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Visualization of the Human Intracranial Vasculature and Intracranial Implants Using Microangioscopy. 用微血管镜观察人颅内血管和颅内植入物的可视化。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-09 DOI: 10.1161/STROKEAHA.125.052675
Robert Fahed, Visish M Srinivasan, Cian O'Kelly, Francois Belzile, Khaled Effendi, Jeremy Rempel, William Siu, Zoe Tsai, Nicole Cancelliere, Pascal J Mosimann, Vitor Mendes Pereira, Peter Kan

Background: Cerebral angiography cannot directly assess the intimal surface of a vessel. The MicroAngioscope is a small and flexible catheter that allows visualization of the inside of the cerebral vasculature. Our objective is to report our first-in-human experience with the live visualization of intracranial vasculature using the MicroAngioscope.

Methods: This was a prospective, single-arm, national multi-center observational study of consecutive intracranial endovascular cases treated using the MicroAngioscope as an adjunct. This first-in-human study aimed at assessing the safety of the technology by prospectively collecting any procedural complications. A secondary end point was the successful visualization of the vasculature and the implants.

Results: The MicroAngioscope, used in 31 cases, was successfully delivered to the location of interest and allowed for a direct live visualization of the condition and the implant that had been deployed. There was no vessel injury based on cerebral angiography. The cases included 9 cases of carotid stent, 6 cases of flow diversion, 11 cases of transverse sinus stenting, 2 cases of aneurysm intrasaccular flow-disruption, 1 case of aneurysm treatment with stent-assisted coiling, and 2 cases of mechanical thrombectomy. All cases were successfully completed without complications. All patients were neurologically unchanged following their respective procedures. Angioscopy was helpful in making the diagnosis in the case of the carotid web, assessing vessel wall apposition immediately after flow diverter and venous stent deployment, and assessing the degree of strut coverage in both arterial and venous stents in follow-up.

Conclusions: This First-in-Human study demonstrated the early feasibility and safety of the MicroAngioscope in neurointerventional procedures. Further studies are needed to determine its relevance in daily practice.

背景:脑血管造影不能直接评估血管的内膜表面。微血管镜是一种小而灵活的导管,可以看到脑血管系统的内部。我们的目的是报告我们首次使用显微血管镜实时可视化颅内血管系统的人类经验。方法:这是一项前瞻性、单臂、国家多中心观察性研究,使用显微血管镜作为辅助治疗连续颅内血管内病例。这项首次人体研究旨在通过前瞻性地收集任何程序并发症来评估该技术的安全性。第二个终点是血管系统和植入物的成功可视化。结果:在31例病例中使用了显微血管镜,成功地到达感兴趣的位置,并允许对情况和已部署的种植体进行直接的实时可视化。脑血管造影未见血管损伤。其中颈动脉支架置入9例,分流6例,横窦支架置入11例,动脉瘤囊内血流阻断2例,动脉瘤支架辅助盘绕治疗1例,机械取栓2例。所有病例均顺利完成手术,无并发症。所有患者在各自的治疗过程中神经系统无变化。血管镜检查有助于在颈动脉网的情况下进行诊断,在分流器和静脉支架部署后立即评估血管壁靠近,并在随访中评估动脉和静脉支架的支撑物覆盖程度。结论:这项首次在人体中进行的研究证明了微血管镜在神经介入手术中的早期可行性和安全性。需要进一步的研究来确定其在日常实践中的相关性。
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引用次数: 0
Cortical Oscillations as an Endophenotype Mediating ApoE-ε2 Effects on Poststroke Functional Status. 脑卒中后功能状态中ApoE-ε2对脑皮层振荡的影响
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-09 DOI: 10.1161/STROKEAHA.125.054238
Célia Delcamp, Anne Schwarz, Kathie J Ngo, Darice Y Wong, Brent L Fogel, Ramesh Srinivasan, Steven C Cramer

Background: Abundant data link ApoE (apolipoprotein E)-ε2 with favorable outcomes in several neurological settings and in healthy subjects, but studies in relation to stroke outcomes are few. ApoE-ε2 activities are associated with poststroke cortical oscillations, which themselves are correlated with poststroke outcomes. The aim of this cohort study was to determine whether cortical oscillations could represent an endophenotype mediating the effects of ApoE-ε2 on poststroke function.

Methods: In 33 patients with recent stroke, resting EEG activity (3 minutes), APOE genotype, and functional outcome (GG scores) were measured. ANCOVAs and partial Pearson correlations were performed to validate the prerequisites for mediation analyses, in which EEG cortical power was tested as a mediator of the relationship between APOE-ε2 and functional outcome.

Results: ApoE-ε2 carriers showed higher ipsilesional beta power and lower ipsilesional theta power, both of which were linked to better functional outcomes. The principal mediation analysis revealed an indirect effect of ApoE-ε2 on functional outcome via ipsilesional M1 beta power (ACME, 14.79 [0.9-34.6], P=0.03*), explaining 14% of the average outcome. Exploratory mediation analyses further highlighted an indirect effect of ApoE-ε2 on functional outcome via ipsilesional M1 theta power (ACME, 48.2 [13.3-89.6], P=0.017*, explaining 43% of the average outcome. Ipsilesional M1 power in other frequency bands (delta, alpha, gamma) and contralesional M1 power across all frequency bands did not reveal significant mediation effects.

Conclusions: The mediation analysis results suggests that ApoE-ε2 supports a pro-repair environment, which may translate into more favorable cortical dynamics after stroke. Cortical oscillatory activity may be considered as an endophenotype that mediates the effects of ApoE-ε2 on functional outcome and could potentially be leveraged as a biomarker to develop personalized interventions targeting stroke recovery.

背景:大量数据表明ApoE(载脂蛋白E)-ε2在一些神经系统环境和健康受试者中具有良好的预后,但与卒中预后相关的研究很少。ApoE-ε2活动与脑卒中后皮层振荡有关,而脑卒中后皮层振荡本身与脑卒中后预后相关。这项队列研究的目的是确定皮层振荡是否可以代表一种介导ApoE-ε2对脑卒中后功能影响的内表型。方法:对33例近期脑卒中患者进行静息脑电图活动(3分钟)、APOE基因型和功能结局(GG评分)的测定。采用ANCOVAs和部分Pearson相关来验证中介分析的前提条件,其中EEG皮质功率作为APOE-ε2与功能结局之间关系的中介进行了测试。结果:ApoE-ε2携带者表现出较高的同效β功率和较低的同效θ功率,两者都与较好的功能预后有关。主中介分析显示,ApoE-ε2通过同效M1 β功率间接影响功能结局(ACME, 14.79 [0.9-34.6], P=0.03*),解释了平均结局的14%。探索性中介分析进一步强调了ApoE-ε2通过同效M1 θ幂(ACME, 48.2 [13.3-89.6], P=0.017*)对功能结局的间接影响,解释了43%的平均结局。其他频带(δ、α、γ)的同视M1功率和所有频带的对视M1功率没有显示出显著的中介效应。结论:ApoE-ε2的中介分析结果表明,ApoE-ε2支持一个促进脑卒中修复的环境,这可能转化为脑卒中后更有利的皮质动力学。皮层振荡活动可能被认为是一种介导ApoE-ε2对功能结果影响的内表型,并可能作为一种生物标志物来开发针对中风恢复的个性化干预措施。
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引用次数: 0
Perinatal Arterial Ischemic Stroke Phase 3 Trial Protocol for Intensive Infant-Toddler Rehabilitation (I-ACQUIRE). 围产期动脉缺血性卒中强化婴幼儿康复(I-ACQUIRE)的3期试验方案。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-06 DOI: 10.1161/STROKEAHA.125.053375
Sharon Landesman Ramey, Warren D Lo, Stephanie C DeLuca, Jill C Heathcock, Amy R Darragh, Craig T Ramey, Max Wintermark, Renee H Martin, Mark R Conaway, Steven L Wolf, L Scott Janis, Joseph P Broderick

Background: Infants and toddlers with perinatal arterial ischemic stroke face a high risk for lifelong neuromotor impairments and multiple disabilities. Phase 3 clinical trial evidence is urgently needed to identify efficacious treatment to improve outcomes.

Methods: The I-ACQUIRE Phase 3 trial (Perinatal Arterial Stroke: A Multisite RCT of Intensive Infant Rehabilitation) is a 15-site randomized clinical trial of 2 dosages of I-ACQUIRE, a multicomponent, therapist-delivered intervention including key components of constraint-induced movement therapy compared with usual and customary treatment. The trial recruited children 8 to 36 months old with parent-reported perinatal arterial ischemic stroke, hemiparesis, good health, and no prior botulinum toxin or constraint-induced movement therapy. Central 1:1:1 randomization assigned children to High-dose I-ACQUIRE (6-hour sessions, 5 days/wk, 4 weeks), Moderate-dose I-ACQUIRE (3-hour sessions, 5 days/wk, 4 weeks), and Usual and Customary Treatment. Blinded assessments at baseline, end-of-treatment, and 6-months later include the Emerging Behaviors Scale (success defined as % with gains ≥7 points), the primary outcome for unilateral skills on the paretic arm-and-hand; and the Mini-Assisting Hand Assessment, the secondary outcome for bimanual activities. Parents also rate children's motor skills, treatment responses, and stress. Statistical analyses include 2-sample binomial tests for group differences and linear mixed regression models. The registered trial adheres to international trial reporting guidelines and has a parent council.

Results: This study protocol describes intervention components plus training and monitoring of treatment fidelity. The trial recruited N=216 children; 198 completed baseline assessments, and 168 (85 boys and 83 girls) qualified for the modified intent-to-treat sample. The mean age was 18.0 (SD=7.6) months. A majority had right-sided paresis (70%); 51% had seizures/epilepsy. Children varied widely in functional classification levels and parent ratings.

Conclusions: The trial sets a unique high threshold for efficacy and proposes sensitivity and exploratory analyses to consider differential response patterns to treatment. If 1 or both I-ACQUIRE dosages lead to significant improvements, then Phase 3 evidence will assist in infant/toddler rehabilitation decision-making.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03910075.

背景:围产期动脉缺血性中风的婴幼儿面临终身神经运动障碍和多重残疾的高风险。迫切需要iii期临床试验证据来确定有效的治疗方法以改善结果。方法:I-ACQUIRE 3期试验(围产期动脉性卒中:一项多地点强化婴儿康复的随机对照试验)是一项15个地点的2种剂量I-ACQUIRE的随机临床试验,这是一种多成分,治疗师提供的干预措施,包括与常规和习惯治疗相比的约束诱导运动治疗的关键成分。该试验招募了8至36个月大的儿童,父母报告围产儿动脉缺血性中风,偏瘫,健康状况良好,先前没有肉毒杆菌毒素或约束诱导运动治疗。中心1:1:1随机分组将儿童分配到高剂量i - acquisition组(6小时疗程,5天/周,4周),中等剂量i - acquisition组(3小时疗程,5天/周,4周),以及常规和习惯治疗组。基线、治疗结束和6个月后的盲法评估包括新出现行为量表(成功定义为获得≥7分的百分比),这是对父母单侧技能的主要结果;以及迷你辅助手评估,这是双手活动的次要结果。父母还会评估孩子的运动技能、治疗反应和压力。统计分析包括两样本二项检验和线性混合回归模型。注册的试验遵循国际试验报告准则,并有一个家长委员会。结果:本研究方案描述了干预成分以及治疗保真度的培训和监测。该试验招募了N=216名儿童;198人完成了基线评估,168人(85名男孩和83名女孩)符合修改意向治疗样本的要求。平均年龄为18.0 (SD=7.6)个月。多数为右侧脑卒中(70%);51%有癫痫发作/癫痫。儿童在功能分类水平和父母评分方面差异很大。结论:该试验为疗效设定了一个独特的高阈值,并提出了敏感性和探索性分析,以考虑治疗的不同反应模式。如果1次或两次I-ACQUIRE剂量都能显著改善,那么3期证据将有助于婴儿/幼儿康复决策。注册:网址:https://www.clinicaltrials.gov;唯一标识符:NCT03910075。
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引用次数: 0
Peri-Stenotic Stagnation Associates With Red Blood Cell-Rich Thrombi, Linked to Stroke Recurrence and Lesion Volume. 血管狭窄周滞积与富含红细胞的血栓有关,与卒中复发和病变体积有关。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-04 DOI: 10.1161/STROKEAHA.125.053896
Dong Young Jeong, Jun Ho Ahn, Wonseok Choi, Han-Bin Lee, Joo Young Kweon, Hyunsun Oh, Sun U Kwon, Ji Sung Lee, Minsik Sung, Donghyeon Oh, Bum Joon Kim, Yong Joo Ahn, Chulhong Kim

Background: Despite antiplatelet therapy, plaque-induced strokes recur frequently. This recurrence may reflect thrombus heterogeneity driven by peri-stenotic stagnation and red blood cell (RBC) entrapment. The clinical implications of such variations for stroke outcomes remain unclear. We investigated whether plaque-derived RBC-rich thrombi, indicated by the clot sign, were associated with recurrence, lesion volume, and stenosis-related hemodynamics.

Methods: Because asymptomatic plaque rupture limits direct evaluation of hemodynamics and thrombus compositions, we performed a hybrid human-animal study. In humans, we conducted a retrospective case-control study across 2 tertiary stroke centers in the Republic of Korea between April 2017 and March 2024, evaluating stroke recurrence and lesion volume by clot sign, using inverse probability of treatment weighting. We included artery-to-artery embolization confirmed by diffusion weighted imaging, excluding other etiologies. In animals, thrombus compositions were histologically analyzed in an FeCl3-induced stenosis model across 3 segments (ascent, peak, and descent). Peri-stenotic hemodynamics, including wall shear stress and relative residence time, were assessed using ultrafast ultrasound imaging to evaluate whether RBC entrapment correlated with elevated relative residence time.

Results: In humans, clot sign-positive patients exhibited higher recurrence risk (hazard ratio, 2.76 [95% CI, 1.32-5.74]; P=0.007), and larger lesion (mean difference, 16.14 [95% CI, 5.03-27.25]; P=0.005). In animals, RBCs proportion was increased in the descent (ascent, 23.89±15.91%; peak, 12.33±11.19%; descent, 59.58±35.09%; P=0.019), correlating with a 3-fold higher relative residence time in the descent than the other regions (ascent, 1.25±0.75 au; peak, 1.55±0.55 au; descent, 4.50±2.74 au; P=0.001).

Conclusions: Peri-stenotic stagnation was associated with RBC-rich thrombi formation under both clinical and experimental conditions, providing mechanistic insight into stroke recurrence and larger lesion volumes. Identifying peri-stenotic stagnation using ultrafast ultrasound imaging may help stratify high-risk patients; however, its therapeutic implications require validation in prospective randomized studies.

背景:尽管有抗血小板治疗,斑块性中风仍经常复发。这种复发可能反映了狭窄周围淤积和红细胞(RBC)夹闭导致的血栓异质性。这些变化对中风结果的临床意义尚不清楚。我们研究了斑块来源的富含红细胞的血栓是否与复发、病变体积和狭窄相关的血流动力学有关。方法:由于无症状斑块破裂限制了对血流动力学和血栓成分的直接评估,我们进行了一项人-动物杂交研究。在人类中,我们在2017年4月至2024年3月期间在韩国的2个三级卒中中心进行了一项回顾性病例对照研究,使用治疗加权的逆概率,通过血栓迹象评估卒中复发和病变体积。我们纳入了经弥散加权成像证实的动脉对动脉栓塞,排除了其他病因。在动物中,在fecl3诱导的狭窄模型中,通过3节段(上升、峰值和下降)对血栓成分进行组织学分析。使用超快超声成像评估狭窄周血流动力学,包括壁剪切应力和相对停留时间,以评估红细胞夹持是否与相对停留时间升高相关。结果:在人类中,凝块体征阳性的患者复发风险较高(危险比2.76 [95% CI, 1.32-5.74]; P=0.007),病灶较大(平均差值16.14 [95% CI, 5.03-27.25]; P=0.005)。动物红细胞比例下降(上升,23.89±15.91%,峰值,12.33±11.19%,下降,59.58±35.09%,P=0.019),与下降相对停留时间(上升,1.25±0.75 au,峰值,1.55±0.55 au,下降,4.50±2.74 au, P=0.001)相比,下降的相对停留时间增加了3倍。结论:在临床和实验条件下,狭窄周围停滞与富含红细胞的血栓形成有关,为卒中复发和更大的病变体积提供了机制见解。使用超快速超声成像识别狭窄周梗阻可能有助于对高危患者进行分层;然而,其治疗意义需要在前瞻性随机研究中验证。
{"title":"Peri-Stenotic Stagnation Associates With Red Blood Cell-Rich Thrombi, Linked to Stroke Recurrence and Lesion Volume.","authors":"Dong Young Jeong, Jun Ho Ahn, Wonseok Choi, Han-Bin Lee, Joo Young Kweon, Hyunsun Oh, Sun U Kwon, Ji Sung Lee, Minsik Sung, Donghyeon Oh, Bum Joon Kim, Yong Joo Ahn, Chulhong Kim","doi":"10.1161/STROKEAHA.125.053896","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.053896","url":null,"abstract":"<p><strong>Background: </strong>Despite antiplatelet therapy, plaque-induced strokes recur frequently. This recurrence may reflect thrombus heterogeneity driven by peri-stenotic stagnation and red blood cell (RBC) entrapment. The clinical implications of such variations for stroke outcomes remain unclear. We investigated whether plaque-derived RBC-rich thrombi, indicated by the clot sign, were associated with recurrence, lesion volume, and stenosis-related hemodynamics.</p><p><strong>Methods: </strong>Because asymptomatic plaque rupture limits direct evaluation of hemodynamics and thrombus compositions, we performed a hybrid human-animal study. In humans, we conducted a retrospective case-control study across 2 tertiary stroke centers in the Republic of Korea between April 2017 and March 2024, evaluating stroke recurrence and lesion volume by clot sign, using inverse probability of treatment weighting. We included artery-to-artery embolization confirmed by diffusion weighted imaging, excluding other etiologies. In animals, thrombus compositions were histologically analyzed in an FeCl<sub>3</sub>-induced stenosis model across 3 segments (ascent, peak, and descent). Peri-stenotic hemodynamics, including wall shear stress and relative residence time, were assessed using ultrafast ultrasound imaging to evaluate whether RBC entrapment correlated with elevated relative residence time.</p><p><strong>Results: </strong>In humans, clot sign-positive patients exhibited higher recurrence risk (hazard ratio, 2.76 [95% CI, 1.32-5.74]; <i>P</i>=0.007), and larger lesion (mean difference, 16.14 [95% CI, 5.03-27.25]; <i>P</i>=0.005). In animals, RBCs proportion was increased in the descent (ascent, 23.89±15.91%; peak, 12.33±11.19%; descent, 59.58±35.09%; <i>P</i>=0.019), correlating with a 3-fold higher relative residence time in the descent than the other regions (ascent, 1.25±0.75 au; peak, 1.55±0.55 au; descent, 4.50±2.74 au; <i>P</i>=0.001).</p><p><strong>Conclusions: </strong>Peri-stenotic stagnation was associated with RBC-rich thrombi formation under both clinical and experimental conditions, providing mechanistic insight into stroke recurrence and larger lesion volumes. Identifying peri-stenotic stagnation using ultrafast ultrasound imaging may help stratify high-risk patients; however, its therapeutic implications require validation in prospective randomized studies.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Consensus Review of Perioperative Immune Modulation for Endovascular Thrombectomy Following Ischemic Stroke. 缺血性卒中后血管内血栓切除术围手术期免疫调节的共识综述。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-02 DOI: 10.1161/STROKEAHA.125.051556
Ling Cai, Yan Li, Chong Wang, Tim Magnus, Chengye Yao, Xiaoming Hu, Ann M Stowe, Anna Rosell, Sunghee Cho, Stuart M Allan, Jieqing Wan, Yulong Ma, Yang Liu, Daniel I Sessler, Johannes Boltze, Tianlong Wang, Weifeng Yu, Yueman Zhang, Peiying Li

Ischemic stroke is a major global health burden, leading to considerable mortality and long-term disability. Endovascular thrombectomy and mechanical recanalization have revolutionized acute stroke care. Nonetheless, many patients experience poor long-term neurological outcomes, which are often attributed to the no-reflow phenomenon and activation of inflammatory cascades. The perioperative period of endovascular thrombectomy, managed under either general anesthesia or conscious sedation, represents a critical window where anesthetic strategies may influence recovery through hemodynamic control and possibly immune modulation. This consensus review was generated by an international multidisciplinary expert group and synthesizes preclinical and clinical evidence to evaluate the promise of various immunomodulatory strategies for improving functional outcomes in patients with ischemic stroke following endovascular thrombectomy. Our goal is to provide a foundational reference for future research and development of novel perioperative immune therapies for patients with endovascular thrombectomy.

缺血性中风是一个主要的全球健康负担,导致大量死亡和长期残疾。血管内血栓切除术和机械再通已经彻底改变了急性中风的护理。尽管如此,许多患者经历较差的长期神经预后,这通常归因于无回流现象和炎症级联反应的激活。在全身麻醉或清醒镇静下进行的血管内血栓切除术的围手术期是一个关键的窗口期,麻醉策略可能通过血液动力学控制和可能的免疫调节来影响恢复。这一共识综述是由一个国际多学科专家组产生的,综合了临床前和临床证据,以评估各种免疫调节策略对改善血管内血栓切除术后缺血性卒中患者功能结局的前景。我们的目标是为未来研究和开发新的血管内血栓切除术患者围手术期免疫疗法提供基础参考。
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引用次数: 0
Classification and Management of Ischemic Stroke in Patients With Active Cancer: A Scientific Statement From the American Heart Association. 活动性癌症患者缺血性卒中的分类和管理:美国心脏协会的科学声明。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-02 DOI: 10.1161/STR.0000000000000517
Babak B Navi, Scott E Kasner, Mary Cushman, Tochi M Okwuosa, Nathaniel H Fleming, Jacqueline M Behr, Jennifer J Yang, Ajay Gupta, Lisa M DeAngelis

About 10% to 15% of patients with ischemic stroke have a history of cancer, half of whom have active malignancy at the time of stroke. With improved cancer treatments extending patient survival, the coprevalence of these diseases has increased steadily since 2000. This has sparked considerable growth in research and knowledge on this topic. Approximately half of ischemic strokes in patients with active cancer are due to conventional mechanisms, although cancer-related factors may contribute. The remaining half of ischemic strokes in this population are typically classified as cryptogenic or attributed to cancer-specific mechanisms. These cryptogenic strokes often have characteristic risk markers and clinical features and are extremely high risk for recurrent stroke and other adverse events, distinguishing them from other stroke subgroups. Recent epidemiological, translational, and histopathological data indicate that many of these events are likely caused by the cancer itself through multifactorial prothrombotic processes. In this scientific statement incorporating multidisciplinary expertise, we critically appraise and synthesize recent evidence and provide clinical suggestions on the epidemiology, presentation, evaluation, pathophysiology, and treatments for ischemic stroke in patients with active cancer. In addition, we propose a novel classification for ischemic stroke attributed to cancer itself, which we define as cancer-related stroke to enable consistent nomenclature and to harmonize stroke classification across clinical practice and research. This system is based on routinely available clinical data and includes different categories for certainty of causality, relating to the patient's distinctive clinical features and estimated risk for recurrent thromboembolism. We hope this framework spurs dedicated controlled trials to address areas of clinical uncertainty.

约10% ~ 15%的缺血性卒中患者有癌症病史,其中一半患者在卒中时有活动性恶性肿瘤。随着癌症治疗方法的改进延长了患者的生存期,自2000年以来,这些疾病的发病率稳步上升。这引发了关于这一主题的研究和知识的大量增长。在活动性癌症患者中,大约一半的缺血性中风是由于常规机制引起的,尽管癌症相关因素也可能起作用。在这一人群中,其余一半的缺血性中风通常被归类为隐源性或归因于癌症特异性机制。这些隐源性卒中通常具有特征性的危险标志和临床特征,并且复发性卒中和其他不良事件的风险极高,将其与其他卒中亚组区分开来。最近的流行病学、转化和组织病理学数据表明,许多这些事件可能是由癌症本身通过多因素血栓形成过程引起的。在这篇结合多学科专业知识的科学声明中,我们批判性地评估和综合了最近的证据,并就活动性癌症患者缺血性卒中的流行病学、表现、评估、病理生理学和治疗提供了临床建议。此外,我们提出了一种归因于癌症本身的缺血性中风的新分类,我们将其定义为癌症相关中风,以实现一致的命名,并协调临床实践和研究中的中风分类。该系统以常规临床数据为基础,根据患者独特的临床特征和复发性血栓栓塞的估计风险,包括确定因果关系的不同类别。我们希望这一框架能刺激专门的对照试验,以解决临床不确定性领域的问题。
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引用次数: 0
Pregnancy and Stroke: Insight From the Cosmos Database. 怀孕和中风:来自宇宙数据库的洞察。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-02 DOI: 10.1161/STROKEAHA.125.054250
Mohammad Anadani, Lina Hamoud, Sami Al Kasab, Kimberly K Kicielinski, Chi Wang, Mohammad H Akanda, Mouhammad Jumaa, Abdul Ghani Hammoud, Kevin Dysart

Background: Maternal stroke is an uncommon but serious complication of pregnancy. This study assessed the incidence, temporal trends, and outcomes of maternal stroke in the United States using the Cosmos Epic database.

Methods: We conducted a retrospective analysis of pregnancies resulting in births between January 1, 2016, and January 1, 2024, using the Cosmos Epic database, which includes deidentified electronic health records from >1800 US hospitals and 41 500 clinics. Maternal stroke was defined as any inpatient admission with a stroke diagnosis during pregnancy or within 6 weeks postpartum. The primary outcome was maternal stroke incidence; secondary outcomes included maternal mortality, delivery complications, and neonatal outcomes. Propensity score matching (1:1) was applied to adjust for confounding.

Results: Among 5 404 933 pregnancies, 2637 were complicated by stroke, yielding an incidence of 48.8 per 100 000 pregnancies. Ischemic stroke was most common (52.6%), followed by hemorrhagic stroke (40.7%). The overall rate remained stable though ischemic stroke showed an upward trend. Women with stroke were older and more likely to be Black, and had higher rates of hypertension, dyslipidemia, congenital heart disease, and eclampsia. In the matched cohort (n=1200 pairs), the stroke group had higher mortality (1.7% versus 0%), more delivery complications, lower birth weight, and longer neonatal hospital stays. Among 409 subsequent pregnancies, recurrent stroke occurred in 14.7% but with no maternal mortality and favorable neonatal outcomes.

Conclusions: Maternal stroke, though rare, carries substantial risks. The increasing ischemic stroke trend warrants targeted prevention and multidisciplinary perinatal management.

背景:产妇脑卒中是一种罕见但严重的妊娠并发症。本研究使用Cosmos Epic数据库评估了美国产妇中风的发生率、时间趋势和结果。方法:我们使用Cosmos Epic数据库对2016年1月1日至2024年1月1日期间分娩的妊娠进行了回顾性分析,该数据库包括来自美国bbb1800家医院和41,500家诊所的未识别电子健康记录。母亲中风被定义为任何在怀孕期间或产后6周内因中风诊断而住院的患者。主要结局为产妇脑卒中发生率;次要结局包括产妇死亡率、分娩并发症和新生儿结局。采用倾向评分匹配(1:1)来校正混杂。结果:5 404 933例妊娠中合并脑卒中2637例,发生率为48.8 / 10万例。缺血性卒中最常见(52.6%),其次是出血性卒中(40.7%)。尽管缺血性中风的发病率呈上升趋势,但总体发病率保持稳定。患中风的女性年龄更大,更可能是黑人,并且高血压、血脂异常、先天性心脏病和子痫的发病率更高。在匹配的队列中(n=1200对),中风组死亡率更高(1.7%对0%),分娩并发症更多,出生体重更低,新生儿住院时间更长。在409例后续妊娠中,复发性卒中发生率为14.7%,但没有产妇死亡,新生儿预后良好。结论:母亲中风虽然罕见,但有很大的风险。缺血性卒中的增加趋势需要有针对性的预防和多学科围产期管理。
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引用次数: 0
Value of 24- to 48-Hour Infarct Volume as a Surrogate for Clinical Outcome in Late-Window Thrombectomy May Be Limited: A Post Hoc Analysis of the AURORA Collaboration. 24- 48小时梗死面积作为晚窗取栓临床结果替代指标的价值可能有限:AURORA合作的事后分析
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-01 Epub Date: 2025-12-04 DOI: 10.1161/STROKEAHA.125.052109
Johanna M Ospel, Scott Brown, Gregory W Albers, Tudor G Jovin, Maarten G Lansberg, Raul G Nogueira, Ashutosh P Jadhav, Diogo C Haussen, Sheila O Martins, Leticia C Rebello, Marc Ribo, Aquilla S Turk, David S Liebeskind, Jeremy J Heit, Michael P Marks, Andrew M Demchuk, Michael D Hill, Mayank Goyal

Background: The utility of 24- to 48-hour follow-up infarct volume (FIV) as a surrogate outcome in late time-window acute ischemic stroke is unclear. We aimed to determine associations of 24- to 48-hour FIV and clinical outcome in patients presenting >6 hours from last known well with and without endovascular treatment (EVT).

Methods: Post hoc analysis of the AURORA (Thrombectomy for Anterior Circulation Stroke Beyond 6 h From Time Last Known Well) patient-level meta-analysis of 6 randomized trials of late-window EVT. Patients were randomized to EVT or the control arm (best medical care). FIV was assessed on follow-up computed tomography or magnetic resonance imaging at 24 to 48 hours. Multivariable binary logistic regression with adjustment for key covariates was performed to estimate probabilities of achieving functional independence (modified Rankin Scale [mRS] score, 0-2 at 90 days) based on FIV. Mediation analysis was performed to determine the proportion of the EVT effect that is explained by FIV reduction.

Results: Four hundred forty-nine patients of 505 patients (88.9%) had available FIV and 90-day mRS and were included. Patients with worse outcomes at 90 days had larger FIV (median FIV in 90-day mRS score, 1:13.7 mL [interquartile range, 6.1-31.3] versus mRS score, 6:59.6 [18.8-145.0]; P<0.01). In the EVT arm, the estimated probability of achieving an mRS score of 0 to 2 declined with increasing FIV, from 65% at 0 mL FIV to 4% at 200 mL. In the control arm, this association was weaker, and the mRS score of 0 to 2 probabilities were overall lower. Only 5.9% of EVT's effect on clinical outcome was explained by FIV reduction.

Conclusions: FIV mediated only a small proportion of the EVT effect on clinical outcome, and the association of FIV and outcomes was much weaker; overall outcomes were worse in the control arm compared with the EVT arm. For FIV up to 100 mL, EVT results in substantially better clinical outcomes than best medical management given the same FIV. The utility of FIV as a surrogate outcome in late time-window stroke may be limited.

背景:24- 48小时随访梗死体积(FIV)作为晚期急性缺血性卒中的替代结果的效用尚不清楚。我们的目的是确定24至48小时的FIV与>至6小时的临床结果之间的关系,无论是否进行血管内治疗(EVT)。方法:对6项晚期EVT随机试验的AURORA患者水平荟萃分析进行事后分析。患者随机分为EVT组和对照组(最佳医疗护理组)。随访24 ~ 48小时通过计算机断层扫描或磁共振成像评估FIV。采用校正关键协变量的多变量二元逻辑回归来估计基于FIV实现功能独立的概率(修正Rankin量表[mRS]评分,90天时0-2)。进行中介分析以确定由FIV降低解释的EVT效应的比例。结果:505例患者中有449例(88.9%)具有可用的FIV和90天mRS。90天预后较差的患者FIV较大(90天mRS评分中位FIV为1:13.7 mL[四分位数间距,6.1-31.3],mRS评分中位FIV为6:59.6[18.8-145.0]);结论:FIV仅介导EVT对临床预后影响的一小部分,FIV与预后的相关性要弱得多;对照组的总体预后较EVT组差。对于FIV高达100 mL, EVT的临床结果明显优于给予相同FIV的最佳医疗管理。FIV作为晚期脑卒中替代结果的效用可能有限。
{"title":"Value of 24- to 48-Hour Infarct Volume as a Surrogate for Clinical Outcome in Late-Window Thrombectomy May Be Limited: A Post Hoc Analysis of the AURORA Collaboration.","authors":"Johanna M Ospel, Scott Brown, Gregory W Albers, Tudor G Jovin, Maarten G Lansberg, Raul G Nogueira, Ashutosh P Jadhav, Diogo C Haussen, Sheila O Martins, Leticia C Rebello, Marc Ribo, Aquilla S Turk, David S Liebeskind, Jeremy J Heit, Michael P Marks, Andrew M Demchuk, Michael D Hill, Mayank Goyal","doi":"10.1161/STROKEAHA.125.052109","DOIUrl":"10.1161/STROKEAHA.125.052109","url":null,"abstract":"<p><strong>Background: </strong>The utility of 24- to 48-hour follow-up infarct volume (FIV) as a surrogate outcome in late time-window acute ischemic stroke is unclear. We aimed to determine associations of 24- to 48-hour FIV and clinical outcome in patients presenting >6 hours from last known well with and without endovascular treatment (EVT).</p><p><strong>Methods: </strong>Post hoc analysis of the AURORA (Thrombectomy for Anterior Circulation Stroke Beyond 6 h From Time Last Known Well) patient-level meta-analysis of 6 randomized trials of late-window EVT. Patients were randomized to EVT or the control arm (best medical care). FIV was assessed on follow-up computed tomography or magnetic resonance imaging at 24 to 48 hours. Multivariable binary logistic regression with adjustment for key covariates was performed to estimate probabilities of achieving functional independence (modified Rankin Scale [mRS] score, 0-2 at 90 days) based on FIV. Mediation analysis was performed to determine the proportion of the EVT effect that is explained by FIV reduction.</p><p><strong>Results: </strong>Four hundred forty-nine patients of 505 patients (88.9%) had available FIV and 90-day mRS and were included. Patients with worse outcomes at 90 days had larger FIV (median FIV in 90-day mRS score, 1:13.7 mL [interquartile range, 6.1-31.3] versus mRS score, 6:59.6 [18.8-145.0]; <i>P</i><0.01). In the EVT arm, the estimated probability of achieving an mRS score of 0 to 2 declined with increasing FIV, from 65% at 0 mL FIV to 4% at 200 mL. In the control arm, this association was weaker, and the mRS score of 0 to 2 probabilities were overall lower. Only 5.9% of EVT's effect on clinical outcome was explained by FIV reduction.</p><p><strong>Conclusions: </strong>FIV mediated only a small proportion of the EVT effect on clinical outcome, and the association of FIV and outcomes was much weaker; overall outcomes were worse in the control arm compared with the EVT arm. For FIV up to 100 mL, EVT results in substantially better clinical outcomes than best medical management given the same FIV. The utility of FIV as a surrogate outcome in late time-window stroke may be limited.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"450-458"},"PeriodicalIF":8.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of Evidence in European Stroke Organisation and American Heart Association Stroke Guidelines. 欧洲中风组织和美国心脏协会中风指南的证据质量。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-01 Epub Date: 2025-10-23 DOI: 10.1161/STROKEAHA.125.053239
Stephen O Brennan, Brian Gordon, Craig S Anderson, Shelagh B Coutts, Jesse Dawson, Michael D Hill, Robin Lemmens, Bijoy K Menon, Christopher I Price, Diana Aguiar de Sousa, Götz Thomalla, Georgios Tsivgoulis, Guillaume Turc, Peter J Kelly, John J McCabe

Background: Evidence-based practice relies on clinical guidelines, whose recommendations depend on the quality, relevance, and validity of supporting research. We evaluated the class/strength and level of evidence (LOE) or quality of evidence (QOE) supporting American Heart Association/American Stroke Association and European Stroke Organisation guideline recommendations, and examined temporal changes in LOE.

Methods: Stroke guidelines from American Heart Association/American Stroke Association (1995-2025) and European Stroke Organisation (2014-2025) were identified through society websites and EMBASE/MEDLINE. Eligible documents contained recommendations with class/strength and LOE/QOE. Consensus statements were excluded. Since 2006, American Heart Association/American Stroke Association has classified LOE as A (multiple or large randomized-controlled trials), B (single trial or observational studies), or C (expert opinion). European Stroke Organisation applies the Grading of Recommendations Assessment, Development, and Evaluation system (high, moderate, low, and very low QOE).

Results: Across 1102 recommendations in 9 current American Heart Association/American Stroke Association stroke guidelines, 156 (14.2%) were supported by LOE A, 559 (50.7%) by LOE B, and 387 (35.1%) by LOE C. Of 407 class I recommendations (ie, should do), and 117 class III recommendations (ie, should not do), 116 (22.1%), 258 (49.2%), and 150 (28.6%) were supported by LOE A, B, and C, respectively. Although the number of recommendations increased across guideline updates (median, 22 [interquartile range, 25th-75th percentiles, 18.0-42.0]), the proportion supported by LOE A declined (median, -4.6% [interquartile range, -7.8 to -0.8]). Across 260 recommendations in 30 European Stroke Organisation guidelines, 19 (7.3%) were supported by high, 62 (23.8%) by moderate, 81 (31.2%) by low, and 98 (37.7%) by very low QOE. Among 90 strong recommendations, 18 (20.0%) were supported by high QOE, and 66.7% of guideline topics had no recommendations supported by high QOE. There was insufficient evidence to make recommendations for 123 (32.7%) clinical questions.

Conclusions: Due to limited randomized data for many important clinical questions, most stroke guideline recommendations are based on low-to-moderate-quality evidence. These findings emphasize the need to improve the funding, design, and delivery of efficient, patient-focused clinical trials.

背景:循证实践依赖于临床指南,其建议依赖于支持性研究的质量、相关性和有效性。我们评估了支持美国心脏协会/美国卒中协会和欧洲卒中组织指南建议的证据类别/强度和水平(LOE)或证据质量(QOE),并检查了LOE的时间变化。方法:通过协会网站和EMBASE/MEDLINE检索美国心脏协会/美国卒中协会(1995-2025)和欧洲卒中组织(2014-2025)卒中指南。合格的文件包含等级/强度和LOE/QOE的建议。排除了共识陈述。自2006年以来,美国心脏协会/美国中风协会将LOE分为A级(多或大型随机对照试验)、B级(单试验或观察性研究)和C级(专家意见)。欧洲卒中组织采用分级建议评估、发展和评估系统(高、中、低和极低QOE)。结果:在目前美国心脏协会/美国卒中协会卒中指南的1102条建议中,LOE A支持156条(14.2%),LOE B支持559条(50.7%),LOE C支持387条(35.1%)。在407条I类建议(即应该做)和117条III类建议(即不应该做)中,分别有116条(22.1%)、258条(49.2%)和150条(28.6%)得到LOE A、B和C的支持。尽管在指南更新期间推荐的数量有所增加(中位数为22[四分位数范围,25 -75百分位数,18.0-42.0]),但LOE A支持的比例下降(中位数为-4.6%[四分位数范围,-7.8至-0.8])。在30个欧洲卒中组织指南的260个建议中,19个(7.3%)被高质量支持,62个(23.8%)被中等质量支持,81个(31.2%)被低质量支持,98个(37.7%)被非常低质量支持。在90条强建议中,18条(20.0%)得到高质量质量评价(QOE)的支持,66.7%的指南主题没有高质量质量评价(QOE)的支持。没有足够的证据对123个(32.7%)临床问题提出建议。结论:由于许多重要临床问题的随机数据有限,大多数卒中指南建议都是基于低到中等质量的证据。这些发现强调需要改进资金、设计和提供有效的、以患者为中心的临床试验。
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引用次数: 0
Thrombolysis With the Non-Immunogenic Staphylokinase for Acute Ischemic Stroke in the FORPI Registry: An Observational Study. 非免疫原性葡萄激酶溶栓治疗急性缺血性卒中:一项观察性研究。
IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-01 Epub Date: 2025-11-26 DOI: 10.1161/STROKEAHA.125.051115
Nikolay A Shamalov, Mikhail Yu Martynov, Elena B Yarovaya, Zhanna Yu Chefranova, Vladimir A Kutsenko, Andrey M Semenov, Sergey V Ivanov, Mikhail P Semenov, Sergey S Markin, Eugene I Gusev

Background: The non-immunogenic staphylokinase is a recombinant staphylokinase with low immunogenicity, high thrombolytic activity, and fibrin selectivity approved in Russia for the acute ischemic stroke (AIS) thrombolytic therapy within 4.5 hours after symptom onset. We evaluated safety and efficacy outcomes of the non-immunogenic staphylokinase usage in patients with AIS in the Fortelyzin Population Investigation registry.

Methods: Between March 2021 and October 2024, patients with AIS treated with the non-immunogenic staphylokinase were enrolled in the prospective, open-label, internet-based, monitored, observational Fortelyzin Population Investigation registry. Demographics, risk factors, baseline stroke severity (defined by National Institutes of Health Stroke Scale), and onset to treatment time were recorded. Safety outcomes included symptomatic intracerebral hemorrhage (according to the ECASS III [European Cooperative Acute Stroke Study III] and SITS-MOST [Safe Implementation of Thrombolysis in Stroke-Monitoring Study] criteria) within 36 hours and all-cause mortality on day 90. Efficacy outcome was evaluated by functional independence using of modified Rankin Scale score of 0 to 2 on day 90.

Results: A total of 17 636 patients with AIS were treated with the non-immunogenic staphylokinase in 329 centers participated in the Fortelyzin Population Investigation registry during the study period (median age 68 [60-75]; 56% male; median baseline National Institutes of Health Stroke Scale score, 11 [8-16] points; median onset to treatment time, 2.4 hours [1.8-3.1]). The rate of symptomatic intracerebral hemorrhage according to the ECASS III criteria was 2% (356/17 636; 1.8-2.2), to the SITS-MOST criteria, 2% (330/17 636; 1.8-2.1). All-cause mortality on day 90 was 9% (1588/17 636; 8.6-9.4). The number of patients with a modified Rankin Scale score of 0 to 2 on day 90 was 61% (10 799/17 636; 60.5-61.9). These safety and efficacy outcomes were comparable with FRIDA (Fortelyzin Randomized Investigation Compared With Alteplase) randomized clinical trial results.

Conclusions: The presented data suggest that intravenous thrombolysis with the non-immunogenic staphylokinase is safe and effective in routine clinical practice when used within 4.5 hours of AIS symptoms onset. These findings should encourage the wider usage of thrombolytic therapy with the non-immunogenic staphylokinase for suitable patients.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06707987.

背景:非免疫原性葡萄激酶是一种重组葡萄激酶,具有低免疫原性、高溶栓活性和纤维蛋白选择性,在俄罗斯被批准用于急性缺血性卒中(AIS)症状发作后4.5小时内的溶栓治疗。我们在Fortelyzin人口调查登记处评估了AIS患者使用非免疫原性葡萄激酶的安全性和有效性结果。方法:在2021年3月至2024年10月期间,接受非免疫原性葡萄激酶治疗的AIS患者被纳入前瞻性、开放标签、基于互联网、监测、观察的Fortelyzin人口调查登记。记录人口统计学、危险因素、基线卒中严重程度(由美国国立卫生研究院卒中量表定义)和发病至治疗时间。安全性结果包括36小时内症状性脑出血(根据ECASS III[欧洲急性卒中合作研究III]和sit - most[卒中监测研究中安全实施溶血栓]标准)和第90天的全因死亡率。第90天采用改良Rankin量表评分0 ~ 2分,以功能独立性评价疗效。结果:在研究期间,共有17636名AIS患者在参与Fortelyzin人口调查登记的329个中心接受了非免疫原性葡激酶治疗(中位年龄为68岁[60-75岁];56%为男性;基线中位美国国立卫生研究院卒中量表评分为11[8-16]分;中位发病至治疗时间为2.4小时[1.8-3.1])。根据ECASS III标准,症状性脑出血发生率为2% (356/17 636;1.8-2.2),SITS-MOST标准为2%(330/17 636;1.8-2.1)。第90天全因死亡率为9%(1588/ 17636;8.6-9.4)。第90天改良Rankin量表评分为0 ~ 2分的患者占61%(10 799/17 636;60.5 ~ 61.9)。这些安全性和有效性结果与FRIDA (Fortelyzin随机调查与阿替普酶比较)随机临床试验结果相当。结论:目前的数据表明,在AIS症状出现4.5小时内使用非免疫原性葡萄激酶静脉溶栓在常规临床实践中是安全有效的。这些发现应该鼓励在合适的患者中更广泛地使用非免疫原性葡萄激酶溶栓治疗。
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引用次数: 0
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