International Journal Of Stroke[JOURNAL]
Sun
200 papers
The risk of femoral fracture is increased in patients with ischemic stroke and transient ischemic attack-a population-based observational secondary analysis of the Austrian stroke cohort.
Heidinger M, Lang C, Ferrari J … +14 more , Krebs S, Sykora M, Kleyhons R, Resch H, Karisik A, Dejakum B, Mölgg K, Granna J, Boehme C, Willeit P, Knoflach M, Schett G, Kiechl S, Lang W
Int J Stroke · 2026 Feb · PMID 40698909 · Full text
BACKGROUND: An increased risk of femoral fractures after ischemic stroke (IS) and transient ischemic attack (TIA) has been shown previously. However, it remains unclear whether the ischemic cerebral event is directly ass...
BACKGROUND: An increased risk of femoral fractures after ischemic stroke (IS) and transient ischemic attack (TIA) has been shown previously. However, it remains unclear whether the ischemic cerebral event is directly associated with the risk of femoral fractures. AIMS: The aim of this study was (1) to assess the association between the frequency of femoral fractures in patient with IS and TIA, and (2) to compare the risk of femoral fractures to the Austrian general population. METHODS: Population-based observational secondary analysis of the Austrian Stroke Cohort to assess the incidence of femoral fractures in the year after IS/TIA compared with the year before, and both intervals compared with the Austrian general population. All patients ⩾20 years treated for IS/TIA in Austria between 1 January 2016 and 31 December 2018 were identified using medical record linkage. Patient trajectories were reconstructed from 1 January 2015 to 31 December 2019 to have a 1-year observational period before and after the event. Femoral fractures within 1 year after IS/TIA compared to 1 year before IS/TIA were analyzed using McNemar test and Cox regression analysis considering sex and age. The 1-year age- and sex-adjusted relative risk of femoral fractures was calculated for patients with IS/TIA and compared to the Austrian general population. RESULTS: A total of 48,996 survivors of IS (n = 34,997) and TIA (n = 13,999) were included. The incidence of femoral fractures increased significantly from the year before the IS/TIA (8.9 per 1000 person-years, 95% CI 7.7-10.2) to the year after the event (11.8 per 1000 person-years, 95% CI 10.1-13.5; = 0.022). Compared to the Austrian general population including 21.1 million patient-years at risk and 37,436 femoral fractures, the risk of femoral fractures was increased both in the year before (RR 2.08, 95% CI 2.06-2.11) and after (RR 3.52, 95% CI 3.48-3.56) the IS/TIA. CONCLUSION: The risk of femoral fractures was found to be increased in the year following an IS/TIA, indicating a direct association with the IS/TIA event.Data access statement:Reconstruction of medical record linkage and individual patient trajectory reconstruction were reported previously. Data from individual patient trajectories was used for this analysis.
Sodium-glucose cotransporter 2 inhibitors and stroke risk in patients with diabetes and stroke risk factors: A real-world cohort study.
Lin BH, Huang HM, Lin HA … +1 more , Lin SF
Int J Stroke · 2026 Feb · PMID 40698904 · Publisher ↗
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve the cardiovascular outcomes of patients with type 2 diabetes (T2D). However, whether this effect extends to stroke prevention in high-risk patients r...
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve the cardiovascular outcomes of patients with type 2 diabetes (T2D). However, whether this effect extends to stroke prevention in high-risk patients remains unclear. AIMS: This study aims to investigate the effect of SGLT2i in stroke prevention in patients with T2D and concomitant risk factors. METHODS: Patients with T2D and various risk factors for stroke were identified from the TriNetX platform from 2013 to 2024. These patients were divided into two cohorts: one treated with SGLT2i, and the other with metformin or dipeptidyl peptidase-4 inhibitors. Propensity score matching was used to balance the patients' demographic characteristics, underlying comorbidities, and antiplatelet and anticoagulant drug use patterns. The primary outcome was the development of ischemic or hemorrhagic stroke or the onset of a transient ischemic attack (TIA) within 1 year. Unadjusted Cox proportional hazards models were applied to estimate hazard ratios (HRs). Sensitivity analyses stratified by age, sex, and hemoglobin A1c (HbA1c) levels were performed, and interaction tests were used to assess potential effect modifiers. In addition, the two cohorts were compared for estimation of numbers needed to treat (NNTs). RESULTS: A total of 3,715,058 patients were identified, of whom 971,727 (26.2%) were SGLT2i users. After matching, 932,419 patients were included in each group. SGLT2i use was associated with a significantly reduced risk of ischemic stroke (HR: 0.84, 95% confidence interval (CI): 0.81-0.87; NNT: 669), hemorrhagic stroke (HR: 0.73, 95% CI: 0.68-0.79; NNT: 1837), and TIA (HR: 0.81, 95% CI: 0.77-0.86; NNT: 1615). The protective effect against ischemic stroke was more pronounced in males and individuals aged over 65 years. Greater benefit was observed in patients with chronic kidney disease (NNT: 466), atrial fibrillation (NNT: 492), and heart failure (NNT: 415). In contrast, the protective effect was attenuated in patients with obesity, among whom SGLT2i use was associated with a modestly increased risk of ischemic stroke after 1 year (HR: 1.05, 95% CI: 1.01-1.09). CONCLUSION: SGLT2i use is associated with a significant reduction in the risk of stroke among selected T2D patients. SGLT2i may be used as a first-line therapy for diabetes patients with concomitant chronic kidney disease, atrial fibrillation, and heart failure.
The rising incidence of stroke in the young: Epidemiology, causes and global impact.
Nehme A, Li L
Int J Stroke · 2026 Jan · PMID 40682212 · Full text
Although reductions in stroke incidence have been reported over recent decades particularly in high-income countries, there has been a worrying trend since the start of the 21st century: stroke incidence in younger indiv...
Although reductions in stroke incidence have been reported over recent decades particularly in high-income countries, there has been a worrying trend since the start of the 21st century: stroke incidence in younger individuals (<55 years) has not showed a similar decrease as at older ages. In high-income countries, several population-based studies have found an increase in the incidence of stroke at younger ages since 2000, reaching up to 90% in Oxfordshire, UK (2010-2018 vs 1981-1986) and 97% in Cincinnati, USA (2010 vs 1993-1994). A similar picture has also been documented in low- and middle-income countries, both in population-based studies (Joinville, Brazil, 35% increase in 2012-2013 vs 2005-2006) and in the Global Burden of Disease study. The exact reasons for this very different picture seen in younger individuals are unknown. One possibility is that traditional modifiable risk factors are increasingly prevalent and often undertreated at younger ages. However, studies have also found increases in the incidence of young-onset cryptogenic stroke and in people with no traditional modifiable risk factors, suggesting a role for emerging risk factors. Potential culprits might include air pollution, long working hours, psychosocial stress, prior autoimmune diseases, and illicit drug use, although further research is required to determine whether these emerging risk factors are causally related to stroke at younger ages. Without further intervention, the global burden of stroke at younger ages is projected to increase further in the coming years. Therefore, there is an urgent need to better understand the drivers of these time trends in incidence, to potentially alleviate the individual and societal impacts of stroke in the young. In this narrative review, we examine the recent global changes in stroke epidemiology at younger ages, their potential drivers, and their projected consequences.
Secondary stroke prevention and improvements in acute intracerebral haemorrhage care.
Markus HS
Int J Stroke · 2025 Aug · PMID 40673437 · Publisher ↗
Abstract loading — click title to view on PubMed.
Outcomes of external ventricular drainage and lumbar drainage in aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.
Musmar B, Abdalrazeq H, Roy JM … +10 more , Salim HA, Pontarelli MK, Adeeb N, Tjoumakaris SI, Gooch MR, Notarianni C, Guthikonda B, Morcos J, Rosenwasser RH, Jabbour P
Int J Stroke · 2025 Dec · PMID 40662333 · Publisher ↗
BACKGROUND: Lumbar drainage (LD) and external ventricular drainage (EVD) are used in patients with aneurysmal subarachnoid hemorrhage (aSAH) for cerebrospinal fluid diversion and blood clearance. While both have potentia...
BACKGROUND: Lumbar drainage (LD) and external ventricular drainage (EVD) are used in patients with aneurysmal subarachnoid hemorrhage (aSAH) for cerebrospinal fluid diversion and blood clearance. While both have potential benefits, the relative efficacy and safety of LD versus EVD remain unclear, particularly given their use in differing clinical contexts. This study aims to provide a crude comparison of LD and EVD in the context of aSAH using the most updated and comprehensive meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review and pair-wise meta-analyses of 28 studies (4390 patients). Cohorts were analyzed across three contrasts-LD versus non-LD, EVD versus non-EVD, and LD versus EVD-using random-effects models. Outcomes included rebleeding, clinical vasospasm, delayed ischemic neurological deficit (DIND)/ischemic stroke, functional status (mRS 0-2 early and late; Glasgow Outcome Scale (GOS) ⩽ 2), mortality, infection, and shunt dependency. RESULTS: Compared with non-LD, LD lowered the odds of vasospasm (odds ratio (OR): 0.51, 95% confidence interval (CI): 0.33 to 0.78), DIND/ischemic stroke (OR: 0.55, 0.37 to 0.83), severe disability/vegetative state (GOS ⩽ 2) (OR: 0.28, 0.17 to 0.46), and mortality (OR: 0.59, 0.41 to 0.85) without affecting rebleeding rates. Versus non-EVD, EVD reduced ischemic complications (OR: 0.39, 0.16 to 0.96) but increased infection risk (OR: 11.58, 1.45 to 92.71); vasospasm and rebleeding were similar. Direct comparison showed LD superior to EVD for early functional independence (OR: 1.92, 1.06 to 3.50) and mortality (OR: 0.49, 0.30 to 0.81), while rebleeding, vasospasm, infections, and shunt dependency were similar. CONCLUSION: LD was associated with lower rates of vasospasm, ischemic complications, severe disability, and mortality compared to non-LD, without increasing rebleeding risk. EVD reduced ischemic complications but was linked to higher infection rates. When directly compared, LD was favored for early functional recovery and survival. These findings should be interpreted in light of differing clinical indications and baseline severity. Further studies are needed.
Neuroinflammation in long-term cognitive impairment after aneurysmal subarachnoid hemorrhage.
Tack RW, Tolboom N, Meyer Viol B … +10 more , Golla SS, van Berckel BN, van der Schaaf IC, Boellaard R, de Luca A, van Zandvoort MJ, Visser-Meily JM, Hol EM, Rinkel GJ, Vergouwen MD
Int J Stroke · 2025 Dec · PMID 40662329 · Full text
BACKGROUND: Survivors of aneurysmal subarachnoid hemorrhage (aSAH) often have cognitive impairment, which may be caused by long-term inflammation. We aimed to determine whether long-term neuroinflammation or microstructu...
BACKGROUND: Survivors of aneurysmal subarachnoid hemorrhage (aSAH) often have cognitive impairment, which may be caused by long-term inflammation. We aimed to determine whether long-term neuroinflammation or microstructural brain damage is associated with cognitive impairment after aSAH. METHODS: In this prospective cohort study, we included patients >3 years after aSAH between 2020 and 2022. Patients underwent neuropsychological evaluation, translocator protein 18 kDA (TSPO) positron emission tomography (PET) imaging using [F]DPA-714 to determine neuroinflammation, and brain diffusion kurtosis imaging (DKI) to determine microstructural damage. We compared TSPO PET binding potential, mean kurtosis (MK), kurtosis anisotropy (KA), axial kurtosis (AK), and radial kurtosis (RA) between groups and determined which metric was correlated with individual cognitive tests. RESULTS: We included 27 patients with aSAH; 14 with and 13 without cognitive impairment. Whole-brain TSPO binding potential was similar between groups (mean BP: -0.046 [95% confidence interval (CI): -0.105; 0.013] vs -0.047 [95% CI -0.108; 0.014], p = 0.98) and there were no regional differences. Those with cognitive impairment had a lower whole-brain MK (mean MK 0.70 [95% CI: 0.69-0.72] vs 0.73 [95% CI: 0.72-0.74], p = 0.03) and whole-brain AK (mean AK 0.81 [95% CI: 0.78-0.83] vs 0.86 [0.84-0.87], p = 0.04). Left thalamic MK and AK were correlated with tests of verbal memory (r = 0.60-0.67, p < 0.01), while other correlation tests were non-significant. CONCLUSION: Our results do not support the hypothesis that long-term cognitive impairment after aSAH is caused by long-term neuroinflammation. Instead, microstructural damage may play a role.
National and provincial trends of mortality and years of life lost due to stroke in children and adolescents in China, 2005-2020: An analysis of national mortality surveillance data.
Wang Z, Li J, Long Z … +8 more , Ren Y, Li J, Wang X, Wang L, Hao J, Zhou M, Yin P, Ma Q
Int J Stroke · 2026 Jan · PMID 40641048 · Publisher ↗
BACKGROUND: Stroke is associated with substantial mortality among children and adolescents, yet evidence on the death burden of stroke in this group in China is scarce. AIMS: To assess the trends of mortality and years o...
BACKGROUND: Stroke is associated with substantial mortality among children and adolescents, yet evidence on the death burden of stroke in this group in China is scarce. AIMS: To assess the trends of mortality and years of life lost (YLL) due to stroke in children and adolescents in China. METHODS: We estimated the number and age-standardized rate of death and YLL caused by stroke and its subtypes among children and adolescents aged 0-19 years in China and its provinces from 2005 to 2020, utilizing data from National Mortality Surveillance System. RESULTS: In China, the age-standardized mortality rate due to stroke among children and adolescents aged 0-19 years decreased from 1.40/100,000 to 0.51/100,000 during 2005-2020, and the YLL rate decreased from 116.28/100,000 to 38.79/100,000. During 2005-2020, intracerebral hemorrhage (ICH) consistently showed significantly higher age-standardized mortality rate than ischemic stroke (IS) and subarachnoid hemorrhage (SAH). In 2020, the mortality rate of ICH was 11.35-fold and 4.96-fold greater than that of IS and SAH, respectively (ICH 0.40/100,000, IS 0.04/100,000, SAH 0.08/100,000). Overall, males among children and adolescents exhibited higher age-standardized mortality and YLL rate due to stroke compared to females. Notably, the stroke mortality rate in 15-19 years age group increased by 16.10% during 2005-2020, primarily attributed to the significant increases in mortality rate of ICH and SAH among males in this age group (ICH males 25.51%, SAH males 107.83%). In 2020, Yunnan (1.56/100,000), Tibet (1.54/100,000), and Henan (1.47/100,000) had the highest age-standardized mortality rate of stroke among children and adolescents, while Shanghai, Fujian and Jiangsu had the lowest rates. In addition, a negative association was observed between the age-standardized YLL rates of stroke among individuals aged 0-19 years and the socio-demographic index across 31 provinces in China from 2005 to 2020. CONCLUSION: In China, the death burden of ICH among children and adolescents was considerably heavier than that of SAH and IS. The rising mortality rate of ICH and SAH among males aged 15-19 years requires greater emphasis. Targeted interventions for stroke in children and adolescents should be expedited to reduce the disease burden in this particular population.
Optimal markers of treatment response to vasodilatory drugs in small vessel disease: An OxHARP trial analysis.
Webb AJS, Feakins K, Lawson A … +3 more , Stewart C, Thomas J, Llwyd O
Int J Stroke · 2026 Jan · PMID 40641043 · Full text
BACKGROUND AND AIMS: Vasodilating drugs targeting the endothelium could reduce long-term harms due to cerebral small vessel disease (cSVD) but there are no commonly accepted methods to measure short-term disease activity...
BACKGROUND AND AIMS: Vasodilating drugs targeting the endothelium could reduce long-term harms due to cerebral small vessel disease (cSVD) but there are no commonly accepted methods to measure short-term disease activity or drug response. In the OxHARP clinical trial, we determined the most sensitive physiological markers of treatment response to sildenafil versus placebo on either transcranial ultrasound (TCD) or magnetic resonance imaging (MRI), and their validity compared to disease severity and other measures of other physiological mechanisms. METHODS: In the OxHARP double-blind, randomized, placebo-controlled crossover trial we measured aortic blood pressure, mean flow velocity (MFV), cerebral pulsatility, cerebrovascular conductance index (CVCi = MFV/aortic mean BP), cerebral perfusion (pcASL-MRI) and cerebrovascular reactivity to inhaled CO2 on TCD (CVR-TCD) and MRI in white (CVR-WM), gray (CVR-GM) and white matter hyperintensities (CVR-WMH). Effects of 3 weeks of sildenafil were compared to placebo. Validity of markers were determined by between-visit repeatability (intraclass correlation coefficient (ICC)); associations with CVR-TCD, CVR-WMH and CVR-GM; associations with other markers; the magnitude of response, and sensitivity, to sildenafil. RESULTS: In 69 participants, repeatability was greatest for MFV, pulsatility, CVCi and CVR-WMH (ICC > 0.8), very good for CVR-TCD and GM-perfusion (ICC > 0.7), and good for CVR-GM (ICC > 0.6). CVR-TCD was associated with CVR on MRI (CVR-WMH: r = 0.12, p = 0.02; CVR-GM: r = 0.22, p = 0.001), while blood flow measures on TCD (MFV, CVCi) were associated with CVR-TCD and perfusion-MRI (all p < 0.05). All markers were associated with WMH volume and improved by sildenafil, but CVCi was most sensitive, requiring only 20 patients for a crossover trial at 80% power, compared to 26 for GM-perfusion or 84 for CVR-GM. CONCLUSIONS: Multiple markers were associated with cSVD, but no single marker reflected all physiological drug effects. CVCi and gray matter perfusion on MRI were the most sensitive markers of disease activity and drug response, although CVR indices may be more specific for endothelial dysfunction.
Left atrial appendage occlusion in patients with atrial fibrillation and previous Intracranial Hemorrhage or Cerebral Amyloid Angiopathy: A systematic review and meta-analysis.
Mavridis T, Archontakis-Barakakis P, Chlorogiannis DD … +1 more , Charidimou A
Int J Stroke · 2025 Oct · PMID 40641042 · Publisher ↗
BACKGROUND: Patients with atrial fibrillation (AF) on oral anticoagulation (OAC) who have a history of intracranial hemorrhage (ICrH) or cerebral amyloid angiopathy (CAA) have an elevated risk of ICrH recurrence. Left at...
BACKGROUND: Patients with atrial fibrillation (AF) on oral anticoagulation (OAC) who have a history of intracranial hemorrhage (ICrH) or cerebral amyloid angiopathy (CAA) have an elevated risk of ICrH recurrence. Left atrial appendage occlusion (LAAO) has emerged as a potential alternative to OAC for stroke prevention in high-bleeding-risk AF patients. Small observational studies suggest that LAAO may be safe and feasible in patients with ICrH, when using single or dual antiplatelet therapy or short-term OAC post-procedure, though data remain limited. This systematic review and meta-analysis aims to consolidate evidence on the safety and efficacy of LAAO in patients with prior ICrH or CAA. METHODS: We conducted a systematic review and meta-analysis examining the safety and efficacy of LAAO in patients with non-valvular AF and prior ICrH and/or CAA. PubMed/MEDLINE and EMBASE (via Scopus) databases were systematically searched from inception until 29 February 2024. Eligible studies included randomized control trials, observational studies, and case series (⩾10 participants) reporting stroke events in patients with AF and previous history of ICrH and/or CAA undergoing LAAO. Pooled incidence rates (IRs) with corresponding 95% confidence intervals (CIs) were calculated for primary outcomes (post-procedural ischemic stroke and recurrent ICrH) and secondary outcomes. RESULTS: Fourteen studies including 1235 patients met inclusion criteria. The pooled average follow-up period was 17.1 months. The pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage were 2% (95% CI: 1-3%, I = 2%), 2% (95% CI: 0.4-3%, I = 45%) and 3% (95% CI: 1-5%, I = 54%), respectively. In prespecified subgroup analyses of studies focusing on patients with intraparenchymal hemorrhage and/or CAA, pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage IR of 4% (95% CI: 1-8%), 4% (95% CI: 0.4-10%) and 6% (95% CI: 3-12%), respectively. CONCLUSIONS: LAAO may be a safe and effective treatment for selected AF patients with a history of ICrH and/or CAA, but the quality of evidence is poor. Future randomized controlled trials are essential to validate LAAO's efficacy and long-term safety.
Association between time and severe hypoperfusion with risk of hemorrhagic transformation in stroke patients.
Pensato U, Rex N, Kashani N … +10 more , Yu AY, Jadhav AP, Rha JH, Puri AS, Burns P, Demchuk AM, Hill MD, Goyal M, Ospel JM, ESCAPE-NA1 Investigators
Int J Stroke · 2026 Jan · PMID 40641041 · Full text
INTRODUCTION: Perfusion imaging studies show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. Preclinical evidence indicates that ischemic damage is influenced not only b...
INTRODUCTION: Perfusion imaging studies show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. Preclinical evidence indicates that ischemic damage is influenced not only by the degree of hypoperfusion but also by the duration of exposure to that hypoperfused state. We aim to investigate the association of time and severe hypoperfusion with parenchymal hematoma (PH) in ischemic stroke and explore whether there is a combined effect of the two variables on PH. METHODS: Data are from the ESCAPE-NA1 trial, which evaluated the effect of nerinetide in large vessel occlusion patients treated with thrombectomy. This study included patients with some degree of recanalization (expanded Thrombolysis in Cerebral Infarct [eTICI] > 0) and available baseline CT perfusion. Severe hypoperfusion was defined as at least 1 mL volume of relative cerebral blood flow (rCBF) <20%. We assess 24-h imaging for the presence of PH, according to Heidelberg bleeding criteria. Univariable and multivariable logistic regression analyses, including interaction terms, were used to assess the effect of time and severe hypoperfusion on outcomes. RESULTS: Out of 1105 patients from ESCAPE-NA1, 396 (35.8%) were included. The median age was 70 years (IQR = 59.8-79.2), 202 (51%) were females, and 50 (12.6%) experienced PH. Onset-to-imaging time (adjusted OR 1.04 [95% CI = 1.01-1.06] per 15-min increase) and the presence of severe hypoperfusion (adjusted OR 2.87 [95% CI = 1.47-5.63]) were the only variables associated with PH in multivariable analysis. No significant interaction effect of time and severe hypoperfusion on PH was found. The presence of severe hypoperfusion had a negative predictive value of 98% and a positive predictive value of 39.4% for predicting PH in patients presenting within 3 h and after 6 h from symptom onset, respectively. CONCLUSION: Both severe hypoperfusion and time affect the risk of hemorrhagic transformation. However, the interaction between these two variables was not statistically significant, indicating that their effects on hemorrhagic transformation risk are not dependent on each other. Analyzing these variables may help identify patients with a leaky, severely compromised blood-brain barrier in the ischemic core-a "leaky core."
Long-term outcome of young patients after ischemic stroke or transient ischemic attack: Insights from a multicenter study.
Pinter D, Broman J, Leitner M … +14 more , von Sarnowski B, Elmegiri M, Gattringer T, Haidegger M, Kneihsl M, Malinowski R, Martola J, Ropele S, Schminke U, Tatlisumak T, Enzinger C, Putaala J, Aarnio K, Fandler-Höfler S
Int J Stroke · 2026 Jan · PMID 40631738 · Publisher ↗
BACKGROUND: The long-term non-motor outcome of young adults with ischemic stroke (IS) or transient ischemic attack (TIA) is poorly understood. AIMS: Therefore, in this observational cohort study, we explored the prevalen...
BACKGROUND: The long-term non-motor outcome of young adults with ischemic stroke (IS) or transient ischemic attack (TIA) is poorly understood. AIMS: Therefore, in this observational cohort study, we explored the prevalence of impairment and factors influencing clinical and neuropsychological outcomes and return-to-work a decade post-stroke. METHODS: After a median follow-up duration of 10.4 years, 163 patients (median age at index event: 46.0 years, 44.8% female, 121 IS and 42 TIA) of the "Stroke in Young Fabry Patients study" attended an in-person follow-up in three European centers. We assessed clinical, neuropsychological, and return-to-work data. RESULTS: A decade post-stroke, most patients (74.8%) showed excellent outcome, scoring 0-1 on the modified Rankin Scale (mRS) and 68.0% had returned to work. However, at follow-up, 27.2% of patients showed cognitive impairment and 27.6% suffered from fatigue. Anxiety and depression were reported by 38.0% and 18.5%, respectively. Even among patients with excellent functional outcome (mRS 0-1), 24.6% showed cognitive problems, 37.7% suffered from anxiety, 22.1% from fatigue, and 12.4% from depression. Female patients had higher rates of anxiety (52.1% vs. 26.7%), fatigue (37.0% vs. 20.0%), and depression (27.4% vs. 11.2%), compared to male patients.In linear regression, female sex was associated with a higher likelihood for anxiety (odds ratio (OR = 2.89, 95% confidence interval (CI) = 0.62-5.16), fatigue (OR = 3.23, CI = 1.52-4.93), and depression (OR = 2.86, CI = 1.12-4.59). Hypertension at follow-up (52.1%) was associated with worse functional outcome (OR = 3.03, CI = 1.32-6.95), while patients smoking at follow-up (20.2%) had higher rates of anxiety (OR = 4.09, CI = 1.21-6.97) and depression (OR = 3.40, CI = 0.87-5.21). CONCLUSIONS: Despite excellent functional outcome, many young stroke patients experience neuropsychological impairment, highlighting the need for targeted screening and treatment. Particularly young women are at higher risk for post-stroke depression, anxiety, and fatigue. Hypertension and smoking were modifiable risk factors contributing to worse outcomes in this young stroke cohort.
Periodontal disease is associated with increased stroke risk, an association partially mediated by inflammation.
Ling Y, Cheng H, Huang X … +8 more , Yuan S, Tan S, Tang Y, Bai Z, Li X, Chen J, Xu A, Lyu J
Int J Stroke · 2026 Jan · PMID 40626551 · Publisher ↗
BACKGROUND: Despite evidence linking periodontal disease to stroke risk, research investigating the potential mediating role of inflammatory markers and the modifying influence of genetic susceptibility in this relations...
BACKGROUND: Despite evidence linking periodontal disease to stroke risk, research investigating the potential mediating role of inflammatory markers and the modifying influence of genetic susceptibility in this relationship remains limited. AIM: The study aimed to assess the association between self-reported high risk of periodontal disease and stroke, while exploring the potential mediating effects of inflammatory markers and the modifying influence of genetic susceptibility. METHODS: Using UK Biobank data, we investigated the association between high risk of periodontal disease and incident stroke using Cox proportional hazards regression models. Participants were classified as having a high risk of periodontal disease if they reported experiencing any of painful gums, bleeding gums, and/or loose teeth. We explored the potential mediating role of inflammatory markers in the observed association through mediation analyses. For genetic analyses, we calculated a genetic risk score (GRS) for stroke using 32 single nucleotide polymorphisms, stratified participants into tertiles, and conducted interaction analyses between GRS and periodontal disease risk with respect to both all stroke and ischemic stroke. RESULTS: The study included 442,648 participants, followed up for a median of 13.7 years. Participants with a high risk of periodontal disease showed significantly increased risk of all stroke (HR = 1.11, 95% CI: 1.05-1.16) and ischemic stroke (HR = 1.11, 95% CI: 1.05-1.18) after adjusting for confounders, but no significant associations were found for hemorrhagic stroke (HR = 1.08, 95% CI: 0.98-1.19). Mediation analyses showed that inflammatory markers partially mediated this relationship, with mediation effects ranging from 0.86% to 8.41% for all stroke and 1.03% to 9.58% for ischemic stroke. Genetic analyses revealed no significant interaction between high risk of periodontal disease and stroke GRS concerning the all stroke risk, but a significant interaction was found for ischemic stroke, with participants having both periodontal disease risk and a high GRS showing the highest risk (HR = 1.19, 95% CI: 1.07-1.32). CONCLUSIONS: This study demonstrates a significant association between high periodontal disease risk and increased stroke risk, particularly ischemic stroke, with partial mediation by inflammatory markers and interaction with genetic risk factors.
Plaque features and lenticulostriate artery morphology in unexplained early neurological deterioration in symptomatic MCA stenosis: A 7 T MRI study.
Shi Y, Bai X, Zhang X … +3 more , Pei X, Wang Y, Sui B
Int J Stroke · 2025 Dec · PMID 40626547 · Publisher ↗
BACKGROUND: A large proportion of early neurological deterioration (END) in stroke due to middle cerebral artery (MCA) stenosis remains unexplained. Unstable plaques on MCA and impaired perforators might contribute to un...
BACKGROUND: A large proportion of early neurological deterioration (END) in stroke due to middle cerebral artery (MCA) stenosis remains unexplained. Unstable plaques on MCA and impaired perforators might contribute to unexplained END. METHODS: We included patients with symptomatic MCA stenosis and classified them into three groups according to symptoms: END, stable, and transient ischemic attack (TIA). High-resolution 7 T vessel wall magnetic resonance imaging (MRI) (VW-MRI) and time-of-flight magnetic resonance (MR) angiography (TOF-MRA) were used to investigate MCA plaque features and lenticulostriate artery (LSA) morphology. We compared demographic data, plaque features and LSA morphology between three groups, and used binary logistic regression models to investigate factors that could potentially be related to END. RESULTS: Fifty-two patients (49.46 ± 13.94 years, 39 males) were included in final analyses. Patients in three groups did not differ in age or vascular risk factors. Irregular plaque surface (16/16 vs 12/16 vs 11/20 in END vs stable vs TIA groups, P = 0.008) and plaques adjacent to LSA origin (14/16 vs 10/16 vs 7/20, P = 0.006) were more commonly seen in the END group than the other two groups. On TOF-MRA, TIA patients had more LSA branches (6[1,15] vs 5[1,9] vs 7[4,12] in END vs stable vs TIA groups, P = 0.018) and longer total LSA length (95.37 ± 43.98 vs 92.42 ± 33.10 vs 129.61 ± 38.77 mm, P = 0.012). Larger lesion size, higher LDL level and plaques adjacent to LSA origin were significantly associated with END, before and after the adjustment for age and sex. CONCLUSION: The 7 T MRA provide precise imaging capabilities for plaque characteristics and LSA in patients with MCA stenosis and END, which could help stratify the risks of END and provide evidence for treatment of ischemic stroke caused by MCA arthrosclerosis.
Predicting long-term movement behavior patterns after stroke: Development of a clinical prediction rule.
Pagen S, Hartman Y, Biemans C … +4 more , Broers S, Verschuren O, Visser-Meily J, Pisters M
Int J Stroke · 2025 Dec · PMID 40626546 · Publisher ↗
BACKGROUND: Within the first years post-discharge, movement behavior of people with a first-ever stroke often deteriorates, with inactive movement behavior increasing the risk of recurrent cardiovascular events. Early id...
BACKGROUND: Within the first years post-discharge, movement behavior of people with a first-ever stroke often deteriorates, with inactive movement behavior increasing the risk of recurrent cardiovascular events. Early identification of patients at risk of inactive movement behavior is essential for referring the right patients and tailoring movement-behavior change interventions, which could support secondary prevention of recurrent cardiovascular events. AIMS: This study aimed to develop and internally validate a clinical prediction rule to identify at hospital discharge people at risk of an inactive movement behavior pattern within the first 2 years following a stroke. METHODS: A prospective cohort study was conducted using data from 200 participants with a first-ever stroke (age 67.8 ± 11.5 years; 64% male; median NIHSS = 3), who were discharged to their home environment. Eligible participants were ⩾18 years, pre-stroke independent, ambulatory, and able to communicate. Movement behavior was objectively assessed within 3 weeks, and at 6 months (n = 184, 92%), 1 year (n = 175, 88%), and 2 years (n = 146, 74%) post-discharge. Movement behavior patterns were based on the amount of light and moderate-to-vigorous physical activity (PA) and prolonged sedentary bouts: "sedentary exercisers" (active), "sedentary movers" (inactive), and "sedentary prolongers" (inactive and prolonged sedentary bouts). Baseline characteristics, including demographic, stroke-related, and health-related factors, were used to identify "sedentary movers and prolongers" (step 1) and "sedentary prolongers" (step 2) by multinominal logistic regression. RESULTS: Female sex (B = -1.03, p < 0.001), older age (B = 0.05, p < 0.001), and increased fatigue (B = 0.04, p = 0.003) predicted inactive movement behavior in the first 2 years after discharge. Inactive movement behavior with prolonged sedentary bouts was predicted by "prolonger" pattern directly after discharge (B = -3.35, p < 0.001), slower walking speed (B = 0.10, p = 0.003), and lower anxiety levels (B = -0.07, p = 0.057). The final model showed good fit (Quasi-likelihood under Independence Model Criterion (QICC) = 737.02) and acceptable discrimination (area under the curve (AUC) = 0.74). Internal validation confirmed the model's robustness, with a shrinkage factor of 0.96. CONCLUSION: A clinical prediction rule to identify patients at risk of inactive movement behavior post-stroke was developed and internally validated. Early identification based on age, sex, and patient-reported fatigue can facilitate stratification for tailored behavior change interventions aimed at secondary prevention of recurrent cardiovascular events. External validation is required before clinical implementation.Data access statement:The datasets used and/or analyzed in this study are accessible from the corresponding author on reasonable request.
Hyperglycaemia does not modify the efficacy of endovascular therapy in the late time window (6-24 hours).
Kersten CJ, Zandbergen AA, Olthuis SG … +6 more , van Zwam WH, Hofmeijer J, Emmer BJ, Hoving JW, van Oostenbrugge RJ, den Hertog HM
Int J Stroke · 2026 Jan · PMID 40607642 · Publisher ↗
INTRODUCTION: Hyperglycemia is common in ischemic stroke. Admission glucose modifies the effect of endovascular therapy (EVT) in patients with ischemic stroke of the anterior circulation, who are treated 0 to 6 hours sin...
INTRODUCTION: Hyperglycemia is common in ischemic stroke. Admission glucose modifies the effect of endovascular therapy (EVT) in patients with ischemic stroke of the anterior circulation, who are treated 0 to 6 hours since onset. Whether this also applies for late-window EVT (6-24 hours since symptom onset or last known well) is unknown. In this study, we assessed whether admission glucose level and/or hyperglycemia modifies the EVT effect in patients with ischemic stroke of the anterior circulation in the late time window. METHODS: We used data from the MR CLEAN LATE trial. The primary outcome measure was the modified Rankin Scale (mRS) score at 90 days. Secondary outcome measures were symptomatic intracranial hemorrhage and mortality at 90 days. Treatment effect modification of EVT by either glucose or hyperglycemia on admission was assessed by multiplicative interaction factors with logistic regression analysis and adjusted for potential confounders. Hyperglycemia was defined as glucose level >7.8 mmol/L on admission. RESULTS: On admission, median glucose was 7.0 mmol/L (IQR 6.0-8.3 mmol/L), and 147 patients (32%) were hyperglycemic. We found no interaction of either hyperglycemia or serum glucose on admission with treatment effect on functional outcome (p = 0.76 and p = 0.79, respectively), symptomatic intracranial hemorrhage (p = 0.29 for hyperglycemia; p = 0.57 for glucose on admission), and for mortality (p = 0.52 for hyperglycemia; p = 0.69 for glucose on admission). CONCLUSION: We found no evidence for effect modification of EVT by admission glucose level or hyperglycemia in patients with acute ischemic stroke and large-vessel occlusion of the anterior circulation in the late treatment window.
Comparison of clinical and imaging features of cerebral small vessel disease associated with heterozygous and mutations.
Lee YC, Chen CH, Chou YT … +6 more , Cheng YW, Chung CP, Chen YD, Chang FC, Tang SC, Liao YC
Int J Stroke · 2026 Jan · PMID 40607620 · Publisher ↗
BACKGROUND: Heterozygous mutations are the second most common cause of monogenic dominant cerebral small vessel disease (-AD-cSVD or CADASIL2), after cerebral autosomal dominant arteriopathy with subcortical infarcts an...
BACKGROUND: Heterozygous mutations are the second most common cause of monogenic dominant cerebral small vessel disease (-AD-cSVD or CADASIL2), after cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) due to cysteine-altering mutations. However, there have been few studies of cohorts of -AD-cSVD and whether it can be differentiated clinically and on neuroimaging from CADASIL is unclear. AIMS: This retrospective study aims to characterize and compare the clinical and neuroimaging features of -AD-cSVD with those of CADASIL. METHODS: We identified 21 unrelated Taiwanese subjects carrying 15 heterozygous variants, all functionally validated as pathogenic through in vitro protease activity assays. -AD-cSVD patients were compared with 406 CADASIL patients, including 44 cases carrying mutations within the high-risk epidermal growth factor-like repeat domains (EGFr), 358 with moderate-risk EGFr mutations, and 4 with low-risk EGFr mutations. Multivariate regression analyses were conducted with adjustments for age at MRI examination and hypertension. RESULTS: Stroke occurred in 81.0% of -AD-cSVD patients, and 47.6% exhibited cognitive dysfunction. MRI revealed moderate-to-severe white matter hyperintensity (WMH) in the deep white matter and external capsule (modified Scheltens' scale: 5.3 ± 1.0 and 4.1 ± 1.7), mild WMH in the temporal pole (1.0 ± 1.7), lacunes in 90.5%, ⩾10 cerebral microbleeds (CMBs) in 66.7%, and intracranial hemorrhage (ICH) lesions in 46.7%, indicating susceptibility to both ischemic and hemorrhagic strokes. Patients with loss-of-function mutations or protease domain missense mutations exhibited a higher prevalence of ⩾10 CMBs on SWI/T2* imaging (100% and 83.3%) compared to those with missense mutations outside this domain (20%). Symptom onset occurred earliest in patients with high-risk EGFr mutations (49.2 ± 10.5 years), followed by those with heterozygous mutations (54.3 ± 10.7 years), and latest in moderate-risk EGFr mutations carriers (59.7 ± 9.5 years). Temporal pole involvement was most prevalent in high-risk EGFr mutations (88.6%), followed by moderate-risk EGFr mutations (32.4%), and least common in heterozygous mutations (28.6%). Even after adjusting for age and hypertension, -AD-cSVD patients exhibited significantly milder temporal pole WMH severity compared to high-risk EGFr mutation carriers (adjusted < 0.001). In addition, ICH lesions were more frequently observed in -AD-cSVD patients (46.7%) than in patients with high-risk or moderate-risk EGFr mutations (18.2% and 21.2%), although the difference was not statistically significant. CONCLUSION: -AD-cSVD shares overlapping clinical and neuroimaging features with CADASIL. Temporal pole WMH involvement can occur in -AD-cSVD but is more common in CADASIL. The high prevalence of ICH in -AD-cSVD has been under-recognized.Data access statement:Data are available upon reasonable request from third parties.
Recanalization of basilar artery occlusion during inter-hospital transfer for thrombectomy.
Adwane G, Lansberg MG, Liebart S … +16 more , Charbonneau F, Schwartz MA, Heit JJ, Mlynash M, Sablot D, Wacongne A, Desilles JP, Costalat V, Obadia M, Henry C, Manchon E, Arquizan C, Albers GW, Ter Schiphorst A, Seners P, Post-Transfer collaborators
Int J Stroke · 2026 Jan · PMID 40596745 · Publisher ↗
BACKGROUND: Patients with acute ischemic stroke and a large vessel occlusion admitted to non-endovascular capable centers frequently require inter-hospital transfer to a comprehensive stroke center (CSC) for thrombectomy...
BACKGROUND: Patients with acute ischemic stroke and a large vessel occlusion admitted to non-endovascular capable centers frequently require inter-hospital transfer to a comprehensive stroke center (CSC) for thrombectomy. Data regarding arterial recanalization of patients with basilar artery occlusion (BAO) during transfer are lacking. METHODS: We analyzed prospectively collected data of acute stroke patients with BAO transferred for consideration of thrombectomy to three CSCs (Rothschild Hospital, France; Montpellier Hospital, France; Stanford Hospital, USA) between 2016 and 2024, with arterial imaging at the referring hospital and on CSC arrival. Inter-hospital recanalization was assessed by comparison of the baseline and post-transfer arterial imaging and was defined as 2a-3 on the modified Thrombolysis In Cerebral Infarction (mTICI) scale. Independent predictors of inter-hospital recanalization were assessed using multivariable logistic regression analysis. RESULTS: Overall, 228 patients were included: median age 71 years, the National Institutes of Health Stroke Scale (NIHSS) of 14, transfer time of 3.5 h, and 39% of patients received intravenous thrombolysis (IVT) before transfer. The primary reason for withholding IVT was late presentation. Inter-hospital BAO recanalization occurred in 15% of patients. Variables independently associated with inter-hospital BAO recanalization were IVT use (adjusted odds ratio (aOR) = 24.3, 95% confidence interval (CI) = 6.9-85.5, < 0.01), distal BAO site (aOR = 2.9, 1.0-8.5, = 0.05), lack of diabetes (aOR = 11.4, 1.4-93.2, = 0.02), and non-atheromatous etiology (aOR = 6.6, 1.4-31.4, = 0.02). BAO recanalization rates ranged from 1% in non-IVT-treated patients with proximal BAO to 45% in IVT-treated patients with distal BAO. Inter-hospital recanalization was associated with an increased odds of good functional outcome (odds ratio (OR) for 3-month modified Rankin Scale (mRS) = 0-2 = 3.3, 95% CI = 1.2-8.8, = 0.02, adjusted for age, pre-stroke mRS, baseline NIHSS, Posterior Circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS), IVT use, and onset-to-imaging time). CONCLUSIONS: BAO recanalization during inter-hospital transfer for thrombectomy occurred in 15% of patients and was associated with a favorable 3-month outcome. IVT use in the referring center was the primary modifiable factor associated with recanalization, yet its use remains low. Expanding IVT indications in primary stroke centers and developing new therapies that increase recanalization may improve outcomes.
Factors influencing time spent in hospital for unscheduled readmissions after stroke discharge.
Turner M, McLernon DJ, Murchie P … +2 more , Langhorne P, Macleod MJ
Int J Stroke · 2025 Dec · PMID 40557868 · Full text
BACKGROUND AND AIMS: Unscheduled hospital readmission following stroke is common and has a significant effect on quality of life for patients and their families. However, there is limited evidence on the factors associat...
BACKGROUND AND AIMS: Unscheduled hospital readmission following stroke is common and has a significant effect on quality of life for patients and their families. However, there is limited evidence on the factors associated with unscheduled hospital readmission time in the first-year post-stroke discharge. This study aims to investigate patient and healthcare system factors associated with unscheduled hospital readmission time in a cohort of first-ever stroke patients in Scotland, UK. METHODS: This is a population-level data-linkage study using data on adult stroke patients admitted to hospital between 2010 and 2018, with follow-up to end of 2019. The association between unscheduled hospital readmission time and patient and healthcare system factors was assessed using multivariable zero-inflated negative binomial estimations. RESULTS: Among the 48,040 stroke patients (median age 73 years [interquartile range (IQR) 63-82]; 48.7% female) included in the study, 14,794 (30.8%) had at least one unscheduled readmission in the 1-year post-stroke discharge follow-up (median age 76 years [IQR 66-83]; 51.5% female). Median time spent in hospital as an unscheduled readmission in the 1-year follow-up was 9 days [IQR 3-25]. After adjustment, an increased risk of total unscheduled readmission time was associated with increasing age (≥ 80 years versus < 50 years Incidence Rate Ratio (IRR) 2.23 (95% CI 1.96-2.53)); living alone before stroke (IRR 1.17 (95% CI 1.11-1.24)); stroke severity (most versus least severe IRR 1.14 (95% CI 1.04-1.26)); intracerebral hemorrhage (IRR 1.29 (95% CI 1.18-1.42)); higher Charlson Comorbidity Index (CCI) (⩾3 versus 0 IRR 1.17 (95% CI 1.08-1.26)); higher frailty index (severe versus none IRR 1.16 (1.01-1.35); and longer length of stay for initial stroke admission (>10 days IRR 1.28 (95% CI 1.21-1.36)). Reduced risk of unscheduled readmission time was associated with lower socio-economic deprivation (least versus most deprived IRR 0.91 (95% CI 0.83-0.99)); prior transient ischaemic attack (TIA) (IRR 0.85 (95% CI 0.75-0.96)); and receipt of complete stroke care bundle (IRR 0.94 (95% CI 0.88-0.99)). CONCLUSION: Increased unscheduled hospital readmission time was associated with several factors including living alone, a higher comorbidity burden, stroke severity, and stroke type. Greater community support for these at-risk patients in terms of living arrangements and more pro-active outpatient management of comorbidities may be needed to reduce unscheduled readmission time following stroke discharge.
Hyperacute stroke care-What's new?
Markus HS
Int J Stroke · 2025 Jul · PMID 40552743 · Publisher ↗
Abstract loading — click title to view on PubMed.
Cerebral venous thrombosis during pregnancy and postpartum: A systematic review and meta-analysis.
Zhang X, Fang K, Zhang Y … +5 more , Song J, Wang R, Ji X, Meng R, Zhou D
Int J Stroke · 2025 Dec · PMID 40552725 · Publisher ↗
BACKGROUND: Cerebral venous thrombosis (CVT) is a rare but life-threatening condition, particularly among pregnant and postpartum women. However, estimates of its incidence, recurrence, and associated adverse outcomes re...
BACKGROUND: Cerebral venous thrombosis (CVT) is a rare but life-threatening condition, particularly among pregnant and postpartum women. However, estimates of its incidence, recurrence, and associated adverse outcomes remain inconsistent. Moreover, the role of antithrombotic prophylaxis in mitigating these risks has not been fully established. OBJECTIVE: This study aimed to synthesize global evidence on the incidence of CVT during pregnancy and postpartum, evaluate recurrence rates of CVT and noncerebral venous thromboembolism (VTE), assess adverse pregnancy outcomes, and explore the efficacy and safety of antithrombotic prophylaxis in high-risk populations. METHODS: A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five major databases were searched for observational studies reporting CVT incidence, recurrence, or pregnancy outcomes in women with prior CVT or noncerebral VTE, covering the period from 1980 to September 2024, with an updated search completed on May 6, 2025. Data were pooled using random-effects models and heterogeneity was quantified via the statistic. RESULTS: Forty-seven studies encompassing 14,218 pregnancies were included. The pooled incidence of postpartum CVT was 7 cases per 100,000 deliveries (95% confidence interval [CI]: 3-15), with significant regional disparities (Asia: 19/100,000; Europe: 3/100,000). The recurrence rate of CVT was 10.2 per 1000 deliveries (95% CI: 5-21), while noncerebral VTE recurred in 15.3 per 1000 pregnancies (95% CI: 8-28). The crude risk of spontaneous abortion was 15.7% (95% CI: 13-19), with higher rates observed in women not receiving prophylaxis. Antithrombotic prophylaxis appeared to reduce the risk of noncerebral VTE recurrence but did not significantly affect CVT recurrence. CONCLUSIONS: CVT and noncerebral VTE pose substantial risks during pregnancy, particularly in women with prior thrombotic events. Although antithrombotic prophylaxis may offer partial protection, its benefits must be carefully weighed against potential maternal and fetal risks. These findings underscore the need for individualized management and further research to inform evidence-based clinical guidelines.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe