha W, Medukhanova S, Karbozova K, Miglane E, Vilionskis A, Kee HF, Gongora-Rivera F, Cantu Brito C, Groppa S, Ciobanu N, Paudel R, Abanto C, Collantes ME, San Jose MC, Kobayashi A, Gomes A, Tiu C, Shamalov N, Mijajlovic M, Gdovinová Z, Kroon L, Sohn SI, Moniche F, Towanabut S, Moskovko S, AlOmar A, Huy Thang N, Middleton S, Barrientos-Guerra JD
Int J Stroke · 2026 Feb · PMID 40698920 · Publisher ↗
BACKGROUND: Stroke globally impacts mortality and disability. Compliance with international standards and evidence-based practices for acute stroke management would improve patient outcomes. OBJECTIVES: We aimed to prese...
BACKGROUND: Stroke globally impacts mortality and disability. Compliance with international standards and evidence-based practices for acute stroke management would improve patient outcomes. OBJECTIVES: We aimed to present a descriptive analysis of the quality of acute stroke care across different countries using the Registry of Stroke Care Quality (RES-Q). METHOD: In a cross-sectional study, data from key quality indicators such as Emergency Medical Services (EMS) deployment rates, hospital arrival to imaging time (door-to-imaging: DIT), hospital arrival to thrombolysis time (door-to-needle: DNT), and Stroke Unit Care/Intensive Care Unit (SU/ICU) admission frequencies were examined. The analysis employed descriptive statistics and Spearman correlation tests. RESULTS: Of 334,184 patients from 1130 hospitals in 70 countries, 218,832 patients (65.5%) from 47 countries were diagnosed with acute ischemic stroke after exclusions. The number of patients per country ranged from 226 to 62,080. International variability in care quality was observed: EMS (7-97%); SU/ICU (12-100%); and median DIT (7-41 min); and DNT (20-75 min). IVT rates varied markedly across countries, ranging from <1% to 52%. Higher patient volumes were positively correlated with SU/ICU admission and negatively with DIT and DNT (ρ = 0.10, -0.22, -0.42, respectively). CONCLUSION: This study demonstrates substantial international variation in the use of quality monitoring in clinical practice as well as in key indicators of acute ischemic stroke care, including intravenous thrombolysis rates and treatment timelines. The extent of variability highlights opportunities for benchmarking and targeted quality improvement efforts across diverse healthcare systems.
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