Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Impact of prehospital comprehensive stroke center vs. primary stroke center triage protocol on outcome of patients with spontaneous intracerebral hemorrhage","authors":"Tracey H Fan ,&nbsp;Molly Lawrence ,&nbsp;Elena Badillo Goicoechea ,&nbsp;Angela Wick ,&nbsp;Shyam Prabhakaran","doi":"10.1016/j.jstrokecerebrovasdis.2026.108555","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108555","url":null,"abstract":"<div><h3>Purpose</h3><div>While prehospital triage protocols for suspected large vessel occlusion (LVO) improve ischemic stroke outcomes, their impact in spontaneous intracerebral hemorrhage (sICH) remain uncertain. We evaluated whether a regional LVO-focused emergency medical service (EMS) transport protocol affected time-based process outcomes and clinical outcomes in sICH patients.</div></div><div><h3>Method</h3><div>We conducted a multicenter pre-post implementation retrospective cohort study using the Get-With-The-Guidelines-Stroke database in Chicago (April 2017–January 2020). Included were EMS-transported sICH patients arriving ≤6 hours from last known normal at 8 comprehensive stroke centers (CSCs) and 15 primary stroke centers (PSCs). In September 2018, EMS implemented the 3-Item Stroke Scale (3I-SS) to triage suspected LVO stroke patients; those scoring ≥4 were routed to a CSC bypassing PSC. Primary outcome was favorable discharge disposition (home/acute rehabilitation). Secondary outcomes included in-hospital mortality, good neurologic outcome (independent ambulation) at discharge and time based process outcomes (door-to-CT, symptom-to-arrival, symptom-to-CT). Interrupted time series (ITS) analysis assessed changes while accounting for temporal trends.</div></div><div><h3>Findings</h3><div>Among 303 sICH patients (111 pre-, 192 post-implementation), there was no difference in favorable discharge disposition (58% vs. 64%, <em>p</em>=0.3), in-hospital mortality (12% vs. 9%, <em>p</em>=0.4) or good neurologic outcomes (13% vs. 19%, <em>p</em>=0.4) between pre-post implementation periods for both unadjusted or ITS analyses. Time based process outcomes showed no significant changes in unadjusted or ITS analyses. The protocol also did not impact CSC admission and inter-hospital transfer rates in ITS analyses.</div></div><div><h3>Discussion/Conclusion</h3><div>Implementation of an LVO-focused EMS transport protocol did not improve clinical outcomes or time-based process outcomes among sICH patients, nor did it influence CSC admission or transfer rates. These findings suggest that while beneficial for ischemic stroke care, LVO triage protocols may not confer the same advantages for sICH patients and may require tailored approaches for this population.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108555"},"PeriodicalIF":1.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological concerns undermining causal interpretation in early gastrostomy timing after intracerebral hemorrhage","authors":"Ahmad Shafi Antar","doi":"10.1016/j.jstrokecerebrovasdis.2026.108551","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108551","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108551"},"PeriodicalIF":1.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of adjunctive tirofiban and eptifibatide in acute ischemic stroke: A systematic review and meta-analysis","authors":"Hameer Ali ,&nbsp;Rida Shehzad ,&nbsp;Usama Ahmed ,&nbsp;Yahya Abualown ,&nbsp;Wajida Perveen ,&nbsp;Junaid Gulzar ,&nbsp;Saad Azam ,&nbsp;Zain ul Abideen ,&nbsp;Shah e Zaman ,&nbsp;Umair Hayat ,&nbsp;Uzair Jafar ,&nbsp;Muhammad Ehsan ,&nbsp;Bilawal Nadeem ,&nbsp;Ankit Agrawal ,&nbsp;Raheel Ahmed","doi":"10.1016/j.jstrokecerebrovasdis.2026.108550","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108550","url":null,"abstract":"<div><h3>Introduction and Objective</h3><div>Acute ischemic stroke (AIS) is one of the most common cerebrovascular diseases, posing a substantial burden on public health systems and individuals. Tirofiban and eptifibatide are used alongside intravenous thrombolysis (IVT) in patients with AIS, as they are believed to improve clinical outcomes. We aimed to investigate the efficacy and safety of IV tirofiban or eptifibatide as adjunctive therapy versus using IVT alone in patients with AIS.</div></div><div><h3>Methods</h3><div>We conducted a systematic search using PubMed, Embase, and Clinicaltrials.gov to retrieve randomized controlled trials and observational studies comparing adjunctive tirofiban or eptifibatide to IVT alone in patients with AIS. The quality of included RCTs and observational studies was assessed using the revised Cochrane “Risk of Bias” tool (RoB 2.0) and Newcastle– Ottawa Scale (NOS), respectively. All statistical analyses were performed using RevMan 5.4, using the random effects model with Risk Ratio (RR) and Mean difference (MD) as effect measures.</div></div><div><h3>Results</h3><div>Our meta-analysis included eleven studies, including seven RCTs and four observational studies, involving 1,796 patients. Our results showed that the number of patients with functional independence in the adjunctive therapy group (mRS score 0–2 at 90 days) was comparable to IVT alone (11 studies; <em>n</em> = 1686; RR 1.10; 95% CI, 0.90 - 1.36). There was no evidence of publication bias. Sensitivity analysis with evidence from RCTs showed that adjunctive Tirofiban may improve functional independence at 90 days. The incidence of symptomatic intracranial hemorrhage (ICH) (8 studies; <em>n</em> = 1234; RR 0.74; 95% CI, 0.37 - 1.48) and mortality (11 studies; <em>n</em> = 1686; RR=1.18; 95% CI, 0.82-1.70) was also found to be comparable between the two groups. There was no significant difference between the two groups when assessing the risk of any ICH, asymptomatic ICH, major hemorrhage or systemic bleeding, and fatal ICH. The incidence of early neurologic deterioration and mean change in mRS score remained comparable between the two groups.</div></div><div><h3>Conclusion</h3><div>Our meta-analysis suggests that while adjunctive tirofiban or eptifibatide with IVT do not yield benefits in terms of reducing mortality or improving functional independence at 90 days in AIS, emerging evidence from RCTs indicates that tirofiban may offer functional benefits, though this remains uncertain. Importantly, adjunctive therapy did not demonstrate a significant increase in bleeding risk in the analyzed studies. . These findings support the need for further large-scale, high-quality randomized controlled trials to explain the role of tirofiban in the management of AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108550"},"PeriodicalIF":1.8,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life after decompressive surgery for severe cerebral venous thrombosis","authors":"Mayte Sanchez van Kammen MD, PhD ,&nbsp;Sanjit Aaron MD ,&nbsp;Jorge M Ferreira MD ,&nbsp;Patrícia Canhão MD, PhD ,&nbsp;Adriana B. Conforto MD ,&nbsp;Antonio Arauz ,&nbsp;Marta Carvalho MD ,&nbsp;Jaime Masjuan MD ,&nbsp;Vijay K Sharma MD ,&nbsp;Jukka Putaala MD, PhD ,&nbsp;Maarten Uyttenboogaart MD ,&nbsp;Rodrigo Bazan MD ,&nbsp;Bert A Coert MD ,&nbsp;Prabhu Kirubakaran MD ,&nbsp;Pankaj Singh MD ,&nbsp;Diana Aguiar de Sousa MD, PhD ,&nbsp;Jonathan M Coutinho MD, PhD ,&nbsp;José M Ferro MD, PhD ,&nbsp;the DECOMPRESS 2 study group","doi":"10.1016/j.jstrokecerebrovasdis.2026.108549","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108549","url":null,"abstract":"<div><h3>Background</h3><div>Decompressive surgery can be lifesaving in patients with severe cerebral venous thrombosis (CVT) and impending brain herniation. However, data on health-related quality of life (HRQoL) after surgery are limited.</div></div><div><h3>Methods</h3><div>DECOMPRESS-2 was a prospective cohort study including adult patients with CVT from 15 centers in 10 countries who underwent decompressive surgery (2011–2019). HRQoL was assessed using EQ5D-3 L utility scores, subdomains, and a visual analogue scale (VAS) at 6 and 12 months post-surgery. Complete case analysis, multiple imputation, best- and worst-case analyses were performed. Predictors of EQ5D-score (Tobit regression) and VAS (linear regression) at 12 months were analyzed.</div></div><div><h3>Results</h3><div>Of 118 patients, 112 were included (median age 38 years [IQR 27–46], 68% female). At 12-months, EQ5D-3 L and VAS were available for 89% and 90% of survivors, respectively. Median EQ5D-3L-score was 0.70 (IQR 0.52–0.85, mean 0.59 [SD 0.38]) and median VAS was 70 (IQR 56–80, mean 69 [SD 18]). Overall, 84% of patients reported problems in ≥1 subdomain of the EQ5D-3L: 68% with usual activities, 59% pain/discomfort, 58% anxiety/depression, 47% with self-care, 43% with mobility. Higher age and residence in a middle-income country (vs. high-income) predicted poorer EQ5D-3 L and VAS. Preoperative coma predicted worse EQ5D-3 L only.</div></div><div><h3>Conclusions</h3><div>Twelve months after decompressive surgery for CVT, over 4 out of 5 survivors reported problems in at least one subdomain of the EQ5D-3 L. Higher age, middle-income country status and preoperative coma were negative predictors of quality of life.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108549"},"PeriodicalIF":1.8,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of low-dose versus standard-dose alteplase in acute ischemic stroke patients aged over 80 years: A real-world propensity score-matched study from China","authors":"Chang-sheng Li MD ,&nbsp;Hong-Qiu Gu MD ,&nbsp;Kai-xuan Yang MS ,&nbsp;Zi-mo Chen MD ,&nbsp;Xia Meng MD ,&nbsp;Chun-juan Wang MD ,&nbsp;Zi-xiao Li MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108548","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108548","url":null,"abstract":"<div><h3>Background</h3><div>Optimal alteplase dosing for intravenous thrombolysis in stroke patients aged &gt;80 years remains debated due to underrepresentation in pivotal trials. This study evaluates the relative effectiveness and safety of low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) alteplase in elderly patients treated within 4.5 hours of onset.</div></div><div><h3>Methods</h3><div>Utilizing the China Stroke Center Alliance registry database (2018-2022), we conducted a propensity score-matched analysis encompassing 6,522 patients over 80 years of age, ultimately generating 2,050 matched pairs. The primary outcome was functional dependence or death at discharge (mRS 2–6). Secondary measures included major disability (mRS 3–6), in-hospital mortality, and symptomatic intracranial hemorrhage (sICH).</div></div><div><h3>Results</h3><div>The primary outcome showed no statistical difference between low-dose (81.6 %) and standard-dose (81.8 %) groups (OR 0.99; 95 % CI 0.84-1.16; P=0.871). Rates of major disability (56.0 % vs. 57.7 %; OR 1.02; P=0.730), mortality (15.6 % vs. 14.4 %; OR 1.10; P=0.294), and sICH (4.4 % vs. 5.2 %; OR 0.85; P=0.274) were broadly alike. Low-dose alteplase showed a numerical decline in bleeding events. Subgroup analysis found no modifying factors.</div></div><div><h3>Conclusions</h3><div>In octogenarian stroke patients, low-dose alteplase offers parallel efficacy and safety to standard therapy, with a possible reduction in hemorrhagic complications. These results support low-dose regimens as a reasonable option for elderly patients, particularly when minimizing bleeding risk is a clinical priority.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108548"},"PeriodicalIF":1.8,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between cumulative changes of the triglyceride glucose index and incidence of Cardio-cerebral vascular diseases in a population with cardiovascular-kidney-metabolic syndrome stage 0–3: a nationwide prospective cohort study","authors":"Li Hou ,&nbsp;Jing Tang ,&nbsp;Lei Zhang ,&nbsp;Yanhong Li ,&nbsp;Yao Niu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108540","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108540","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the relationship between the longitudinal changes of the triglyceride-glucose (TyG) index and the incidence of cardio-cerebral vascular diseases (CCVD) among individuals with CKM syndrome stages 0-3.</div></div><div><h3>Methods</h3><div>Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal study included 3,416 participants aged 45 and above. Participants were categorized into different TyG trajectory groups using k-means clustering analysis. Logistic regression and restricted cubic spline (RCS) models were employed to assess the associations between cumTyG and TyG changes with CCVD incidence.</div></div><div><h3>Results</h3><div>Over a median follow-up of 5 years, 698 participants developed CCVD. The relationship between cumTyG and CCVD risk was linear in RCS regression. After adjusting for potential confounders, the risk of CCVD was found to be significantly higher for participants in Class 2, Class 4, and Class 5 compared to those in Class 1. Specifically, Class 2 had an odds ratio (OR) of 1.45 (95% confidence interval [CI]: 1.14, 1.84), Class 4 had an OR of 1.42 (95% CI: 1.09, 1.86), and Class 5 had an OR of 1.64 (95% CI: 1.14, 2.34). Additionally, an elevated cumTyG index was associated with an increased risk of CCVD, with an OR of 1.13 (95% CI: 1.05, 1.22, P=0.002).</div></div><div><h3>Conclusion</h3><div>CumTyG and its longitudinal trend are independent and potent predictors of CCVD in patients with stage 1–3 CKM syndrome. Dynamic monitoring of the TyG trajectory can enable the early identification of high-risk individuals, providing reliable evidence for individualized and cost-effective prevention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108540"},"PeriodicalIF":1.8,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global and regional burden of ischemic stroke attributable to smoking and high alcohol use from 1990 to 2021, with projections to 2050","authors":"Sijia Guo ,&nbsp;Bo Qu ,&nbsp;Qiqi Wang ,&nbsp;Yan Sun","doi":"10.1016/j.jstrokecerebrovasdis.2026.108543","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108543","url":null,"abstract":"<div><h3>Objective</h3><div>This study employs data from the Global Burden of Disease Study (GBD) 2021 to analyze the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of ischemic stroke (IS) attributable to smoking and high alcohol use from 1990 to 2021 across 204 countries and territories, stratified by Socio-demographic Index (SDI), region, sex, and age. Trends are assessed using estimated annual percentage change (EAPC), and future burdens are projected to 2050 using an autoregressive integrated moving average (ARIMA) model.</div></div><div><h3>Results</h3><div>Globally, the burden of IS attributable to both risk factors declined, with smoking consistently associated with higher ASMR and ASDR than high alcohol use. High-SDI regions showed the most substantial reductions, whereas low-SDI regions experienced stagnant or slightly increasing burdens. Southeast Asia was the only region with a rising trend in smoking-related IS, while Tropical Latin America achieved remarkable success in alcohol control. The burden was higher among males and older age groups for smoking, and more prominent in young and middle-aged adults for alcohol use. Projections suggested a continuing decline in high-SDI regions but limited improvement in low-SDI areas by 2050.</div></div><div><h3>Conclusion</h3><div>Significant geographic and demographic disparities persist in the IS burden attributable to smoking and high alcohol use. Targeted policy interventions—especially enhanced tobacco and alcohol control in low- and middle-SDI regions, along with focused strategies for males and high-risk age groups—are urgently needed to reduce the global burden of ischemic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108543"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to neighborhood destinations that offer opportunities for physical activity and socialization is associated with favorable post-stroke outcomes","authors":"Leanna M Delhey PhD ,&nbsp;Jon Zelner PhD ,&nbsp;Xu Shi PhD ,&nbsp;Lewis B Morgenstern MD ,&nbsp;Devin L Brown MD ,&nbsp;Melinda A Smith DrPH ,&nbsp;Erin C Case BA ,&nbsp;Lynda D Lisabeth PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108545","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108545","url":null,"abstract":"<div><h3>Objective</h3><div><strong>:</strong> Assess associations between destinations near stroke survivor's residence – places like restaurants, recreation centers, and stores that offer opportunities for physical activity and socialization outside of the home and work – and their poststroke outcomes.</div></div><div><h3>Methods</h3><div><strong>:</strong> We included non-Hispanic white and Mexican American incident stroke survivors enrolled in the Brain Attack Surveillance in Corpus Christi project (2009-19), a population-based cohort in Texas. Exposure: count of destinations within 0.5-miles around survivors’ residences. Outcomes assessed at approximately 3-, 6-, and 12-months poststroke: cognition (Modified Mini-Mental State Examination), functioning (activities of daily living (ADL)/instrumental ADL), health-related quality of life (abbreviated Stroke-Specific Quality of Life scale), and depression (Patient Health Questionnaire-8). We fit adjusted linear mixed models and considered interactions with follow-up time and stroke severity (NIH stroke scale - mild (&lt;5), moderate-severe (≥5)).</div></div><div><h3>Results</h3><div><strong>:</strong> We included 1,786 survivors who completed 3 (<em>N</em> = 1,321), 6 (<em>N</em> = 677), or 12-month interviews (<em>N</em> = 652). Median age was 64 years, 55% male, and 74% mild stroke. Stroke severity modified associations with functioning (<em>p</em> = 0.09) and quality of life (<em>p</em> = 0.05), follow-up time did not (<em>p</em> &gt; 0.25). Among moderate-severe stroke survivors, more destinations were associated with more favorable functioning (mean difference=-0.12, 95% CI=-0.22, -0.01) and quality of life (mean difference=0.16, 95% CI=0.03, 0.30). No associations were observed among mild stroke survivors or with cognition or depression (<em>p</em> &gt; 0.05).</div></div><div><h3>Interpretation</h3><div><strong>:</strong> Among moderate-severe stroke survivors, more nearby destinations were associated with more favorable functioning and quality of life in the first year. Future research is needed to explore if specific types of destinations may support more favorable outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108545"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of artificial intelligence in estimating stroke events in Moyamoya patients: A systematic review and meta-analysis of diagnostic test accuracy","authors":"Jeremiah Hilkiah Wijaya ,&nbsp;Miguel Quintero Consuegra ,&nbsp;Daniela A Perez-Chadid ,&nbsp;Aafreen Azmi ,&nbsp;Juan Pablo Avila Madrigal ,&nbsp;Shane Shahrestani ,&nbsp;Sofia Ramirez-Guerrero ,&nbsp;Anil Nanda ,&nbsp;Abdelrahman Ramadan Elashry ,&nbsp;Nestor R. Gonzalez","doi":"10.1016/j.jstrokecerebrovasdis.2026.108542","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108542","url":null,"abstract":"<div><h3>Introduction</h3><div>Moyamoya disease (MMD) and syndrome (MMS) are rare cerebrovascular arteriopathies marked by progressive internal carotid stenosis, fragile collateral networks, and a five-year stroke risk near 10% despite optimal care. Artificial-intelligence (AI) models integrating angiographic, perfusion, and clinical data show promise for risk stratification, but their diagnostic accuracy and clinical readiness remain uncertain.</div></div><div><h3>Method</h3><div>We conducted a systematic review of AI algorithms for predicting ischemic or hemorrhagic stroke events in angiographically or magnetic resonance imaging (MRI)-confirmed MMD/MMS. PubMed, EMBASE, and Scopus were searched through September 3, 2025, for English-language studies employing machine-learning, deep-learning, or radiomics models. We extracted sensitivity, specificity, and area under the curve (AUC) metrics and assessed study quality with Radiomics Quality Score and CLEAR checklists. Pooled estimates and summary receiver-operating characteristic curves were generated; decision-curve analysis evaluated clinical net benefit.</div></div><div><h3>Results</h3><div>Seven retrospective cohorts (<em>n</em> = 4,795) met inclusion criteria. The pooled sensitivity was 0.65 (95% CI 0.50–0.79) and specificity 0.85 (95% CI 0.82–0.89). The summary AUC was 0.85. Decision-curve analysis demonstrated that AI predictions improved net benefit over “treat-all” or “treat-none” strategies across relevant risk thresholds. Tree-based classifiers (XGBoost, random forest) showed more stable external performance than deep-learning networks. Explainability tools enhanced model interpretability.</div></div><div><h3>Conclusion</h3><div>AI models achieve moderate-to-high accuracy for stroke prediction in MMD/MMS and offer potential for individualized risk stratification. However, small single-center datasets, heterogeneous imaging protocols, and opaque modeling limit clinical adoption. Prospective multicenter validation, standardized data pipelines, and robust explainability frameworks are essential for integrating AI into routine neurovascular care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108542"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-stroke epilepsy in revascularized versus not revascularized stroke patients: A prospective cohort study","authors":"Stefania Lazzari ,&nbsp;Carlotta Mutti ,&nbsp;Francesca Bozzetti ,&nbsp;Antonio Genovese ,&nbsp;Maddalena Frapporti ,&nbsp;Francesca Badini ,&nbsp;Carmine Siniscalchi ,&nbsp;Andrea Becciolini ,&nbsp;Valentina Tontini ,&nbsp;Elisa Mannini ,&nbsp;Irene Florindo ,&nbsp;Francesco Misirocchi ,&nbsp;Francesca Iuculano ,&nbsp;Liborio Parrino ,&nbsp;Lucia Zinno","doi":"10.1016/j.jstrokecerebrovasdis.2026.108544","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108544","url":null,"abstract":"<div><h3>Objective</h3><div>The association between post stroke epilepsy (PSE) and revascularization therapy in stroke patients remains controversial. The prognostic significance of other supportive techniques such as Computed Tomography (CT) brain data and electroencephalograph (EEG) in PSE prediction is poorly understood.</div></div><div><h3>Methods</h3><div>We performed a single-center prospective observational study to evaluate the incidence of acute symptomatic seizures (ASS) and PSE in adult patients affected by acute ischaemic stroke undergoing reperfusional approaches compared to non-revascularized patients, with a 30-months follow-up.</div></div><div><h3>Results</h3><div>We enrolled 258 patients with stroke: 155 cases (treated with intravenous tissue plasminogen activator (IV-tPA)) and/or endovascular thrombectomy (ET) and 103 controls (non-revascularized). The global incidence of ASS was 3.4%, while PSE was diagnosed in 5% of patients. Reperfusion treatments were not associated with increased risk of ASS or PSE. Hemorrhagic infarction was found as the only independent risk factor for PSE development (HR 5.33, (95% CI, 1.69 – 16.82), p=0.004). In parallel, we analyzed the relationship between ASS and hemorrhagic infarction using the chi-square test (OR 8.59 (95% CI, 2.19 - 33.7), p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Reperfusion therapies for acute ischemic stroke do not increase the risk of epilepsy during the first 30 months after stroke. Hemorrhagic infarction was the main risk for epilepsy after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108544"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}