Pub Date : 2025-12-01Epub Date: 2025-11-05DOI: 10.1016/j.jstrokecerebrovasdis.2025.108486
Charlotte S. Weyland , Michael Neidlin , Cilli Danker , Linda Puppendahl , Christian Sitzer , Julian Wynhoff , Ulrich Steinseifer , Omid Nikoubashman
Background
Intracranial sinus stenoses (ISS) or sinus occlusions (ISO) can lead to elevated intracranial venous blood pressure. Treatment strategies are advancing, but clinical decision making and the prediction of treatment success is hampered by the variable venous anatomy. We aimed to create a patient-specific computational model that allows for simulating pathologies and their influence on venous flow dynamics and pressure.
Methods
The model was created based on a stroke patient’s CT-angiography using semi-automatic threshold-based segmentation with subsequent flow modeling through computational fluid dynamics. Venous flow velocities were compared to a healthy cohort’s flow encoded magnetic resonance imaging (4D Flow MRI). Nine scenarios, including ISS and ISO at different locations, were simulated and their influence on venous pressure and blood flow was quantified.
Results
In comparison to a healthy cohort’s 4D Flow MRI, the model showed comparable venous velocities at all reference points. Unilateral transverse sinus occlusion or stenosis led to compensatory contralateral flow and elevated pressures up to 12 mmHg. Extensive ISO or bilateral transverse ISS led to markedly increased pressures > 100 mmHg.
Conclusion
Our model depicts realistic venous blood pressures and gradients and could support in identifying patients with intracranial sinus stenosis or sinus occlusions profiting from endovascular treatment strategies.
{"title":"Effect of stenoses and occlusions in the cerebral venous vasculature on intracranial venous hemodynamics - a patient-specific computational model","authors":"Charlotte S. Weyland , Michael Neidlin , Cilli Danker , Linda Puppendahl , Christian Sitzer , Julian Wynhoff , Ulrich Steinseifer , Omid Nikoubashman","doi":"10.1016/j.jstrokecerebrovasdis.2025.108486","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108486","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial sinus stenoses (ISS) or sinus occlusions (ISO) can lead to elevated intracranial venous blood pressure. Treatment strategies are advancing, but clinical decision making and the prediction of treatment success is hampered by the variable venous anatomy. We aimed to create a patient-specific computational model that allows for simulating pathologies and their influence on venous flow dynamics and pressure.</div></div><div><h3>Methods</h3><div>The model was created based on a stroke patient’s CT-angiography using semi-automatic threshold-based segmentation with subsequent flow modeling through computational fluid dynamics. Venous flow velocities were compared to a healthy cohort’s flow encoded magnetic resonance imaging (4D Flow MRI). Nine scenarios, including ISS and ISO at different locations, were simulated and their influence on venous pressure and blood flow was quantified.</div></div><div><h3>Results</h3><div>In comparison to a healthy cohort’s 4D Flow MRI, the model showed comparable venous velocities at all reference points. Unilateral transverse sinus occlusion or stenosis led to compensatory contralateral flow and elevated pressures up to 12 mmHg. Extensive ISO or bilateral transverse ISS led to markedly increased pressures > 100 mmHg.</div></div><div><h3>Conclusion</h3><div>Our model depicts realistic venous blood pressures and gradients and could support in identifying patients with intracranial sinus stenosis or sinus occlusions profiting from endovascular treatment strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108486"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472618","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}
Pub Date : 2025-12-01Epub Date: 2025-11-26DOI: 10.1016/j.jstrokecerebrovasdis.2025.108507
Xiaozhu Yu Master of Nursing (Lecturer) , Xichao Xia Doctor of Medicine (Professor) , Yanfang Guo Master of Nursing (Senior Nurse) , Yuhong Wu Master of Nursing (Chief Nurse)
Objective
To systematically analyze the application effect of holistic nursing intervention based on Harmonious Nursing Theory in patients during stroke recovery period, and provide evidence-based basis for optimizing clinical nursing programs.
Methods
Patients in the stroke recovery period were divided into observation group and control group with 83 cases each by random number table method. The control group received routine nursing intervention, while the observation group received holistic nursing intervention based on Harmonious Nursing Theory. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Herth Hope Index (HHI), SF-36 Short-Form Health Survey, and nursing satisfaction questionnaire were used to compare the differences in negative emotions, hope level, quality of life, and satisfaction between the two groups of patients before and after intervention.
Results
After the intervention, the self-reported anxiety score of the observation group was (42.87±17.32) and the self-reported depression score was (45.28±16.67), both significantly lower than those of the control group [(51.59±15.19) and (50.51±15.52), respectively; all P<0.05]. The total score of hope level in the observation group was (40.87±6.03), which was higher than that in the control group [(34.78±5.93); P<0.05]. The scores of all 8 dimensions of health status in the observation group were higher than those in the control group (all P<0.05). The nursing satisfaction rate of the observation group was 92.77%, which was higher than 78.31% of the control group (P<0.05).
Conclusion
Implementing holistic nursing intervention based on Harmonious Nursing Theory for patients in stroke recovery period can effectively alleviate negative emotions, improve hope level and quality of life, as well as enhance nursing satisfaction, which has high clinical promotion value.
{"title":"Effect of holistic nursing intervention based on harmonious nursing theory on patients in stroke recovery period","authors":"Xiaozhu Yu Master of Nursing (Lecturer) , Xichao Xia Doctor of Medicine (Professor) , Yanfang Guo Master of Nursing (Senior Nurse) , Yuhong Wu Master of Nursing (Chief Nurse)","doi":"10.1016/j.jstrokecerebrovasdis.2025.108507","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108507","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically analyze the application effect of holistic nursing intervention based on Harmonious Nursing Theory in patients during stroke recovery period, and provide evidence-based basis for optimizing clinical nursing programs.</div></div><div><h3>Methods</h3><div>Patients in the stroke recovery period were divided into observation group and control group with 83 cases each by random number table method. The control group received routine nursing intervention, while the observation group received holistic nursing intervention based on Harmonious Nursing Theory. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Herth Hope Index (HHI), SF-36 Short-Form Health Survey, and nursing satisfaction questionnaire were used to compare the differences in negative emotions, hope level, quality of life, and satisfaction between the two groups of patients before and after intervention.</div></div><div><h3>Results</h3><div>After the intervention, the self-reported anxiety score of the observation group was (42.87±17.32) and the self-reported depression score was (45.28±16.67), both significantly lower than those of the control group [(51.59±15.19) and (50.51±15.52), respectively; all <em>P</em><0.05]. The total score of hope level in the observation group was (40.87±6.03), which was higher than that in the control group [(34.78±5.93); <em>P</em><0.05]. The scores of all 8 dimensions of health status in the observation group were higher than those in the control group (all <em>P</em><0.05). The nursing satisfaction rate of the observation group was 92.77%, which was higher than 78.31% of the control group (<em>P</em><0.05).</div></div><div><h3>Conclusion</h3><div>Implementing holistic nursing intervention based on Harmonious Nursing Theory for patients in stroke recovery period can effectively alleviate negative emotions, improve hope level and quality of life, as well as enhance nursing satisfaction, which has high clinical promotion value.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108507"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623650","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}
Pub Date : 2025-12-01Epub Date: 2025-10-30DOI: 10.1016/j.jstrokecerebrovasdis.2025.108480
Kimberly Hreha , Marissa C. Ashner , Sarah Peskoe , Timothy Reistetter , Priya Palta , Lisa Wruck , Rebecca Gottesman , B. Gwen Windham , Heather E. Whitson
Vision loss is a risk factor for dementia, but it is unknown whether stroke-related vision impairment is linked to dementia risk in stroke survivors. This secondary analysis aimed to quantify the association between stroke-related vision impairment and time to incident dementia diagnosis, from time of stroke, using the Arthrosclerosis Risk in Communities study dataset. We included participants who sustained a non-fatal probable or definite ischemic, incident stroke captured from hospital surveillance during the study period and excluded those who were diagnosed with incident dementia prior to or less than half a year after the incident stroke. The association between stroke-related vision impairment (binary) and time from incident stroke to dementia diagnosis was analyzed using a Fine-Gray survival model to account for the competing risk of death, adjusting for age at incident stroke, stroke severity, biological sex, education and race-center. Among 787 stroke survivors, 31 % were diagnosed with dementia during the follow-up period and 19.5 % had stroke-related vision impairment. The presence of stroke-related vision impairment was not significantly associated with dementia diagnosis (HR = 1.18; 95 % CI 0.85, 1.63; p = 0.32). While results suggest that stroke-related vision impairment corresponds to a higher cumulative incidence of dementia, the association was not statistically significant.
视力丧失是痴呆症的一个危险因素，但目前尚不清楚中风相关的视力损害是否与中风幸存者患痴呆症的风险有关。这项二级分析旨在利用社区关节硬化风险研究数据集，量化卒中相关视力损害与卒中时间到痴呆诊断之间的关系。我们纳入了在研究期间从医院监测中获得的非致命性的、可能的或明确的缺血性卒中的参与者，排除了那些在卒中发生前或发生后不到半年被诊断为痴呆的参与者。使用Fine-Gray生存模型分析卒中相关视力障碍（二元）与卒中至痴呆诊断时间之间的关联，以考虑卒中发生时的年龄、卒中严重程度、生理性别、教育程度和种族中心等因素的竞争死亡风险。在787名中风幸存者中，31%在随访期间被诊断患有痴呆症，19.5%患有与中风相关的视力障碍。卒中相关视力障碍的存在与痴呆诊断无显著相关性（HR=1.18; 95% CI 0.85, 1.63; p = 0.32）。虽然研究结果表明，中风相关的视力损害与较高的痴呆累积发病率相对应，但这种关联在统计上并不显著。
{"title":"Investigating stroke-related vision impairments and time to incident dementia diagnosis","authors":"Kimberly Hreha , Marissa C. Ashner , Sarah Peskoe , Timothy Reistetter , Priya Palta , Lisa Wruck , Rebecca Gottesman , B. Gwen Windham , Heather E. Whitson","doi":"10.1016/j.jstrokecerebrovasdis.2025.108480","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108480","url":null,"abstract":"<div><div>Vision loss is a risk factor for dementia, but it is unknown whether stroke-related vision impairment is linked to dementia risk in stroke survivors. This secondary analysis aimed to quantify the association between stroke-related vision impairment and time to incident dementia diagnosis, from time of stroke, using the Arthrosclerosis Risk in Communities study dataset. We included participants who sustained a non-fatal probable or definite ischemic, incident stroke captured from hospital surveillance during the study period and excluded those who were diagnosed with incident dementia prior to or less than half a year after the incident stroke. The association between stroke-related vision impairment (binary) and time from incident stroke to dementia diagnosis was analyzed using a Fine-Gray survival model to account for the competing risk of death, adjusting for age at incident stroke, stroke severity, biological sex, education and race-center. Among 787 stroke survivors, 31 % were diagnosed with dementia during the follow-up period and 19.5 % had stroke-related vision impairment. The presence of stroke-related vision impairment was not significantly associated with dementia diagnosis (HR = 1.18; 95 % CI 0.85, 1.63; <em>p</em> = 0.32). While results suggest that stroke-related vision impairment corresponds to a higher cumulative incidence of dementia, the association was not statistically significant.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108480"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426897","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}
Pub Date : 2025-12-01Epub Date: 2025-11-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108483
Johanna Seiden MD, MPH , Juan Felipe Daza-Ovalle MD , Zhengrui Xiao MD , Olga Rubalsky MD , Irina Murakhovskaya MD , Ellen Friedman MD , Kathryn Kirchoff-Torres MD , Daniel Labovitz MD, MS , Charles Esenwa MD, MS
Introduction
Cerebral Infarction due to Severe ADAMTS-13 Deficiency (CISAD) remains an underrecognized cause of cryptogenic stroke. Despite the absence of classic hematologic features, CISAD confers a risk of recurrent ischemic events if not promptly identified and treated. Increased clinical awareness is essential to prompt appropriate laboratory testing and reduce stroke recurrence.
Methods
We conducted a retrospective cohort study at Montefiore Medical Center to identify patients with ischemic stroke and severe ADAMTS-13 deficiency from January 2017 to June 2025. Of 235 screened patients, 197 had an acute ischemic stroke. 9 met final inclusion criteria for CISAD: confirmed ischemic stroke, severe ADAMTS-13 deficiency at index event, and absence of microangiopathic hemolytic anemia (MAHA). Clinical, hematologic, and imaging characteristics were analyzed descriptively in the final cohort.
Results
Of 9 patients, 7 were female. Mean age was 51.3 years. Platelet counts were normal in 6 of 9 cases. 4 of 9 patients had large vessel occlusions. 3 patients had multifocal infarcts. 8 of 9 patients met Embolic Stroke of Undetermined Source (ESUS) criteria before ADAMTS-13 testing. 1 had three ESUS events before ADAMTS-13 deficiency was identified. The remaining 6 patients had an established history of thrombotic thrombocytopenic purpura (TTP) and presented with recurrent strokes and severe ADAMTS-13 deficiency. 2 patients had multiple strokes with severe ADAMTS-13 deficiency. All patients were treated with steroids, therapeutic plasma-exchange (TPE), and/or Rituximab.
Conclusion
CISAD may present without hematologic abnormalities and should be considered as a rare cause of stroke. Early ADAMTS-13 activity and inhibitor testing in select patients may allow timely diagnosis, treatment, and prevention of recurrence.
{"title":"Severe ADAMTS-13 deficiency without hemolysis as a cause of cryptogenic stroke: A single center case series","authors":"Johanna Seiden MD, MPH , Juan Felipe Daza-Ovalle MD , Zhengrui Xiao MD , Olga Rubalsky MD , Irina Murakhovskaya MD , Ellen Friedman MD , Kathryn Kirchoff-Torres MD , Daniel Labovitz MD, MS , Charles Esenwa MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108483","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108483","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebral Infarction due to Severe ADAMTS-13 Deficiency (CISAD) remains an underrecognized cause of cryptogenic stroke. Despite the absence of classic hematologic features, CISAD confers a risk of recurrent ischemic events if not promptly identified and treated. Increased clinical awareness is essential to prompt appropriate laboratory testing and reduce stroke recurrence.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study at Montefiore Medical Center to identify patients with ischemic stroke and severe ADAMTS-13 deficiency from January 2017 to June 2025. Of 235 screened patients, 197 had an acute ischemic stroke. 9 met final inclusion criteria for CISAD: confirmed ischemic stroke, severe ADAMTS-13 deficiency at index event, and absence of microangiopathic hemolytic anemia (MAHA). Clinical, hematologic, and imaging characteristics were analyzed descriptively in the final cohort.</div></div><div><h3>Results</h3><div>Of 9 patients, 7 were female. Mean age was 51.3 years. Platelet counts were normal in 6 of 9 cases. 4 of 9 patients had large vessel occlusions. 3 patients had multifocal infarcts. 8 of 9 patients met Embolic Stroke of Undetermined Source (ESUS) criteria before ADAMTS-13 testing. 1 had three ESUS events before ADAMTS-13 deficiency was identified. The remaining 6 patients had an established history of thrombotic thrombocytopenic purpura (TTP) and presented with recurrent strokes and severe ADAMTS-13 deficiency. 2 patients had multiple strokes with severe ADAMTS-13 deficiency. All patients were treated with steroids, therapeutic plasma-exchange (TPE), and/or Rituximab.</div></div><div><h3>Conclusion</h3><div>CISAD may present without hematologic abnormalities and should be considered as a rare cause of stroke. Early ADAMTS-13 activity and inhibitor testing in select patients may allow timely diagnosis, treatment, and prevention of recurrence.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108483"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440473","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}
Pub Date : 2025-12-01Epub Date: 2025-11-03DOI: 10.1016/j.jstrokecerebrovasdis.2025.108485
Lixia Zhu PhD , Zhao Pu , Thomas W. Leung MD , Lawrence Ka Sing Wong MD , Jack Jiaqi Zhang PhD , Li Xiong PhD
Background and Purpose
External counterpulsation (ECP) noninvasively augments cerebral blood flow in patients with ischemic stroke. We investigated whether the cerebral augmentation index (CAI), measured by transcranial Doppler (TCD) during ECP, could predict the functional outcome of ischemic stroke.
Methods
Patients with unilateral ischemic stroke in the anterior circulation territory were enrolled within 7 days of symptom onset. Mean flow velocities in both middle cerebral arteries (MCA) were monitored by TCD before, during and immediately after ECP. CAI was defined as the percentage increase in MCA mean flow velocity during ECP relative to baseline. TCD data from the ipsilateral and contralateral sides of the cerebral infarct were analyzed and compared between patients with good outcomes (modified Rankin Scale (mRS) 0-2) and those with poor outcomes (mRS 3-6) at 3 months post-stroke.
Results
Among 200 recruited patients (mean age, 64.5 ± 8.9 years; 86.5 % men), functional outcomes were good in 148 (74.0 %) and poor in 52 (26.0 %). Admission NIH Stroke Scale, history of ischemic heart disease, and CAI on both the ipsilateral and contralateral sides differed significantly between the two groups (all P < 0.05). In multivariate analysis, NIH Stroke Scale (OR, 1.677 [95 % CI, 1.363-2.064]; P < 0.001), ipsilateral CAI (OR, 1.282 [95 % CI, 1.148-1.646]; P = 0.012), and contralateral CAI (OR, 1.104 [95 % CI, 1.002-1.234]; P = 0.038) independently predicted poor functional outcomes.
Conclusion
CAI, a cerebral hemodynamic index measured over the MCA on either the ipsilateral or contralateral side of an acute cerebral infarct, may predict unfavorable stroke outcomes.
{"title":"Cerebral augmentation index derived from external counterpulsation predicts ischemic stroke outcome: A prospective observational study","authors":"Lixia Zhu PhD , Zhao Pu , Thomas W. Leung MD , Lawrence Ka Sing Wong MD , Jack Jiaqi Zhang PhD , Li Xiong PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108485","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108485","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>External counterpulsation (ECP) noninvasively augments cerebral blood flow in patients with ischemic stroke. We investigated whether the cerebral augmentation index (CAI), measured by transcranial Doppler (TCD) during ECP, could predict the functional outcome of ischemic stroke.</div></div><div><h3>Methods</h3><div>Patients with unilateral ischemic stroke in the anterior circulation territory were enrolled within 7 days of symptom onset. Mean flow velocities in both middle cerebral arteries (MCA) were monitored by TCD before, during and immediately after ECP. CAI was defined as the percentage increase in MCA mean flow velocity during ECP relative to baseline. TCD data from the ipsilateral and contralateral sides of the cerebral infarct were analyzed and compared between patients with good outcomes (modified Rankin Scale (mRS) 0-2) and those with poor outcomes (mRS 3-6) at 3 months post-stroke.</div></div><div><h3>Results</h3><div>Among 200 recruited patients (mean age, 64.5 ± 8.9 years; 86.5 % men), functional outcomes were good in 148 (74.0 %) and poor in 52 (26.0 %). Admission NIH Stroke Scale, history of ischemic heart disease, and CAI on both the ipsilateral and contralateral sides differed significantly between the two groups (all <em>P</em> < 0.05). In multivariate analysis, NIH Stroke Scale (OR, 1.677 [95 % CI, 1.363-2.064]; <em>P</em> < 0.001), ipsilateral CAI (OR, 1.282 [95 % CI, 1.148-1.646]; <em>P</em> = 0.012), and contralateral CAI (OR, 1.104 [95 % CI, 1.002-1.234]; <em>P</em> = 0.038) independently predicted poor functional outcomes.</div></div><div><h3>Conclusion</h3><div>CAI, a cerebral hemodynamic index measured over the MCA on either the ipsilateral or contralateral side of an acute cerebral infarct, may predict unfavorable stroke outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108485"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454474","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}
Pub Date : 2025-12-01Epub Date: 2025-10-06DOI: 10.1016/j.jstrokecerebrovasdis.2025.108465
Temidayo A. Abe MD , William Tressel MS , Traci M. Bartz PhD , John S. Gottdiener MD , Hooman Kamel MD, MS , Jorge R. Kizer MD, MSc , Will T. Longstreth Jr. MD, MPH , Sanjiv J. Shah MD , Luc Djoussée MD, ScD , Kenneth J. Mukamal MD, MPH
Introduction
Dementia has been strongly linked with cardiovascular disease, but the relationships between cardiovascular disease and brain health at subclinical stages have not been fully explored. We investigated the associations between subclinical cardiac dysfunction, defined by cardiac biomarkers and echocardiography, and novel neurobiomarkers associated with the brain injury in older adults.
Methods
We included 962 participants from the Cardiovascular Health Study who had no history of stroke, transient ischemic attack, atrial fibrillation, heart failure, or myocardial infarction. We analyzed cross-sectional associations using linear regression. Outcomes variables were serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP), two markers of subclinical brain injury. Exposure variables were serum N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) and subclinical cardiac measures including echocardiographic left atrial reservoir strain, left ventricular average longitudinal strain, early diastolic strain rate of the left ventricle, decreased left ventricular ejection fraction, average E/e’, percent predicted left ventricular mass, and left atrial diameter.
Results
Among 844 participants with serum biomarkers, hs-cTnT was significantly associated with NfL (β = 1.881, 95 % CI: (0.729, 3.032), p = 0.001), and this association remained significant even after mutual adjustment for NT-proBNP (β = 1.781, 95 % CI: (0.626, 2.937), p = 0.003). NT-proBNP was also associated with NfL (β = 1.170, 95 % CI: (0.047, 2.293), p = 0.041), although this association was slightly attenuated and not statistically significant after adjustment for hs-cTnT (β = 1.004, 95 % CI: (-0.119, 2.126), p = 0.08). There were no significant associations observed for either circulating marker with GFAP, nor were echocardiographic variables associated with NfL or GFAP.
Conclusions
In older adults without clinically identified cardiovascular disease, subclinical cardiac dysfunction identified through hs-cTnT and, to a lesser extent, NT-proBNP, was associated with higher levels of NfL, a marker of brain injury. This novel insight suggests that even subclinical cardiac disease is linked to brain health.
{"title":"Subclinical cardiac dysfunction and circulating markers of brain injury in older adults: The cardiovascular health study","authors":"Temidayo A. Abe MD , William Tressel MS , Traci M. Bartz PhD , John S. Gottdiener MD , Hooman Kamel MD, MS , Jorge R. Kizer MD, MSc , Will T. Longstreth Jr. MD, MPH , Sanjiv J. Shah MD , Luc Djoussée MD, ScD , Kenneth J. Mukamal MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2025.108465","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108465","url":null,"abstract":"<div><h3>Introduction</h3><div>Dementia has been strongly linked with cardiovascular disease, but the relationships between cardiovascular disease and brain health at subclinical stages have not been fully explored. We investigated the associations between subclinical cardiac dysfunction, defined by cardiac biomarkers and echocardiography, and novel neurobiomarkers associated with the brain injury in older adults.</div></div><div><h3>Methods</h3><div>We included 962 participants from the Cardiovascular Health Study who had no history of stroke, transient ischemic attack, atrial fibrillation, heart failure, or myocardial infarction. We analyzed cross-sectional associations using linear regression. Outcomes variables were serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP), two markers of subclinical brain injury. Exposure variables were serum N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) and subclinical cardiac measures including echocardiographic left atrial reservoir strain, left ventricular average longitudinal strain, early diastolic strain rate of the left ventricle, decreased left ventricular ejection fraction, average E/e’, percent predicted left ventricular mass, and left atrial diameter.</div></div><div><h3>Results</h3><div>Among 844 participants with serum biomarkers, hs-cTnT was significantly associated with NfL (β = 1.881, 95 % CI: (0.729, 3.032), p = 0.001), and this association remained significant even after mutual adjustment for NT-proBNP (β = 1.781, 95 % CI: (0.626, 2.937), p = 0.003). NT-proBNP was also associated with NfL (β = 1.170, 95 % CI: (0.047, 2.293), p = 0.041), although this association was slightly attenuated and not statistically significant after adjustment for hs-cTnT (β = 1.004, 95 % CI: (-0.119, 2.126), p = 0.08). There were no significant associations observed for either circulating marker with GFAP, nor were echocardiographic variables associated with NfL or GFAP.</div></div><div><h3>Conclusions</h3><div>In older adults without clinically identified cardiovascular disease, subclinical cardiac dysfunction identified through hs-cTnT and, to a lesser extent, NT-proBNP, was associated with higher levels of NfL, a marker of brain injury. This novel insight suggests that even subclinical cardiac disease is linked to brain health.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108465"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253814","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}
Pub Date : 2025-12-01Epub Date: 2025-10-30DOI: 10.1016/j.jstrokecerebrovasdis.2025.108481
Chen Yiping MD , Chen Suyu MD , Li Min MD , Li Yongli MD, Zhang Yujing MD, Liu Sihan MD, Xu Chenggui MD, Zhang Tinghui MD, Liao Yong MD, Zhang Ji MD, Zhang Xinghe MD, Tai Xiantao MD
<div><h3>Background</h3><div>Massage is kown to effectively alleviate symptoms of Cerebral Palsy (CP), yet its specific mechanism in CP remains unclear. Cerebral white matter damage is a primary consequence of hypoxia-ischemia (HI) in CP rats. This study aims to explore the potential of massage in facilitating the migration of bone marrow mesenchymal stem cells (BMSCs-Exo) to the brain through the chemokine axis, with the goal of moderating cerebral white matter injury in CP rats.</div></div><div><h3>Method</h3><div>Forty-eight rats were randomized to Sham, Model, Massage, and Inhibition groups. HI injury was induced in 3-day-old rat pups and confirmed through righting reflex assessment and cerebral blood flow imaging. The Massage group received daily massage therapy from postnatal day 5 for 28 days. The Inhibition group was treated with a CXCR4 inhibitor (AMD3100), while the remaining groups were administered saline. Behavioral assessments were conducted at 2 and 4 weeks post-treatment. The homing efficiency of BMSCs-Exo was monitored using small animal live imaging, and cerebral oxygen saturation was measured noninvasively through photoacoustic imaging. Neuronal morphology was evaluated using Nissl staining, and immunofluorescence was employed to co-label oligodendrocytes with CXCR4/SDF-1. SDF-1/CXCR4 expression in bone marrow, serum, and brain white matter was assessed using PCR. In vitro experiments involved co-culturing BMSCs with oligodendrocytes under hypoxic and low glucose conditions. The cell groups included Normal control, DMSO control, Massage, and Massage + GW4869 Group. Viability of BMSCs and oligodendrocytes was determined using CCK-8 assays. Additionally, immunofluorescence staining was performed to visualize exosomes in oligodendrocytes.</div></div><div><h3>Results</h3><div>HI injury prolonged righting reflex latency and decreased cerebral blood flow. Massage intervention was linked to improved blood flow, increased brain homing of BMSCs-Exo, and enhanced limb function, particularly evident after 4 weeks. Histological analysis using Nissl staining and immunofluorescence demonstrated that massage was coincided with reduced neuronal injury and the upregulation of SDF-1/CXCR4 expression in oligodendrocytes. Initially reduced following HI, SDF-1/CXCR4 levels were restored by massage, with the CXCR4 inhibitor significantly abrogating the therapeutic effects of massage. CCK-8 assays indicated that massage was associated with promoted viability of BMSCs and oligodendrocytes, which was attenuated in the presence of exosome inhibition. Furthermore, the uptake capacity of oligodendrocyte cells for exosomes was superior in the Massage group compared to the DMSO control group.</div></div><div><h3>Conclusion</h3><div>Massage is associated with enhanced motor function and white matter restoration in cerebral palsy, potentially through mechanisms involving the SDF-1/CXCR4 axis, increased homing of BMSCs-Exo to the brain, and enhanced oligodendr
{"title":"White matter injury in young rats with cerebral palsy: the role of massage in regulating exosomes via the chemokine axis","authors":"Chen Yiping MD , Chen Suyu MD , Li Min MD , Li Yongli MD, Zhang Yujing MD, Liu Sihan MD, Xu Chenggui MD, Zhang Tinghui MD, Liao Yong MD, Zhang Ji MD, Zhang Xinghe MD, Tai Xiantao MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108481","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108481","url":null,"abstract":"<div><h3>Background</h3><div>Massage is kown to effectively alleviate symptoms of Cerebral Palsy (CP), yet its specific mechanism in CP remains unclear. Cerebral white matter damage is a primary consequence of hypoxia-ischemia (HI) in CP rats. This study aims to explore the potential of massage in facilitating the migration of bone marrow mesenchymal stem cells (BMSCs-Exo) to the brain through the chemokine axis, with the goal of moderating cerebral white matter injury in CP rats.</div></div><div><h3>Method</h3><div>Forty-eight rats were randomized to Sham, Model, Massage, and Inhibition groups. HI injury was induced in 3-day-old rat pups and confirmed through righting reflex assessment and cerebral blood flow imaging. The Massage group received daily massage therapy from postnatal day 5 for 28 days. The Inhibition group was treated with a CXCR4 inhibitor (AMD3100), while the remaining groups were administered saline. Behavioral assessments were conducted at 2 and 4 weeks post-treatment. The homing efficiency of BMSCs-Exo was monitored using small animal live imaging, and cerebral oxygen saturation was measured noninvasively through photoacoustic imaging. Neuronal morphology was evaluated using Nissl staining, and immunofluorescence was employed to co-label oligodendrocytes with CXCR4/SDF-1. SDF-1/CXCR4 expression in bone marrow, serum, and brain white matter was assessed using PCR. In vitro experiments involved co-culturing BMSCs with oligodendrocytes under hypoxic and low glucose conditions. The cell groups included Normal control, DMSO control, Massage, and Massage + GW4869 Group. Viability of BMSCs and oligodendrocytes was determined using CCK-8 assays. Additionally, immunofluorescence staining was performed to visualize exosomes in oligodendrocytes.</div></div><div><h3>Results</h3><div>HI injury prolonged righting reflex latency and decreased cerebral blood flow. Massage intervention was linked to improved blood flow, increased brain homing of BMSCs-Exo, and enhanced limb function, particularly evident after 4 weeks. Histological analysis using Nissl staining and immunofluorescence demonstrated that massage was coincided with reduced neuronal injury and the upregulation of SDF-1/CXCR4 expression in oligodendrocytes. Initially reduced following HI, SDF-1/CXCR4 levels were restored by massage, with the CXCR4 inhibitor significantly abrogating the therapeutic effects of massage. CCK-8 assays indicated that massage was associated with promoted viability of BMSCs and oligodendrocytes, which was attenuated in the presence of exosome inhibition. Furthermore, the uptake capacity of oligodendrocyte cells for exosomes was superior in the Massage group compared to the DMSO control group.</div></div><div><h3>Conclusion</h3><div>Massage is associated with enhanced motor function and white matter restoration in cerebral palsy, potentially through mechanisms involving the SDF-1/CXCR4 axis, increased homing of BMSCs-Exo to the brain, and enhanced oligodendr","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108481"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427084","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}
Pub Date : 2025-12-01Epub Date: 2025-11-21DOI: 10.1016/j.jstrokecerebrovasdis.2025.108500
Prasen R Marella , Jacob A Sambursky , Kriti Bhayana , Asha P Jacob , Varsha Muddasani , Murli Mishra , Alexandra L Czap , James C Grotta
Background
For stroke patients with history of possible Direct Acting Oral Anticoagulant use, clinicians must make treatment decisions without knowledge of whether the patient is therapeutically anticoagulated. A urine-based point-of-care test might help guide these emergency decisions.
Methods
We prospectively enrolled patients with suspected recent factor-Xa-inhibitor (Xai) use being evaluated for acute stroke therapy in an urban teaching hospital. We obtained the urine test and plasma anti-Xa level in parallel with usual clinical management; the treating clinician did not use test results for decision-making but recorded treatment they would have given had they known the urine test was accurate. The primary outcome was feasibility. Secondary outcomes were accuracy of the urine test at plasma anti-Xa level >30 ng/mL and consequent change in clinical management.
Results
Twenty-one patients were enrolled over 1 year. The urine test was successfully carried out in all patients, median 59 minutes after Emergency Department arrival. Sensitivity and specificity for the urine test to detect threshold anti-Xa activity were 100 % and 87.5 %. Of 20 patients with ischemic stroke, none of whom were treated with thrombolytics, 6 had a negative test which would have resulted in treatment of 4 (66 %).
Conclusion
A urine point-of-care test for Xai activity is feasible, accurate, and would likely result in treatment of stroke patients currently excluded from thrombolysis.
{"title":"A urine-based point-of-care test for Factor Xa inhibitors in acute stroke management","authors":"Prasen R Marella , Jacob A Sambursky , Kriti Bhayana , Asha P Jacob , Varsha Muddasani , Murli Mishra , Alexandra L Czap , James C Grotta","doi":"10.1016/j.jstrokecerebrovasdis.2025.108500","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108500","url":null,"abstract":"<div><h3>Background</h3><div>For stroke patients with history of possible Direct Acting Oral Anticoagulant use, clinicians must make treatment decisions without knowledge of whether the patient is therapeutically anticoagulated. A urine-based point-of-care test might help guide these emergency decisions.</div></div><div><h3>Methods</h3><div>We prospectively enrolled patients with suspected recent factor-Xa-inhibitor (Xai) use being evaluated for acute stroke therapy in an urban teaching hospital. We obtained the urine test and plasma anti-Xa level in parallel with usual clinical management; the treating clinician did not use test results for decision-making but recorded treatment they would have given had they known the urine test was accurate. The primary outcome was feasibility. Secondary outcomes were accuracy of the urine test at plasma anti-Xa level >30 ng/mL and consequent change in clinical management.</div></div><div><h3>Results</h3><div>Twenty-one patients were enrolled over 1 year. The urine test was successfully carried out in all patients, median 59 minutes after Emergency Department arrival. Sensitivity and specificity for the urine test to detect threshold anti-Xa activity were 100 % and 87.5 %. Of 20 patients with ischemic stroke, none of whom were treated with thrombolytics, 6 had a negative test which would have resulted in treatment of 4 (66 %).</div></div><div><h3>Conclusion</h3><div>A urine point-of-care test for Xai activity is feasible, accurate, and would likely result in treatment of stroke patients currently excluded from thrombolysis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108500"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582808","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}
Pub Date : 2025-12-01Epub Date: 2025-10-28DOI: 10.1016/j.jstrokecerebrovasdis.2025.108478
Tan V. Bui , Yichao A. Sun , Katherine Chappell , Sabah Rehman , Hoang T. Phan , Helen Castley , Lee Nedkoff , Judith M. Katzenellenbogen , Seana L. Gall
Background
Although socio-economic status (SES) is a recognised risk factor for stroke, few studies have examined stroke incidence by SES in Australia. We investigated the incidence of first-ever stroke by SES using state-wide record linkage data.
Methods
This retrospective cohort study used linked Tasmanian Admitted Patient Care and the Death Registry data. Fatal and non-fatal strokes 2007–2020 were identified using ICD-10 codes (8-year clearance period) to identify first-ever strokes 2015–2020. SES was from Index of Relative Socio-economic Advantage and Disadvantage by quintiles (low, low medium, medium, medium high, high). Covariates included sex, age, and remoteness. Population denominators (2016 Australian population) were used to calculate crude and age-standardised incidence rates. Poisson regression models estimated adjusted incidence rate ratios (IRR) for first-ever stroke by SES group.
Results
We identified 4901 first-ever stroke cases (63% ischaemic stroke, mean [SD] age 75 [14] years, 52% female). Ischaemic heart disease (12% lowest vs 7% highest SES), diabetes (26% lowest vs 18% highest SES), and hypertension (48% lowest vs 39% highest SES) were significantly different by SES. The age-standardised rate was 134/100,000 persons (95% CI 130, 138). Compared to the high SES group, the IRR for first-ever stroke was 1.20 (95% CI 1.09, 1.33) for the low medium SES group and 1.33 (95% CI 1.22, 1.46) for the low SES group, adjusting for age, sex, stroke incident year, and remoteness.
Conclusions
Lower SES groups had a higher incidence of first-ever stroke. Public health and primary care strategies targeting stroke risk factors in these groups may reduce stroke incidence.
背景：虽然社会经济地位（SES）是卒中的一个公认的危险因素，但在澳大利亚很少有研究通过社会经济地位来检查卒中的发病率。我们调查了首次中风的发病率SES使用全国范围内的记录联动数据。方法：这项回顾性队列研究使用了塔斯马尼亚住院病人护理和死亡登记的相关数据。使用ICD-10代码（8年清除期）确定2007-2020年的致命性和非致命性中风，以确定2015-2020年的首次中风。SES为相对社会经济优势和劣势指数，分五位数（低、中低、中、中高、高）。协变量包括性别、年龄和偏远地区。人口分母（2016年澳大利亚人口）用于计算粗发病率和年龄标准化发病率。泊松回归模型估计了SES组首次卒中的调整发病率比（IRR）。结果：我们确定了4901例首次卒中病例（63%为缺血性卒中，平均[SD]年龄75岁，52%为女性）。缺血性心脏病（12%最低SES vs 7%最高SES）、糖尿病（26%最低SES vs 18%最高SES）和高血压（48%最低SES vs 39%最高SES）因SES而有显著差异。年龄标准化率为134/100,000人（95% CI 130,138）。与高经济地位组相比，中低经济地位组首次卒中的IRR为1.20 (95% CI 1.09, 1.33)，低经济地位组为1.33 (95% CI 1.22, 1.46)，调整了年龄、性别、卒中发生年份和偏远地区。结论：社会经济地位较低的组首次卒中的发生率较高。针对这些人群卒中危险因素的公共卫生和初级保健策略可能会降低卒中发病率。
{"title":"Lower socio-economic status is associated with first-ever stroke incidence: An Australian state-wide record linkage study","authors":"Tan V. Bui , Yichao A. Sun , Katherine Chappell , Sabah Rehman , Hoang T. Phan , Helen Castley , Lee Nedkoff , Judith M. Katzenellenbogen , Seana L. Gall","doi":"10.1016/j.jstrokecerebrovasdis.2025.108478","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108478","url":null,"abstract":"<div><h3>Background</h3><div>Although socio-economic status (SES) is a recognised risk factor for stroke, few studies have examined stroke incidence by SES in Australia. We investigated the incidence of first-ever stroke by SES using state-wide record linkage data.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used linked Tasmanian Admitted Patient Care and the Death Registry data. Fatal and non-fatal strokes 2007–2020 were identified using ICD-10 codes (8-year clearance period) to identify first-ever strokes 2015–2020. SES was from Index of Relative Socio-economic Advantage and Disadvantage by quintiles (low, low medium, medium, medium high, high). Covariates included sex, age, and remoteness. Population denominators (2016 Australian population) were used to calculate crude and age-standardised incidence rates. Poisson regression models estimated adjusted incidence rate ratios (IRR) for first-ever stroke by SES group.</div></div><div><h3>Results</h3><div>We identified 4901 first-ever stroke cases (63% ischaemic stroke, mean [SD] age 75 [14] years, 52% female). Ischaemic heart disease (12% lowest vs 7% highest SES), diabetes (26% lowest vs 18% highest SES), and hypertension (48% lowest vs 39% highest SES) were significantly different by SES. The age-standardised rate was 134/100,000 persons (95% CI 130, 138). Compared to the high SES group, the IRR for first-ever stroke was 1.20 (95% CI 1.09, 1.33) for the low medium SES group and 1.33 (95% CI 1.22, 1.46) for the low SES group, adjusting for age, sex, stroke incident year, and remoteness.</div></div><div><h3>Conclusions</h3><div>Lower SES groups had a higher incidence of first-ever stroke. Public health and primary care strategies targeting stroke risk factors in these groups may reduce stroke incidence.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108478"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411380","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}
Pub Date : 2025-12-01Epub Date: 2025-10-27DOI: 10.1016/j.jstrokecerebrovasdis.2025.108477
Baoyi Li MM , Qin Wang MD , Haibo Su MD , Yihua Guo MD , Linna Jiao MD
Background
Ischemic stroke often results in persistent motor impairments due to disrupted cortical excitability in the lesional hemisphere. Acupuncture and repetitive transcranial magnetic stimulation (rTMS) have each shown potential in enhancing neural plasticity. Their combination may provide synergistic effects, but no meta-analysis has specifically examined objective neurophysiological outcomes.
Objective
To evaluate the efficacy of acupuncture combined with rTMS in improving cortical excitability after ischemic stroke using neurophysiological indicators.
Methods
A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched up to June 30, 2025. Randomized controlled trials (RCTs) comparing acupuncture+rTMS with rTMS alone, acupuncture alone, sham stimulation, or conventional rehabilitation, and reporting at least one cortical excitability indicator—motor evoked potential (MEP) amplitude or latency, resting motor threshold (RMT), or central motor conduction time (CMCT)—were included. Risk of bias was assessed with the Cochrane tool, and trial sequential analysis (TSA) was performed.
Results
Twelve RCTs involving 1,012 patients were included. Compared with controls, acupuncture+rTMS significantly increased MEP amplitude (SMD = 1.08, 95 % CI: 0.90–1.26), decreased MEP latency (SMD = –0.90, 95 % CI:1.13 to –0.66), reduced RMT (SMD = –0.76, 95 % CI:0.99 to –0.53), and shortened CMCT (SMD = –0.83, 95 % CI:1.14 to –0.52), all with low heterogeneity (I2 = 0–20.4 %). TSA showed that the cumulative Z-curve crossed the monitoring boundary but the required information size (RIS = 1,268) was not reached, indicating that while the current evidence is promising, further adequately powered randomized controlled trials are still required.
Conclusions
Acupuncture combined with rTMS significantly enhances cortical excitability after ischemic stroke, supporting its value in neurorehabilitation. Larger, standardized trials are warranted to confirm these findings and evaluate long-term benefits.
{"title":"Acupuncture combined with repetitive transcranial magnetic stimulation for enhancing cortical excitability in the lesional hemisphere after ischemic stroke: A systematic review and meta-analysis","authors":"Baoyi Li MM , Qin Wang MD , Haibo Su MD , Yihua Guo MD , Linna Jiao MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108477","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108477","url":null,"abstract":"<div><h3>Background</h3><div>Ischemic stroke often results in persistent motor impairments due to disrupted cortical excitability in the lesional hemisphere. Acupuncture and repetitive transcranial magnetic stimulation (rTMS) have each shown potential in enhancing neural plasticity. Their combination may provide synergistic effects, but no meta-analysis has specifically examined objective neurophysiological outcomes.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy of acupuncture combined with rTMS in improving cortical excitability after ischemic stroke using neurophysiological indicators.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched up to June 30, 2025. Randomized controlled trials (RCTs) comparing acupuncture+rTMS with rTMS alone, acupuncture alone, sham stimulation, or conventional rehabilitation, and reporting at least one cortical excitability indicator—motor evoked potential (MEP) amplitude or latency, resting motor threshold (RMT), or central motor conduction time (CMCT)—were included. Risk of bias was assessed with the Cochrane tool, and trial sequential analysis (TSA) was performed.</div></div><div><h3>Results</h3><div>Twelve RCTs involving 1,012 patients were included. Compared with controls, acupuncture+rTMS significantly increased MEP amplitude (SMD = 1.08, 95 % CI: 0.90–1.26), decreased MEP latency (SMD = –0.90, 95 % CI:1.13 to –0.66), reduced RMT (SMD = –0.76, 95 % CI:0.99 to –0.53), and shortened CMCT (SMD = –0.83, 95 % CI:1.14 to –0.52), all with low heterogeneity (I<sup>2</sup> = 0–20.4 %). TSA showed that the cumulative Z-curve crossed the monitoring boundary but the required information size (RIS = 1,268) was not reached, indicating that while the current evidence is promising, further adequately powered randomized controlled trials are still required.</div></div><div><h3>Conclusions</h3><div>Acupuncture combined with rTMS significantly enhances cortical excitability after ischemic stroke, supporting its value in neurorehabilitation. Larger, standardized trials are warranted to confirm these findings and evaluate long-term benefits.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108477"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403728","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}
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