Stroke最新文献

Background: Severe upper limb motor impairment is one of the most disabling consequences of stroke. Although brain-controlled rehabilitation technologies, such as brain/neural exoskeletons (B/NE), have been shown to be effective in promoting motor recovery, their clinical adoption remains limited because of insufficient integration of B/NE into existing clinical workflows. Here, we introduce and validate a fully portable B/NE system that overcomes this limitation by relying on brain (electroencephalography) and ocular (electrooculography) signals to restore bimanual activities of daily living within a novel therapeutic framework.

Methods: In this pilot study, we tested the feasibility of the novel approach in 5 stroke survivors (mean age, 51 years; SD=14.8) undergoing inpatient neurorehabilitation. Stroke survivors aged 18 to 80 years, who exhibited hemiparesis and sufficient cognitive ability to understand and follow instructions, were invited to participate in a 1-hour training session. This session included system setup and calibration, followed by performing B/NE-supported, self-paced bimanual activities of daily living. As primary outcome measures, we assessed control accuracy, the ability to reliably modulate electroencephalography and electrooculography signals, and time to initialize, defined as the time required to react to cues and initiate the task, serving as a measure of control intuitiveness. In addition, participants' B/NE control performance during assisted training of bimanual activities of daily living, as well as setup preparation time, were assessed via direct observation.

Results: Participants demonstrated reliable control accuracy in using both brain (mean, 83%; SD=15.36) and ocular (mean=100%) signals, as well as intuitive control (time to initialize <2 s). All participants reliably controlled the B/NE performing a battery of 10 bimanual activities of daily living. Moreover, setup and calibration times remained below 20 minutes.

Conclusions: These findings highlight the compatibility of the novel B/NE with existing clinical workflows and its feasibility to enable B/NE-supported stroke neurorehabilitation by facilitating seamless integration into clinical practice.

Background: Evidence on the association between the stress hyperglycemia ratio (SHR) and adverse outcomes in patients with mild ischemic stroke (IS) or high-risk transient ischemic attack remains limited.

Methods: This was a secondary analysis of the INSPIRES (Intensive Statin and Antiplatelet Therapy for Acute High-Risk Intracranial or Extracranial Atherosclerosis) randomized clinical trial. SHR was calculated as admission blood glucose (mmol/L) divided by (1.59* HbA1c [%]-2.59). Multivariable Cox regression models were used to assess the association between SHR and adverse clinical outcomes, adjusting for age, sex, and other potential factors. The primary efficacy outcome was any stroke (ischemic or hemorrhagic) within 90 days. Secondary efficacy outcomes comprised composite vascular events, recurrent IS, poor functional outcome, and early neurological deterioration. The primary safety outcome was moderate-to-severe bleeding within 90 days.

Results: The INSPIRES trial, ultimately enrolled 6100 patients with mild IS or high-risk transient ischemic attack caused by intracranial or extracranial atherosclerosis, of whom 4515 were included in this secondary analysis. The median age was 65 years (interquartile range, 57-71), and 2894 (64.10%) were male. During the 90-day follow-up, recurrent stroke occurred in 356 patients (7.88%), composite vascular events in 363 (8.04%), recurrent IS in 340 (7.53%), poor functional outcome in 474 (10.51%), and early neurological deterioration in 196 (4.34%). After adjustment for conventional confounders, compared with patients in the lower SHR group (Q1), those with higher SHR levels (Q4) had significantly increased risks of recurrent stroke (hazard ratio [HR], 1.84 [95% CI, 1.30-2.61]), composite vascular events (HR, 1.72 [95% CI, 1.22-2.41]), recurrent IS (HR, 1.79 [95% CI, 1.25-2.55]), poor functional outcome (HR, 1.56 [95% CI, 1.13-2.15]), and early neurological deterioration (HR, 1.62 [95% CI, 1.00-2.61]). In contrast, SHR was not significantly associated with any safety outcomes.

Conclusions: Among patients with acute mild IS or high-risk transient ischemic attack of presumed atherosclerotic cause, elevated SHR levels were independently associated with increased risks of recurrent stroke, composite vascular events, recurrent IS, poor functional outcome, and early neurological deterioration.

Background: Reperfusion therapies for ischemic stroke are a cornerstone of acute treatment, though only available for a subset of patients due to a narrow time window. Other supplementary treatment is warranted, as only half of the patients reach functional independence. GLP-1 RA (glucagon-like peptide-1 receptor agonists) are associated with decreased cardiovascular disease, mainly driven by reduced stroke risk, and have gained interest as therapeutic agents for stroke recovery in experimental stroke models. This review aims to evaluate the current data on the effect and safety of GLP-1 RA in nondiabetic patients with ischemic stroke and in animal models of cerebral ischemia. We will describe its potential neuroprotective mechanisms.

Methods: On June 20, 2024, keyword-based literature searches were conducted in PubMed and Embase and repeated on March 6, 2025. Records evaluating GLP-1-based therapies in animals and patients with ischemic stroke who did not have diabetes were included.

Results: In total, 35 studies, 31 preclinical and 4 clinical, applying 9 different GLP-1 therapies were reviewed. GLP-1 RA improved functional outcome and induced a marked infarct volume reduction compared with vehicle (placebo) in preclinical animal stroke models. The proposed mechanisms include reduced oxidative stress, hypoxia-triggered cell death, and inflammatory response following acute ischemic stroke. Despite these neuroprotective effects observed in stroke models, evidence for improved clinical outcomes in humans remains limited. Recent randomized trials have not shown a significant effect on stroke incidence or neurological recovery in patients without diabetes who are treated with GLP-1 RA. GLP-1 RA appears safe and well-tolerated in both acute and chronic settings.

Conclusions: GLP-1 RA improves functional outcome and reduces infarct volume in preclinical animal stroke models without diabetes. Translating these promising preclinical findings into clinical benefits remains a key challenge and a critical opportunity for future research.

Background: It remains unclear whether outcomes of patients treated with endovascular thrombectomy with large-vessel occlusion and unwitnessed onset of stroke differ from those with witnessed onset in the extended time window.

Methods: We enrolled patients with anterior circulation large-vessel occlusion (internal carotid artery, M1, or M2 segment of the middle cerebral artery) undergoing endovascular thrombectomy within 6 to 24 hours from the time last seen well, from 2014 to 2022, at 66 sites in Europe, North America, and Asia. Patients with a prestroke modified Rankin Scale score of >3 or age <18 were excluded. We categorized patients by onset mode as witnessed or unwitnessed. The primary outcome was the modified Rankin Scale shift at 90 days. Secondary outcomes were functional independence, a composite of functional independence or return of Rankin to prestroke level, symptomatic intracranial hemorrhage, mortality, and a composite of severe disability or mortality at 90 days. We applied inverse probability of treatment weighting to compare outcomes between the groups.

Results: Of 5098 patients assessed for eligibility, we included 2073, of whom 1760 (84.9%) had unwitnessed onset, and 313 (15.1%) were witnessed. In the univariate comparison (before inverse probability of treatment weighting), 38.8% of the unwitnessed and 45.7% of the witnessed patients achieved functional independence (P=0.022). Mortality was 21.6% among unwitnessed and 22.0% among witnessed (P=0.847), and symptomatic intracranial hemorrhage rates were 6.6% and 5.8%, respectively (P=0.623). The primary outcome (modified Rankin Scale shift) showed no difference comparing unwitnessed to witnessed patients (odds ratio, 1.35 [95% CI, 0.82-2.20]; P=0.235) in the inverse probability of treatment weighting. Unwitnessed patients were more likely to achieve functional independence or return of Rankin (1.53 [1.01-2.33]; P=0.045). Other secondary outcomes did not differ between the witnessed and unwitnessed patients.

Conclusions: In the extended time window, unwitnessed patients with large-vessel occlusion undergoing endovascular thrombectomy have at least the same likelihood of favorable outcomes as witnessed patients.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.

Minor ischemic strokes, usually defined as acute ischemic strokes with National Institutes of Health Stroke Scale score ≤5, account for over half of all cases and are often underestimated due to initially mild symptoms. Yet up to 30% of patients develop disability within 90 days, challenging the notion of a benign course. This guidance offers a pragmatic, scenario-based framework for acute minor ischemic stroke management, considering symptom severity (disabling versus nondisabling), eligibility for reperfusion, and presence of large vessel occlusion. Drawing from randomized trials, real-world evidence, and international guidelines, we examine therapeutic strategies, including dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor, anticoagulation, intravenous thrombolysis, and endovascular treatment. Intravenous thrombolysis is preferred for disabling symptoms within 4.5 hours of symptom onset, whereas dual antiplatelet therapy remains standard for noncardioembolic, nondisabling events. For cardioembolic minor ischemic stroke ineligible for reperfusion, early anticoagulation within 48 hours appears safe and beneficial. Evidence for routine endovascular treatment in minor ischemic stroke with large vessel occlusion remains limited and controversial. We also address management of rapidly improving yet disabling symptoms and postreperfusion antithrombotic strategies, emphasizing individualized care and the need for further research.

Stroke remains a rare but life-threatening complication of pregnancy, with significant implications for both maternal and fetal health. Current stroke prevention and treatment guidelines offer limited guidance for managing stroke in pregnant and postpartum patients. Despite advances in obstetric and neurological care, the diagnosis and management of pregnancy-associated stroke continue to be challenged by delayed recognition, a lack of tailored clinical guidelines, and persistent disparities in outcomes. This scientific statement represents a multidisciplinary effort to synthesize current knowledge of the risk factors and diverse causes of stroke in pregnancy and to offer consensus-driven suggestions for prevention, acute management, and postpartum recovery. Nearly half of all US pregnancy-associated stroke hospitalizations occur in the setting of hypertensive disorders. Primary stroke prevention strategies include risk factor modification, aggressive hypertension management and prompt treatment of severe hypertension in pregnancy and postpartum, and antithrombotic therapy in some high-risk groups. Secondary stroke prevention strategies in pregnancy depend on the mechanism of the prior stroke. Pregnancy should not delay evidence-based treatments for acute stroke. The use of telemedicine can facilitate early consultation with a vascular neurologist and a maternal-fetal medicine specialist in cases of acute pregnancy-related stroke, helping to guide initial decision-making. Computed tomography, computed tomography angiography, and magnetic resonance imaging without contrast are all safe neuroimaging modalities for rapid evaluation of pregnant patients with acute stroke symptoms. Acute stroke alone is not an indication for immediate delivery, and stabilization of the mother should come first. Vaginal delivery after stroke is preferred when feasible because it avoids the surgical risks and hemodynamic stress associated with cesarean delivery. Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and breastfeeding and require support from a multidisciplinary rehabilitation team. Continued research, including inclusive clinical trials, is urgently needed to refine stroke risk assessment, to expand treatment options, and to improve maternal outcomes.