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        <title>Frontiers in Neurology | Stroke section | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/neurology/sections/stroke</link>
        <description>RSS Feed for Stroke section in the Frontiers in Neurology journal | New and Recent Articles</description>
        <language>en-us</language>
        <generator>Frontiers Feed Generator,version:1</generator>
        <pubDate>2026-05-01T13:05:54.541+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1819703</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1819703</link>
        <title><![CDATA[Clinical multidimensional prediction model for futile reperfusion in acute ischemic stroke after endovascular thrombectomy]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sisi Jiang</author><author>Weinv Fan</author><author>Yunqin Wu</author><author>Xiaoxia Liu</author><author>Da Li</author><author>Ou Zhang</author><author>Xiaofeng Xie</author><author>Feiyu Chen</author><author>Yindan Yao</author>
        <description><![CDATA[BackgroundPrevious Studies on prediction models for futile reperfusion after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) related to large vessel occlusion (LVO) have yielded inconsistent results. This inconsistency may be largely attributed to methodological limitations, particularly in variable selection and missing data handling. Consequently, the prognostic value of several key clinical predictors remains to be fully elucidated.MethodsThis retrospective study included 390 patients with AIS who underwent EVT at Ningbo No.2 Hospital. All of them achieved successful reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) score ≥ 2b. Futile reperfusion was defined as a modified Rankin Scale score of 3–6 at 90-day. Missing data were handled with multiple imputation. Logistic regression models were built using a two step predictor selection process: first univariable screening with p < 0.2; then further selection based on event count constraints. Only variables that were selected in all five imputed datasets, meaning a 100% selection frequency, were retained. Model performance measures were pooled following Rubin’s rules.ResultsBased on preoperative assessments integrating clinical, imaging, and laboratory markers, the final model comprised nine variables: National Institutes of Health Stroke Scale (NIHSS) score, Computed Tomography angiography-source images Alberta Stroke Program Early Computed Tomography Score (CTA-SI ASPECTS), time from onset to reperfusion (OTR), collateral circulation scores (CCS), C-reactive protein (CRP), glucose, white blood cell (WBC) count, neutrophil count, and monocyte count. The final model demonstrated good discriminative ability, with a pooled test AUC of 0.795 and a Brier score of 0.178. At the optimal threshold (mean 0.457), the model achieved a specificity of 0.822 and accuracy of 0.761, with positive net benefit across clinically relevant threshold probabilities on decision curve analysis. A nomogram incorporating the nine consistently selected predictors was developed to facilitate individualized risk prediction.ConclusionWe developed a multidimensional model integrating clinical, imaging, and laboratory markers to predict futile reperfusion following EVT in patients with anterior circulation stroke. Each marker provides independent prognostic information; collectively, they represent the multidimensional risk architecture underlying postprocedural outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1721769</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1721769</link>
        <title><![CDATA[Association of HbA1c and comorbidities on stroke severity: insights from a cross-sectional analysis in a tertiary hospital]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Bader N. Alharbi</author><author>Fahad K. Alsharef</author><author>Fahad K. Aldossary</author><author>Hamad A. Alsaggabi</author><author>Saleh A. Alhawery</author><author>Hussain S. Aldera</author><author>Moeber M. Mahzari</author><author>Nasser Alotaibi</author><author>Bijesh Yadav</author><author>Naif M. Alhawiti</author>
        <description><![CDATA[IntroductionElevated HbA1c levels, in combination with comorbidities such as diabetes and hypertension, have been linked to increased stroke severity, poorer functional recovery, and higher mortality. However, the predictive value of HbA1c—a marker of long-term glycemic control—for acute stroke severity remains unclear. This study investigated the relationship between admission HbA1c levels and comorbidities on stroke severity in patients presenting to a tertiary care center.MethodsWe conducted a retrospective cross-sectional study at King Abdulaziz Medical City in Riyadh, Saudi Arabia, including 672 adult patients with acute ischemic stroke between January 2016 and January 2023. Patients were stratified into three groups based on admission HbA1c (≤6.4%, 6.5–7.9%, ≥8%). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge.ResultsA total of 672 patients were included (mean age 63.7 ± 13.2 years; 68.6% male). At admission, 49.9% had mild, 42.3% moderate, and 7.9% severe strokes, with no significant association between HbA1c and stroke severity (p = 0.177). Although higher HbA1c levels were associated with vascular comorbidities in bivariate analysis, only LDL (OR = 1.06, 95% CI: 1.00–1.12; p = 0.045) and atrial fibrillation (OR = 0.73, 95% CI: 0.58–0.91; p = 0.005) remained significant after adjustment. Antihypertensive use was independently associated with higher HbA1c (OR = 1.53, 95% CI: 1.30–1.80; p < 0.001), while NOAC use showed an inverse association (OR = 0.74, 95% CI: 0.55–0.99; p = 0.040). In multivariable analysis, atrial fibrillation was the only independent predictor of increased stroke severity, whereas HbA1c and other vascular risk factors were not significant. Stroke severity strongly predicted in-hospital mortality (OR = 1.27, 95% CI: 1.02–1.59; p = 0.032), prolonged hospitalization (OR = 1.31, 95% CI: 1.15–1.49; p < 0.001), and stroke-related death (OR = 2.18, 95% CI: 1.37–3.47; p = 0.002), while HbA1c was not associated with these outcomes.DiscussionIn conclusion, HbA1c was not associated with acute stroke severity. While it remains a valuable marker of long-term vascular risk, its role in predicting acute neurological injury appears limited. In contrast, established clinical tools—particularly the NIHSS—remain the most reliable instruments for early prognostic evaluation of stroke severity.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1807072</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1807072</link>
        <title><![CDATA[Prevalence of anxiety and depression in young stroke patients, and associated factors: a meta-analysis]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Yuxue Tong</author><author>Songmei Cao</author><author>Jingjing Wang</author><author>Yuan Qin</author><author>Jingxi Lin</author><author>Zhen Fang</author><author>Jing Qiu</author>
        <description><![CDATA[ObjectiveTo systematically evaluate the prevalence of anxiety and depression among young stroke patients and their associated factors using a meta-analysis.MethodsIn this review, young stroke was defined as stroke occurring in individuals aged 15–60 years. A comprehensive literature search was conducted in the China National Knowledge Infrastructure (CNKI), Wanfang Data, China Biomedical Literature Database, PubMed, Embase, Web of Science, the Cochrane Library, and Wiley for studies reporting the prevalence of anxiety and depression as well as their associated factors in young stroke patients. The search period spanned from database inception to September 2025. Meta-analysis was performed using RevMan 5.4, and publication bias analyses were conducted in Stata 17.0.ResultsTwenty-six studies involving 5,634 patients were included, with 555 cases of anxiety and 1,334 cases of depression. Meta-analysis revealed that the prevalence rates of anxiety and depression among young stroke patients were 35% [95% CI (29–41%)] and 35% [95% CI (29–41%)], respectively. Subgroup analyses revealed the following: by publication year, 32% anxiety and 33% depression among young stroke patients from 2005 to 2018; 43% anxiety and 32% depression from January 2019 to September 2025. By country, the prevalence rates of anxiety and depression among young stroke patients in China were 35 and 34%, respectively, while those in other countries were 36 and 30%. By first-ever stroke, the prevalence rates among first-ever stroke patients were 32 and 31%, respectively, while those for non-first-ever patients were 37 and 34%. By gender, the prevalence rates of anxiety and depression among male patients were 32 and 36%, respectively, while those among female patients were 43 and 37%, respectively. Alcohol consumption and prior depressive symptoms showed relatively stable associations with anxiety in young stroke patients. Gender reached statistical significance in the primary analysis, but this finding was not robust in sensitivity analysis. National Institutes of Health Stroke Scale (NIHSS) score [OR = 3.22, 95% CI (2.04, 5.08)], alcohol consumption [OR = 3.15, 95% CI (1.85, 5.36)], lesion location [OR = 4.8, 95% CI (2.55, 9.06)], Herth Hope Index (HHI) score [OR = 1.96, 95% CI (1.42, 2.71)], Stroke-related shame (SSS) score [OR = 2.04, 95% CI (1.47, 2.81)], hypertension [OR = 1.64, 95% CI (1.31, 2.04)], diabetes [OR = 2.15, 95% CI (1.6, 2.88)], hyperlipidemia [OR = 1.53, 95% CI (1.2, 1.96)], monthly household income [OR = 1.93, 95% CI (1.18, 3.15)], lesion area [OR = 3.25, 95% CI (1.8, 5.87)], multiple lesions [OR = 2.31, 95% CI (1.51, 3.55)], and length of hospitalization [OR = 1.62, 95% CI (1.16, 2.27)] were identified as factors influencing depression in young stroke patients (p < 0.05).ConclusionIn conclusion, this review indicates that anxiety and depression are both common among young stroke patients and deserve greater attention in routine stroke care. Alcohol consumption appears to be a common factor associated with both anxiety and depression, while prior depressive symptoms may also be associated with anxiety. For depression, neurological severity, lesion-related characteristics, vascular comorbidities, and psychosocial factors were identified as potential associated factors. However, some findings, particularly those related to gender and several other exploratory variables, were not stable in sensitivity analyses and should therefore be interpreted with caution. More standardized, prospective, and longitudinal studies are needed to further clarify the mental health burden and associated factors in young stroke patients and to support earlier and more targeted psychological assessment and intervention in this population.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier, CRD420251181939.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1711050</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1711050</link>
        <title><![CDATA[MSC-derived exosomes for hemorrhagic stroke: preclinical evidence and translational challenges]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Perspective</category>
        <author>Ivonne Salinas</author><author>Laura Vela</author><author>Shabnam Santos</author><author>Ariel Moncayo</author><author>Kevin Moreno</author><author>Auki Guaillas</author><author>Ramiro F. Diaz</author><author>Andrés Caicedo</author>
        <description><![CDATA[Hemorrhagic stroke, caused by bleeding into the brain parenchyma or subarachnoid space, accounts for 10–20% of cerebrovascular events worldwide. It is classified as intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH). Despite distinct etiologies, both forms initiate a shared injury cascade marked by metabolic failure, mitochondrial dysfunction, oxidative stress, cytotoxic edema, and progressive neuronal loss. Current guidelines prioritize time-sensitive, neuroprotective measures aimed at acute stabilization and complication prevention. However, these interventions remain largely supportive and fail to directly address the sustained secondary injury processes that underlie long-term neurological disability. In this Perspective, we focus on mesenchymal stem/stromal cell (MSCs)–derived exosomes as a promising cell-free therapeutic strategy with distinct advantages over MSC-based therapies. We first provide an overview of the key mechanisms of neuronal injury in hemorrhagic stroke, distinguishing early brain injury from delayed, secondary damage. We then define exosomes within the broader extracellular vesicle landscape and explain why MSC-derived exosomes are emphasized as principal mediators of MSC paracrine effects. Finally, we synthesize preclinical evidence showing that exosomes can attenuate neuroinflammation, limit apoptosis, and promote angiogenesis and neurogenesis, with associated improvements in functional recovery in experimental stroke models. We also highlight unresolved challenges identified in the current literature, including uncertainties surrounding therapeutic timing, dosing strategies, vesicle heterogeneity, and the need for improved in vivo tracking and mechanistic resolution. As the field advances, addressing these critical issues will be essential for translating MSC-derived exosomes into effective therapies for hemorrhagic stroke.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1832156</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1832156</link>
        <title><![CDATA[Clinical utility of the RACE score for differentiating stroke from stroke mimics in the emergency department]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Hatice Yelda Yildiz</author><author>Kaan Gülcan</author><author>Süreyya Ece Kozbaǧ</author><author>İrem Özürün</author><author>Zeynep Demirkiran</author><author>Yakup Krespi</author>
        <description><![CDATA[ObjectiveRapid differentiation of true stroke from stroke mimics remains a major challenge during emergency department stroke evaluations. This study aimed to evaluate the clinical utility of the Rapid Arterial Occlusion Evaluation (RACE) score in distinguishing stroke from stroke mimics and identifying large vessel occlusion (LVO) in patients evaluated through an emergency department stroke activation workflow.Materials and methodsThis retrospective observational study analyzed routinely collected clinical data from consecutive adult patients evaluated through an emergency department stroke activation pathway. The RACE score was calculated at bedside as part of routine stroke workflow, and final diagnoses were established by vascular neurologists based on clinical evaluation and neuroimaging findings. Patients were classified as stroke or stroke mimic cases. The diagnostic performance of the RACE score for identifying LVO was assessed using receiver operating characteristic (ROC) curve analysis, and logistic regression was used to evaluate the association between RACE score and LVO.ResultsA total of 303 patients were included in the final analysis, of whom 133 (43.9%) were diagnosed with stroke and 170 (56.1%) were classified as stroke mimics. Patients with stroke were significantly older than those with stroke mimics (69.13 ± 12.59 vs. 61.67 ± 17.72 years, p = 0.001). The mean RACE score was significantly higher in stroke patients than in stroke mimics (3.15 ± 2.62 vs. 1.64 ± 1.91, p < 0.001), and RACE scores ≥5 were more frequent in stroke cases (30.8% vs. 8.8%, p < 0.001). LVO was identified in 46 patients (15.4%). Patients with LVO had significantly higher RACE scores than those without LVO (4.59 ± 2.63 vs. 1.85 ± 2.03, p < 0.001), and 56.5% of LVO cases had RACE scores ≥5. Logistic regression analysis showed that higher RACE scores were significantly associated with the presence of LVO [odds ratio (OR) 1.59, 95% Confidence Interval (CI) 1.38–1.83, p < 0.001].ConclusionThe RACE score may provide clinically useful information for differentiating stroke from stroke mimics during emergency department evaluations. Higher RACE scores were associated with confirmed stroke and the presence of LVO, suggesting that the RACE score may serve as a practical adjunct to bedside neurological assessment within acute stroke workflows.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1829539</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1829539</link>
        <title><![CDATA[Long-term mortality and time to minimally invasive puncture and drainage in spontaneous intracerebral hemorrhage]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Nan Gan</author><author>Qiyu Li</author><author>Jinrong Hu</author><author>Jian Liu</author><author>Xinyue Zheng</author><author>Xupeng Li</author><author>Jian Miao</author><author>Tao Ke</author>
        <description><![CDATA[ObjectivesMinimally invasive puncture and drainage (MIPD) is a safe and effective treatment for spontaneous intracerebral hemorrhage (sICH). However, the impact of time to evacuation on clinical outcomes remains unclear. This study aims to assess the association between the time from symptom onset to MIPD and long-term mortality.MethodsThe study retrospectively included consecutive patients with a hematoma ≥ 20 mL who underwent MIPD within 24 h of symptom onset. Patients were stratified by different time windows (0–6 h, 6–12 h, and 12–24 h) from symptom onset to MIPD. One-year (long-term) mortality was defined as the primary outcome. Secondary outcomes included the incidence of rebleeding, the Glasgow Coma Scale (GCS) score at discharge, and modified Rankin Scale (mRS) scores at 3 and 6 months. The association between time to evacuation and clinical outcomes was assessed using multivariate logistic regression and inverse probability of treatment weighting (IPTW) analysis.ResultsA total of 214 eligible patients were included in our study. Patients who underwent MIPD within 6 h or 6 to 12 h had a higher long-term mortality rate compared to those treated within 12 to 24 h (48.48, 50.56, and 30.34%, respectively; p = 0.02). In IPTW analysis, undergoing MIPD within 12–24 h of symptom onset was associated with reduced short-term mortality [odds ratio (OR), 0.519; 95%CI (0.290–0.929), p = 0.03] and long-term mortality [OR, 0.530; 95% CI (0.300–0.937), p = 0.03].ConclusionIn patients with sICH, the time to MIPD within 12 to 24 h was associated with a decreased risk of long-term mortality.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1773324</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1773324</link>
        <title><![CDATA[Efficacy and safety of intravenous thrombolysis versus standard medical management for minor stroke: a systematic review and meta-analysis of RCTs]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Xianrong Feng</author><author>Yujiao Tang</author><author>Baojia Wang</author><author>Zhiqing Liu</author>
        <description><![CDATA[BackgroundThe efficacy and safety of intravenous thrombolysis (IVT) compared to standard medical management (SMM) remain unclear in patients with minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] ≤ 5). This meta-analysis of randomized controlled trials (RCTs) aimed to synthesize evidence from a direct comparison of these treatments.MethodsWe systematically searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to June 30th, 2025. The primary efficacy outcome was an excellent functional outcome (modified Rankin Scale [mRS] score 0–1) at 90 days. The secondary efficacy outcome was functional independence (mRS score 0–2) at 90 days. Key safety outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day all-cause mortality. Data were analyzed using a random-effects model. This study was registered with PROSPERO (CRD420251089799).ResultsFive RCTs involving 4,361 patients were included. The meta-analysis revealed no significant difference between IVT and SMM in efficacy, both for the primary efficacy outcome (90-day mRS 0–1: OR 0.85, 95% CI 0.72–1.00) or the secondary efficacy outcome (90-day mRS 0–2: OR 0.85, 95% CI 0.63–1.13). Regarding safety, the risk of sICH was significantly higher in the IVT group (OR 4.70, 95% CI 1.76–12.52), whereas no significant difference was found in 90-day all-cause mortality (OR 1.62, 95% CI 0.69–3.79).ConclusionIn patients with minor ischemic stroke, IVT offers no superior benefit in functional outcomes over SMM but significantly increases sICH risk. Therefore, routine use of IVT should be approached with caution. Future research should identify specific subgroups who might benefit.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251089799.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1796559</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1796559</link>
        <title><![CDATA[Identification and validation of neuroinflammation related lncRNA PVT1 with transcriptome-wide analysis in cerebral ischemia-reperfusion injury]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xiaochan Xiao</author><author>Huodan Yu</author><author>Haichuan Zhou</author><author>Wenjian Lu</author><author>Yanping Zeng</author><author>Qianxue Chen</author>
        <description><![CDATA[BackgroundThe cerebral ischemia/reperfusion injury (CIRI) is an essential pathological process of ischemic stroke (IS). Secondary neuroinflammation exacerbate neuronal damage following CIRI. To identify long non-coding RNAs (lncRNAs) implicated in neuroinflammation subsequent to CIRI would significantly advance the development of potential therapeutic interventions.MethodsThrough comprehensive analysis of whole-genome RNA-seq profiles in focal ischemic mice models, we identified differentially expressed genes utilizing Gene Ontology term enrichment, Kyoto Encyclopedia of Genes and Genomes pathway analysis, and gene set enrichment analysis. We further implemented immune cell infiltration deconvolution, constructed protein–protein interaction networks, and performed co-expression network analysis for lncRNA screening. Subsequently, we established the mice model with lncRNA PVT1 knockdown prior to CIRI induction. Quantitative assessment of cytokine levels was conducted using enzyme-linked immunosorbent assay, while morphological alterations were evaluated through hematoxylin–eosin staining. And T cell infiltration in cerebral tissues was detected with immunofluorescence analysis.ResultsEnrichment analysis demonstrated that differentially expressed mRNAs were implicated in neuroinflammation following cerebral ischemic. Through immune deconvolution analysis, we observed a increased levels in the CD4 + and CD8 + T cells proportion of cerebral ischemic groups compared with control groups. It identified five hub lncRNAs (AI662270, AU020206, Gm20667, PVT1 and Mir142hg) exhibiting significant correlations with the expression of proinflammatory factors. Notably, PVT1 demonstrated the strongest correlation coefficient with pro-inflammatory factor mRNA expression levels. The vivo experimental validation revealed aberrantly elevated PVT1 expression following CIRI. Importantly, PVT1 knockdown substantially ameliorated CIRI through the reduction of activated T cell infiltration and pro-inflammatory cytokine secretion.ConclusionThe identified lncRNA PVT1 correlated with the activated T cell infiltration and pro-inflammatory cytokine secretion, which could be treatment target for neuroinflammation in CIRI.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1815354</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1815354</link>
        <title><![CDATA[Decentralizing acute stroke reperfusion therapies: moving from structural centralization to organizational equity]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Opinion</category>
        <author>Carla Vera-Cáceres</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1801372</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1801372</link>
        <title><![CDATA[Prognostic value of CT contrast staining after endovascular therapy in basilar artery occlusion stroke]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Natascha Hohmann</author><author>Matthias P. Fabritius</author><author>Sijing Gu</author><author>Daniel Puhr-Westerheide</author><author>Philipp Lohse</author><author>Steffen Tiedt</author><author>Lars Kellert</author><author>Konstantinos Dimitriadis</author><author>Sergio Grosu</author><author>Thomas Liebig</author><author>Jens Ricke</author><author>Wolfgang G. Kunz</author><author>Osman Öcal</author><author>Paul Reidler</author>
        <description><![CDATA[BackgroundContrast staining signifies prolonged tissue absorption of iodinated contrast media following endovascular therapy (EVT) for large-vessel occlusion stroke, indicating blood–brain barrier disruption. With EVT becoming the standard treatment for treating basilar artery occlusion (BAO) stroke and considering the substantial variability in patient outcomes, our study aimed to determine the prognostic significance of post-interventional contrast staining in BAO stroke cases.MethodsWe included BAO patients who received postinterventional non-contrast CT within 24 h after EVT. Expert radiologists confirmed the presence of contrast staining on CT, and its volume was quantified. Functional outcomes were assessed on the modified Rankin scale (mRS) at 90 days, and an unfavorable outcome was defined as an mRS score of ≥4. A multivariable LASSO-penalized logistic regression analysis was performed to determine the association between contrast staining and other clinical and imaging parameters with functional outcomes.ResultsA total of 42 patients met the inclusion criteria (15 women, 35.7%). Contrast staining on postinterventional CT was present in 18 patients (42.9%) with a median [interquartile range / IQR] volume of 7.9 mL [3.7–14.6]. Patients with contrast staining had worse outcomes, with higher mRS scores at 90 days (median [IQR]: 6 [4–6] vs. 2 [1–4], p < 0.001). A multivariable LASSO analysis revealed a significant association of contrast staining with clinical outcome.ConclusionContrast staining on postinterventional CT after EVT for BAO is a strong predictor of unfavorable functional outcomes, outperforming other pre- and post-interventional imaging parameters.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1830391</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1830391</link>
        <title><![CDATA[Subtype-specific effects of clonal hematopoiesis on cerebrovascular and cardiometabolic disease risk]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Wenqiang Zhu</author><author>Miao Tian</author><author>Zihan Zhao</author><author>Xiaoquan Rao</author>
        <description><![CDATA[BackgroundCerebrovascular and related cardiometabolic diseases frequently cluster in aging populations characterized by metabolic dysfunction and chronic inflammation. Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as an age-related modifier associated with inflammation, metabolic disturbance, and vascular risk. However, whether CHIP exerts subtype-specific effects on cerebrovascular outcomes within a broader cardiometabolic context remains incompletely understood.ObjectivesThis study aimed to investigate the causal associations of CHIP and its major genetic subtypes with cerebrovascular and cardiovascular diseases, while examining cancer outcomes as broader systemic context.MethodsWe performed Mendelian randomization analyses of overall CHIP and its five subtypes (DNMT3A, TET2, JAK2, TP53, and ASXL1) in relation to 20 cerebrovascular and cardiovascular diseases and 19 site-specific cancers. Complementary in vitro experiments were conducted to validate the biological contribution of the key subtype under inflammatory and metabolic stress conditions.ResultsGenetically predicted CHIP showed marked heterogeneity across cerebrovascular and cardiovascular outcomes. Among the CHIP subtypes, TET2-CHIP showed the clearest cerebrovascular signal, with significant associations with ischemic stroke, intracerebral hemorrhage, and hypertension. ASXL1-CHIP also showed directional risk elevations for intracerebral hemorrhage and hypertension. In contrast, JAK2-CHIP exhibited inverse associations with intracerebral hemorrhage and atrial fibrillation, whereas DNMT3A-CHIP was positively associated with atrial fibrillation and inversely associated with abdominal aortic aneurysm. Cancer analyses showed additional subtype-specific associations across disease outcomes. Experimental studies further showed that TET2 deficiency promoted macrophage lipid accumulation and inflammatory activation and induced endothelial dysfunction, supporting the biological relevance of the cerebrovascular and cardiometabolic associations.ConclusionsCHIP is associated with subtype-specific patterns of cerebrovascular risk within a broader cardiometabolic context. TET2-CHIP showed the most consistent associations with cerebrovascular outcomes. The marked heterogeneity across CHIP subtypes indicates that clonal hematopoiesis should not be considered a uniform exposure, but rather a mutation-defined condition with distinct clinical consequences.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1836134</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1836134</link>
        <title><![CDATA[Long-term LDL cholesterol burden and stroke: mechanistic insights and emerging strategies for personalized lipid management]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Zhuanfang Li</author><author>Lan Ye</author><author>Jie Li</author><author>Yinping Wang</author><author>Jun Yang</author>
        <description><![CDATA[Low-density lipoprotein cholesterol (LDL-C) is a causal and modifiable driver of atherosclerotic cardiovascular disease and an important contributor to atherosclerotic ischemic stroke. Increasing evidence suggests that cumulative LDL-C exposure—the combined effect of LDL-C magnitude and duration over time—captures vascular injury more accurately than a single measurement obtained at one clinical encounter. This review uses cumulative LDL-C exposure as an organizing framework for stroke prevention. We summarize current approaches to quantifying long-term LDL-C burden, review epidemiological evidence linking cumulative exposure to incident and recurrent ischemic stroke, and discuss biological mechanisms that may explain these associations. We then examine how lipid-lowering therapies, including statins, PCSK9 inhibitors, and small-interfering RNA-based agents, may reduce cumulative vascular injury. Particular attention is paid to the clinical challenge of balancing ischemic benefit against potential hemorrhagic vulnerability in selected high-risk phenotypes, such as patients with probable cerebral amyloid angiopathy or multiple lobar cerebral microbleeds. We propose a precision-management framework that integrates longitudinal lipid exposure, stroke subtype, genetics, neuroimaging, and dynamic risk assessment. By shifting attention from static lipid values to lifelong exposure, cumulative LDL-C burden may offer a more coherent basis for individualized cerebrovascular prevention.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1773854</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1773854</link>
        <title><![CDATA[Muscle energy techniques for post-stroke spasticity: mechanisms and clinical applications]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Lifeng Qian</author><author>Yanbo Shi</author><author>Wen Liu</author><author>Qing Yao</author>
        <description><![CDATA[Spasticity is a common and disabling complication after stroke, often leading to progressive joint stiffness, restricted movement, and reduced functional independence. Current management strategies for post-stroke spasticity (PSS) are limited by inconsistent efficacy and a lack of standardized protocols. Muscle energy techniques (MET) have emerged as a promising non-invasive approach, though their mechanisms and clinical value in PSS remain poorly understood. This review summarizes available evidence on MET for PSS based on systematic searches of PubMed, Web of Science, CNKI, and WanFang up to November 2025. MET may alleviate PSS through two main routes, namely inhibiting spinal and cortical motor neuron excitability and modulating pain pathways, though the evidence for these mechanisms remains limited and comes mainly from experimental studies. Key clinical studies indicate that MET can reduce muscle tone, improve range of motion, and enhance functional outcomes, with particularly notable effects on upper limb spasticity. However, heterogeneity in treatment protocols and a shortage of high-quality trials limit the strength of current conclusions. We further discussed critical limitations, including the reliance on active patient participation, which may preclude its use in persons with stroke with significant cognitive or motor deficits. Future directions include standardizing treatment protocols and integrating MET with emerging technologies such as biofeedback and brain-computer interfaces. This review offers a mechanistic and clinical framework to support the evidence-based integration of MET into PSS rehabilitation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1820699</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1820699</link>
        <title><![CDATA[Development and internal validation of a clinical prediction model for 1-year recurrence after first-ever ischemic stroke]]></title>
        <pubdate>2026-04-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>DaYing Fan</author><author>LinHai Zhang</author><author>Rui Miao</author><author>MingLan Zhu</author><author>Cai Li</author><author>RenLi Deng</author><author>Hao Huang</author>
        <description><![CDATA[ObjectiveIschemic stroke (IS) recurrence remains a major contributor to poor prognosis, particularly within the 1 year after the index event. This study aimed to develop and internally validate a clinical prediction model for estimating the risk of 1-year recurrence after first-ever IS using routinely available admission data.MethodsWe conducted a retrospective cohort study including consecutive patients with first-ever IS admitted to a tertiary hospital in China between January and December 2021. The primary outcome was IS recurrence within 1 year after discharge. Missing predictor data were handled using multiple imputation by chained equations. A multivariable logistic regression model was developed in the full cohort using six predictors: National Institutes of Health Stroke Scale (NIHSS) score, age, admission systolic blood pressure, uric acid, apolipoprotein A1, and neutrophil percentage. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), bootstrap internal validation with 1,000 resamples, calibration intercept, calibration slope, Brier score, and decision curve analysis.ResultsAmong 738 eligible patients, 96 (13.0%) experienced IS recurrence within 1 year. Higher NIHSS score, older age, higher uric acid, and higher neutrophil percentage were associated with increased recurrence risk, whereas higher apolipoprotein A1 was associated with reduced risk. Admission systolic blood pressure showed a borderline association with recurrence risk. The model demonstrated moderate discrimination, with an apparent AUC of 0.764 (95% CI 0.710–0.819). Bootstrap internal validation yielded an optimism-corrected AUC of 0.750. The bootstrap-corrected calibration intercept, calibration slope, and Brier score were 0.0058, 0.9354, and 0.0981, respectively. Decision curve analysis showed greater net benefit than the treat-all and treat-none strategies across most threshold probabilities from 0.05 to 0.60.ConclusionWe developed and internally validated a six-predictor clinical prediction model for 1-year recurrence after first-ever IS using routinely available admission variables. The model showed moderate discrimination and acceptable calibration after bootstrap correction. It may serve as a preliminary tool for risk stratification, but external validation is required before routine clinical application.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1779666</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1779666</link>
        <title><![CDATA[Neutrophil extracellular traps in retrieved thrombi and functional outcome after stroke thrombectomy]]></title>
        <pubdate>2026-04-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Lizhang Chen</author><author>Fayun Hu</author><author>Hongbo Zheng</author><author>Yanbo Li</author><author>Li He</author>
        <description><![CDATA[ObjectiveTo investigate the association between neutrophil extracellular traps (NETs) content in retrieved thrombi and 90-day functional outcomes in patients with acute ischemic stroke (AIS) secondary to anterior circulation large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT).MethodsThis retrospective study analyzed data from a prospectively maintained cohort of 129 consecutive AIS patients who underwent MT at West China Hospital between January 2023 and October 2024. Retrieved thrombi were stained for citrullinated histone H3 (CitH3) and myeloperoxidase (MPO) using immunofluorescence, and the percentage of positive area was quantified to represent NETs content (% area). Patients were dichotomized into high-NETs and low-NETs groups based on an optimal cutoff determined by receiver operating characteristic (ROC) curve analysis for predicting poor outcome (modified Rankin Scale [mRS] score 3–6). The primary endpoint was functional independence (mRS 0–2) at 90 days. Multivariable logistic regression was employed to identify independent predictors of outcome.ResultsThe ROC analysis yielded an AUC of 0.644. The optimal cutoff value of defining high NETs content was 2.01%. Among 129 patients (mean age 67.9 years, 48.8% male), 88 (68.2%) were in the high-NETs group. Baseline characteristics were largely comparable, though the high-NETs group had significantly higher admission blood glucose (7.9 vs. 6.7 mmol/L, p = 0.009) and a greater prevalence of atrial fibrillation (65.9% vs. 36.6%, p = 0.002). Despite achieving similarly high rates of successful recanalization (mTICI 2b-3) in both groups (96.6% vs. 97.6%, p = 0.99), patients in the high-NETs group had a significantly lower rate of 90-day functional independence (35.2% vs. 68.3%, p < 0.001). After adjusting for confounding variables, high thrombus NETs content remained a robust independent predictor of a lower likelihood of achieving a good outcome (adjusted Odds Ratio [aOR] = 0.60, 95% CI 0.43–0.84, p = 0.003), along with higher baseline NIHSS (aOR = 0.90, 95% CI 0.84–0.97, p = 0.007) and an increased number of retrieval attempts (aOR = 0.66, 95% CI 0.46–0.96, p = 0.028).ConclusionQuantitative assessment of NETs in retrieved thrombi may serve as an accessible biomarker to identify patients at high risk of poor functional recovery despite successful recanalization. However, the predictive performance was only moderate (ROC AUC = 0.644). Moreover, infarct core volume was not assessed and thus not incorporated into the statistical models, which may limit interpretation and generalizability. Prospective multicenter validation and studies incorporating infarct core volume are warranted, together with exploration of NET-targeted adjunctive therapies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1806643</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1806643</link>
        <title><![CDATA[Endovascular therapy versus standard medical treatment for vertebrobasilar artery occlusion: a systematic review and meta-analysis]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Qifan Zhang</author><author>Qing Zhao</author><author>He He</author><author>Kuang Yan</author><author>Jiarui Liu</author><author>Shunda Liu</author><author>Zhimin Shi</author><author>Aihua Liu</author>
        <description><![CDATA[BackgroundAcute vertebrobasilar artery occlusion (VBAO) is a devastating condition with high mortality and severe disability. Recent randomized controlled trials (RCTs) have significantly demonstrated that endovascular therapy is highly effective for VBAO, but its effectiveness for broader and real-world patient populations remains uncertain. This review aims to systematically evaluate the efficacy and safety of endovascular therapy for VBAO, integrating evidence from both RCTs and real-world data.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library from January 2000 to July 2025 for RCTs and observational cohort studies comparing endovascular therapy with standard medical treatment in patients with VBAO. Our primary outcome was 90-day favourable functional status, defined as a modified Rankin Scale score of 0 to 3. Secondary outcomes included functional independence (90-day modified Rankin Scale score of 0–2). Safety outcomes were symptomatic intracranial haemorrhage and 90-day mortality.ResultsA total of 15 studies were included in the analysis, consisting of 4 RCTs (n = 988) and 11 observational cohort studies (n = 7,521). Compared with SMT, EVT was associated with a significantly higher likelihood of a favorable functional outcome (mRS score 0–3: OR = 1.92; 95%CI 1.51–2.43) and functional independence (mRS score 0–2: OR = 1.76; 95%CI 1.39–2.23), and a significantly lower risk of 90-day all-cause mortality (OR = 0.58; 95%CI 0.49–0.68). However, endovascular therapy increased the risk of symptomatic intracranial hemorrhage (OR = 2.57, 95%CI 1.31–5.06). Subgroup analyses showed that EVT was beneficial in patients with NIHSS ≥10, PC-ASPECTS <8, and onset-to-admission time >6 h (all p < 0.05). However, the treatment benefit was not significant in several subgroups, including elderly patients (≥75 years), those with mild deficits (NIHSS<10), distal basilar occlusion, and patients who received intravenous thrombolysis.ConclusionThis integrated analysis confirms endovascular therapy as a cornerstone treatment for acute vertebrobasilar artery occlusion, demonstrating significant improvements in functional outcomes and mortality despite increased symptomatic intracranial hemorrhage risk.Systematic review registrationhttps://inplasy.com/projects/, identifier INPLASY202590088.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1800093</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1800093</link>
        <title><![CDATA[Spatiotemporal patterns and future trends of global ischemic stroke burden]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ruojing Zhang</author><author>Wenjun Chen</author><author>Mingjin Zhu</author><author>Yufei Xu</author>
        <description><![CDATA[BackgroundIschemic stroke remains a leading cause of morbidity and mortality worldwide, with substantial heterogeneity across regions, sexes, age groups, and levels of socioeconomic development. Previous studies have described global trends; however, integrated analyses combining long-term spatiotemporal patterns, sociodemographic stratification, and future projections remain limited.MethodsData on ischemic stroke from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database, covering 204 countries and territories. Age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs) were analyzed by age, sex, region, and sociodemographic index (SDI). Temporal trends were assessed using estimated annual percentage change (EAPC). Future disease burden from 2022 to 2041 was projected using autoregressive integrated moving average (ARIMA) models implemented with the R package forecast (version 8.24.0).ResultsGlobally, from 1990 to 2021, age-standardized incidence declined from 109.79 to 92.39 per 100,000 (EAPC = −0.67), mortality from 73.15 to 44.18 per 100,000 (EAPC = −1.83), and DALYs from 1286.31 to 837.36 per 100,000 (EAPC = −1.59), whereas prevalence showed only a modest decrease (EAPC = −0.18). Marked disparities were observed across SDI levels: middle SDI regions experienced increasing prevalence (EAPC = 0.27) and incidence (EAPC = 0.12), while high SDI regions demonstrated the most pronounced reductions in mortality and DALYs. Eastern Europe, East Asia, and Southern Sub-Saharan Africa remained high-burden regions. Pronounced sex- and age-specific patterns were identified, with men exhibiting earlier peak incidence (65–79 years) and women showing later and shifting peak prevalence toward older age groups. Projections indicate that by 2041, global age-standardized prevalence will increase by approximately 15.3%, driven primarily by a substantial rise among females (from 769.40 to 1005.77 per 100,000), despite continued declines in mortality and DALYs.ConclusionThis comprehensive spatiotemporal analysis reveals a paradoxical pattern of increasing ischemic stroke prevalence amid declining mortality and disability, with widening sex- and SDI-related disparities. By integrating long-term trends with sex-specific future projections, this study provides novel evidence to inform targeted prevention strategies, gender-sensitive interventions, and context-specific health policy planning to mitigate the evolving global burden of ischemic stroke.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1738335</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1738335</link>
        <title><![CDATA[Hormonal and laboratory predictors of patent foramen ovale in cryptogenic ischemic events: a SHAP-enhanced logistic regression approach]]></title>
        <pubdate>2026-04-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yao Zheng</author><author>Zhihui Wang</author><author>Hongli Pan</author><author>Xin Wang</author><author>Dan Li</author><author>Qi Suo</author>
        <description><![CDATA[BackgroundPatent foramen ovale (PFO) is associated with cryptogenic ischemic events. Detection relies on advanced imaging modalities, yet early detection tools remain limited.MethodsWe developed a predictive model for PFO detection in cryptogenic stroke/TIA patients using clinical and laboratory data. This retrospective study included 300 female patients (18–65 years) with cryptogenic ischemic events (TOAST criteria) who underwent contrast-enhanced transcranial Doppler and echocardiography for PFO assessment. Forty-three variables were analyzed, with LASSO and mRMR feature selection identifying five key predictors: age, estradiol, follicle-stimulating hormone (FSH), D-dimer, and LDL cholesterol. Nine machine learning models were evaluated, with logistic regression selected as the final model. Performance was assessed via AUC, accuracy, sensitivity, specificity, F1 score, and decision curve analysis. SHAP analysis explained feature contributions. We also conducted a prespecified subgroup analysis by reproductive stage (reproductive-age 22–45 years vs. menopausal 45–65 years) to account for stage-related hormonal differences.ResultsAmong 300 female patients, 60 (20%) were PFO-positive. PFO carriers were younger (46.8 vs. 53.9 years, p < 0.001) with higher estradiol (94.1 vs. 60.3 pg./mL, p < 0.001) and D-dimer (2.1 vs. 1.2 mg/L, p < 0.001). The logistic regression model achieved an AUC of 0.990, accuracy of 95.6%, sensitivity of 89.5%, and specificity of 97.2%. SHAP analysis highlighted estradiol, D-dimer, and age as top predictors. Findings were consistent across reproductive-stage strata: estradiol and FSH remained differentiating markers (all p < 0.05), and the model maintained strong discrimination in both groups (AUC 0.988 in reproductive-age; 0.982 in menopausal).ConclusionAn interpretable, high-performing model can aid early PFO risk stratification in females; performance was robust across reproductive-age and menopausal strata, and external validation especially in larger female cohorts is warranted. Our model does not assess causality but aims to help clinicians identify those who are most likely to have a PFO, which can then be further investigated to determine the causal role of PFO in the ischemic event.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1666960</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1666960</link>
        <title><![CDATA[Building a SHAP interpretable prediction model for stroke-associated pneumonia [stroke-associated pneumonia (SAP)] in patients with aneurysmal subarachnoid hemorrhage (aSAH)]]></title>
        <pubdate>2026-04-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yuqi Zhang</author><author>Mingjian Lin</author><author>Yun-Xiang Zhou</author><author>Xiaoyong Lin</author><author>Yingcong Wei</author><author>Bo Li</author><author>Jintang Li</author><author>Honghai Luo</author><author>Yifan Deng</author><author>Zhongzong Qin</author><author>Gang Zhu</author>
        <description><![CDATA[BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is a neurological emergency characterized by intracranial aneurysm rupture, leading to blood influx into the subarachnoid space and imposing high mortality and disability rates. The aim of this study was combining the epidemiological characteristics of aSAH and the high incidence of stroke-associated pneumonia (SAP), we aimed to develop a SHAP-explainable prediction model that may provide clinical reference value, providing a new approach to reduce the burden of complications. We take the random forest (RF) model combined with SHAP interpretation as the primary predictive model, and the logistic regression-based nomogram as a supplementary transparent tool for clinical bedside application.MethodsA retrospective analysis was conducted in aSAH patients at Huizhou Central People’s Hospital. The patients were randomly split into training and validation sets for methodological purposes to generate and validate a SHAP interpretable machine learning model.ResultsA total of 375 patients were initially enrolled, with 85 excluded due to exclusion criteria, leaving 290 patients for retrospective analysis. Univariate logistic regression, LASSO regression, and Boruta algorithm were used for multivariable feature selection and the common factors across the three methods were lactate dehydrogenase (LDH, SIRI, BMI, Age, AST, D-Dimer, and Hunt–Hess score). We established a nomogram model with good predictive performance, low error rate, and significant clinical benefits. The RF model showed stable performance and good efficacy in both training and validation sets. Based on the RF model, SHAP analysis was conducted to evaluate risk factor importance and individual impacts. The RF model with SHAP interpretation was identified as the primary predictive model, while the nomogram served as a supplementary transparent tool.ConclusionThis study identifies postoperative stroke-associated pneumonia [stroke-associated pneumonia (SAP)] within 14 days after endovascular embolization BMI, Age, SIRI, Hunt–Hess score, D-Dimer, AST, and lactate dehydrogenase LDH as key predictors of postoperative stroke-associated pneumonia (SAP) in aSAH, and demonstrates the efficient performance of the RF random forest model (with SHAP interpretation) in prediction.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1810149</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1810149</link>
        <title><![CDATA[Stroke progression index as a dynamic metric is associated with functional outcome in progressive ischemic stroke with large vessel occlusion]]></title>
        <pubdate>2026-04-16T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Bang Liu</author><author>Qishuo Yang</author><author>Ning Han</author><author>Kuochang Yin</author><author>Liang Ma</author><author>Wentao Yao</author><author>Qiang Sun</author><author>Yanzhao Xie</author><author>Guodong Xu</author>
        <description><![CDATA[ObjectiveCurrent evaluation of progressive ischemic stroke (PIS) with large vessel occlusion (LVO) relies on static clinical or imaging measures and lacks quantitative assessment of dynamic neurological deterioration. We proposed a novel metric, stroke progression index (SPI), to assess its association with clinical outcomes and benefit from endovascular treatment (EVT), and to explore its potential clinical relevance.MethodsWe retrospectively enrolled consecutive LVO-PIS patients treated at our center between January 2022 and June 2025, limited to those with large-artery atherosclerosis. SPI was derived from National Institutes of Health Stroke Scale (NIHSS) change and progression time using a mathematically adjusted ratio. The primary endpoint was poor outcome at 90 days (mRS 3–6). We analyzed the association between SPI and outcomes, evaluated the effect of EVT, and explored relationships between SPI and disease course–related factors.ResultsAmong 190 patients, 44.2% (84/190) had a poor 90-day outcome, and 63.2% (120/190) received EVT. Regression analysis identified SPI as an independent risk factor for poor outcome (OR 1.223, 95% CI 1.100–1.360; p < 0.001). Adding SPI to a baseline model with traditional clinical variables improved discrimination (AUC 0.654 to 0.757; DeLong p < 0.001). In the EVT subgroup, SPI remained an independent risk factor (OR 1.134; 95% CI 1.018–1.263; p = 0.023). In treatment-effect analyses, lower SPI was associated with greater absolute benefit from EVT. Absolute risk reduction (ARR) was approximately 30% at SPI ≈11 and 10% at SPI ≈ 20. Exploratory analyses showed overall higher SPI in early than delayed progression, with poor outcomes being more common in patients with high SPI and poor collateral status.ConclusionSPI is an independent prognostic risk factor in LVO-PIS that captures disease dynamics. The benefit of EVT varied across different SPI levels, suggesting that SPI may help inform clinical decision-making. These findings require further validation in larger, multicenter studies.]]></description>
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