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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>2026-05-09T17:58:48.483+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1808174</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1808174</link>
        <title><![CDATA[Beyond the coagulopathy phenotype in cancer-associated stroke: routine radiology report-based phenotyping and a practical diagnostic prioritization]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Shinsuke Muraoka</author><author>Kaito Kimura</author><author>Issei Takeuchi</author><author>Shunsaku Goto</author><author>Masahiro Nishihori</author><author>Takashi Izumi</author><author>Ryuta Saito</author>
        <description><![CDATA[BackgroundCancer-related ischemic stroke is commonly suspected when diffusion-weighted imaging (DWI) shows multi-territory infarction with markedly elevated D-dimer. However, the prevalence and clinical relevance of non-coagulopathy phenotypes in patients with active cancer are not well defined.MethodsWe retrospectively studied consecutive ischemic stroke admissions undergoing MRI-DWI at a single center. Active cancer was defined as diagnosis or treatment within 6 months, or metastatic/recurrent disease. Infarct distribution (multi- vs. single-territory) was classified from official routine radiology reports by board-certified radiologists blinded to outcomes. We compared D-dimer across groups defined by cancer status and DWI distribution and examined predictors of multi-territory infarction within the active-cancer cohort using multivariable logistic regression.ResultsAmong patients with active cancer (n = 182), 25.3% (46/182) had multi-territory infarction and 74.7% (136/182) had single-territory infarction. D-dimer was higher in active-cancer patients with multi-territory infarction (median 6.8 μg/mL; IQR 1.3–14.2) than in active-cancer patients with single-territory infarction (median 1.2 μg/mL; IQR 0.5–3.3) and in non-cancer stroke groups (p < 0.001). Each doubling of D-dimer was independently associated with multi-territory infarction (adjusted OR 1.62; 95% CI 1.33–1.98).ConclusionsRoutine report-based phenotyping indicates that the classic coagulopathy phenotype is a strong marker but represents a minority of strokes with active cancer. When multi-territory infarction accompanies elevated D-dimer, evaluation should prioritize malignancy activity, systemic thrombosis/coagulopathy, and non-bacterial thrombotic endocarditis; otherwise, a mechanism-oriented stroke work-up should be maintained, with attention to cancer treatment– and radiation-related vascular injury.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1810507</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1810507</link>
        <title><![CDATA[Associations of intracranial arterial stenosis and cerebral small vessel diseases with acute ischemic lesions in spontaneous intracerebral hemorrhage]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yutong Hou</author><author>Shuna Yang</author><author>Yue Li</author><author>Wenli Hu</author><author>Lei Yang</author>
        <description><![CDATA[Background and purposeCerebral small vessel disease (CSVD) has been declared to diffusion-weighted imaging (DWI) lesions in patients with intracerebral hemorrhage (ICH). The impact of large vessel stenosis on stroke remains uncertain. Therefore, this study examines the relationship between CSVD, intracranial arterial stenosis (ICAS), and DWI lesions in patients with ICH.MethodA consecutive cohort of 541 patients with spontaneous ICH who had brain MRI and MRA within 14 days of ICH onset was collected and analyzed retrospectively. DWI lesions as well as CSVD were assessed in MRI, and the severity of ICAS was evaluated in MRA. We compared the demographic and clinical features, laboratory parameters, and imaging characteristics of patients with and without DWI lesions and explored the associations of burdens of CSVD and ICAS with DWI lesions in ICH patients using multivariate logistic regression models.ResultsOf the 541 patients enrolled, 137 (25.3%) presented with DWI lesions. Severe total CSVD burden was significantly associated with DWI lesions (OR 3.56, 95% CI 2.22–5.72, p < 0.001), and a six-point modified CSVD score (OR 4.66, 95% CI 2.86–7.61, p < 0.001) enhanced the prediction of DWI lesions in patients with ICH. Moderate to severe ICAS (OR 2.27, 95% CI 1.39–3.77, p = 0.019) was associated with DWI lesions, which became more significant when moderate to severe ICAS coexisted with moderate total CSVD burden (OR 4.44, 95% CI 1.85–10.69, p = 0.001). Nevertheless, moderate ICAS without CSVD was not linked to DWI lesions in ICH patients.ConclusionPatients with severe CSVD burden are associated with DWI lesions in ICH patients, with a significant correlation also observed between ICAS and DWI lesions. The probability of DWI lesions increases when both ICAS and CSVD are present, suggesting a potential novel association for the development of these lesions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1757307</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1757307</link>
        <title><![CDATA[Critical role of accompanying authorized surrogates among the multifactorial determinants of in-hospital delays in patients with acute stroke]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Haoyu Wang</author><author>Wei Ni</author><author>Yao Chen</author><author>Haifang Yu</author><author>Yarong He</author>
        <description><![CDATA[BackgroundDespite the widespread establishment of stroke centers, delays in pre-hospital and in-hospital care persist. To date, no studies have investigated the role of accompanying authorized surrogates in early emergency care timelines and the outcomes of acute stroke. This study aimed to analyze the influence of types of surrogate decision-maker on critical time intervals and early clinical outcomes.MethodsThis retrospective cohort study was conducted in patients with acute stroke or those with suspected stroke admitted to a stroke center. The correlation between the type of accompanying authorized surrogate at patient admission and both early in-hospital emergency timelines [medical order, computed tomography (CT) imaging and emergency treatment times] and early prognosis (neurological outcome, incidence of adverse events) was analyzed using statistical methods, including univariate and multivariate regression analysis.ResultsA total of 508 patients were managed via the stroke fast-track; among these, 414 were diagnosed with acute stroke. The type of accompanying authorized surrogate significantly influenced all in-hospital treatment time metrics. Patients without a surrogate decision-maker experienced significantly longer orders, CT imaging, and emergency treatment times than those with a surrogate (p < 0.05). Notably, patients whose colleague or friend was the surrogate decision-maker had the shortest in-hospital emergency treatment time (p < 0.05). Patients who sought medical care alone had the shortest length of hospital stay, lowest incidence of adverse events, and best neurofunctional outcomes.ConclusionEarly in-hospital delays in patients with acute stroke are multifactorial. The presence and type of accompanying authorized surrogates have a considerable effect on in-hospital emergency treatment time for acute stroke. However, the type of accompanying authorized surrogate showed a weak correlation with early prognosis in patients with acute stroke.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1821579</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1821579</link>
        <title><![CDATA[Symptomatic stratification based on morphological features of carotid web (SCORE-WEB)]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sávio Batista</author><author>Mateus Damiani Monteiro</author><author>Fadi Nahab</author><author>Pedro Nascimento Martins</author><author>Jaydevsinh N. Dolia</author><author>Theja Yelam</author><author>Michael Frankel</author><author>John Oshinski</author><author>Ghada A. Mohamed</author><author>Jason Allen</author><author>Diogo C. Haussen</author>
        <description><![CDATA[IntroductionCarotid web (CaW) is an underrecognized variant of fibromuscular disease increasingly implicated in cryptogenic ischemic stroke. Several morphologic features, including lesion length, proximal angulation, and pocket size, have been associated with symptomatic presentation. However, no pragmatic prediction score has been validated to stratify asymptomatic patients.MethodsWe performed a cross-sectional analysis of a prospectively maintained database of CaW cases collected between 2014 and July 2025 at two comprehensive stroke centers. Lesions were classified as symptomatic if associated with stroke or TIA involving the lesion vascular territory, and as asymptomatic if incidentally detected. Morphologic parameters extracted from computed tomography angiography (CTA) included pre-web angle, pocket area, lesion length, carotid bulb and distal cervical internal carotid caliber. A multivariable logistic regression model was developed, and a simplified score (SCORE-WEB) was derived based on cutoffs across these variables. Discriminative performance was assessed through ROC curves.ResultsA total of 126 CaW were analyzed, including 80 symptomatic and 46 asymptomatic cases (30 incidental and 16 contralateral to a symptomatic CaW). Symptomatic lesions had more acute pre-web angles, larger pocket areas, and greater distal cervical internal carotid and bulb calibers compared with asymptomatic lesions, while substantial overlap in web length was observed. The multivariable logistic regression model demonstrated good discriminative performance for symptomatic presentation (AUC 0.803). The simplified SCORE-WEB (ranging from 0–11) achieved an AUC of 0.824. The Youden Index (J = 0.51) identified an optimal cutoff of ≥7 points, yielding a sensitivity of 0.54, specificity 0.97, positive predictive value 97.4%, and negative predictive value 44.4%.ConclusionThe constellation of distinct morphological features appear to collectively and significantly determine the symptomatic status of CaW. The simplified SCORE-WEB, derived from five anatomical parameters, showed good discrimination and potential practical applicability. These findings warrant validation in larger and prospective datasets. The role of clinical variables in enhancing predictive performance merits further investigation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1792925</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1792925</link>
        <title><![CDATA[PFO closure in ischemic stroke: insights from a single-center real-world cohort]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Felix Müller</author><author>Arda Civelek</author><author>Luis Weitbrecht</author><author>Lukas Badura</author><author>Kai Helge Schmidt</author><author>Florian Schlotter</author><author>Philipp Lurz</author><author>Stavros V. Konstantinides</author><author>Karsten Keller</author><author>Klaus Gröschel</author><author>Marianne Hahn</author><author>Timo Uphaus</author>
        <description><![CDATA[BackgroundIndications for patent foramen ovale (PFO) closure after ischemic stroke are primarily guided by the Risk of Paradoxical Embolism (RoPE) score and the PFO-associated Stroke Causal Likelihood Classification (PASCAL). Their application in routine care, however, is not well characterized. This study describes real-world management of patients with PFO presenting with ischemic stroke or transient ischemic attack (TIA). TIA cases were included to reflect clinical practice but are interpreted descriptively, as PFO closure is not guideline-supported after TIA alone. As a secondary aim, the “Age, Stroke Severity (NIHSS >5) to Find AF” (AS5F) score was explored for atrial fibrillation (AF) risk assessment.MethodsThis retrospective single-center study included consecutive patients with ischemic stroke or TIA and PFO treated at the University Medical Centre Mainz (2015–2022). TIA was defined clinically by symptom resolution within 24 h due to inconsistent MRI availability. Follow-up was performed via standardized telephone interviews ≥12 months after the index event. Subgroup analyses compared patients by PFO closure status, AF diagnosis, recurrent ischemic events, and age ≥60 years.ResultsAmong 188 patients, 62 underwent PFO closure. These patients were younger, had fewer cardiovascular risk factors, and more often exhibited embolic PFO features (PASCAL). The RoPE score was higher in the closure group (6.0 ± 1.7 vs. 4.1 ± 1.5; p < 0.001). The AS5F score was lower in closure patients but higher in those with AF (p < 0.001). In patients ≥60 years, higher AS5F scores were associated with AF (cut-off 3.8; p = 0.026). Despite greater comorbidity, over half of patients with recurrent events remained classified as cryptogenic.ConclusionThese findings reflect real-world decision-making in PFO-associated stroke and highlight limitations of score-based approaches. While RoPE and PASCAL remain central, structured AF risk assessment may provide additional value, particularly in older patients. The high rate of cryptogenic recurrence suggests that the role of PFO may be underestimated in clinical practice. Given the moderate sample size, especially in elderly patients, these results should be considered exploratory and hypothesis-generating.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1788829</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1788829</link>
        <title><![CDATA[Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: a systematic review]]></title>
        <pubdate>2026-05-07T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Johanna C. M. Schilder</author><author>Maurits H. J. Hoonhorst</author><author>Ralph de Vries</author><author>Gert Kwakkel</author>
        <description><![CDATA[BackgroundProspective prognostic studies examining transcranial magnetic stimulation-induced motor evoked potentials (TMS-MEP) as predictors of upper limb (UL) motor function and capacity following stroke are influenced by variations in TMS procedures, outcome measures, and the timing of assessments. This prognostic review investigated three key areas: 1) the technical and methodological quality of TMS-MEP studies; 2) the prognostic accuracy for outcome related to muscle strength, muscle synergies and UL-capacity; and 3) the influence of the timing of TMS-MEP on outcomes.MethodsWith the QUAPAS (Quality Assessment of Prognostic Accuracy Studies) tool and Chipchase checklist the risk of bias (RoB) and technical quality of TMS-MEP studies were assessed, respectively. Sensitivity, specificity, negative predicted values (NPV), and positive predicted values (PPV) were analyzed for muscle strength, muscle synergies, and UL-capacity.ResultsSixteen prospective TMS-MEP studies were included, all of which showed low RoB. Three studies reported all the recommended technical items for TMS testing. After pooling the data, muscle strength showed a sensitivity of 0.76 (95% CI: 0.64–0.85), specificity of 0.96 (95% CI: 0.55–1.00), PPV of 0.96 (95% CI: 0.85–0.99) and NPV of 0.62 (95% CI: 0.43–0.78). For muscle synergies, sensitivity was 0.70 (95% CI: 0.57–0.81), specificity was 0.98 (95% CI: 0.65–1.00), PPV was 0.98 (95% CI: 0.54–1.00) and NPV was 0.69 (95% CI: 0.42–0.87). For UL-capacity, the sensitivity was 0.84 (95% CI: 0.76–0.89), specificity was 0.91 (95% CI: 0.78–0.96), positive predictive value (PPV) was 0.91 (95% CI: 0.79–0.97), and negative predictive value (NPV) was 0.81 (95% CI: 0.65–0.91). No significant differences in accuracy were observed between type of outcome measures (i.e., muscle strength, muscle synergies or UL-capacity) and no differences were found between groups application of TMS-MEP before or beyond the seventh day after stroke onset.ConclusionTMS-MEP accurately predicts favorable UL-motor recovery regarding muscle strength, muscle synergy, and UL-capacity. However, its accuracy in identifying individuals who do not regain UL motor function and capacity remains limited early post-stroke.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1658764</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1658764</link>
        <title><![CDATA[A double-blind randomized control trial of transcranial direct current stimulation in post-stroke fatigue]]></title>
        <pubdate>2026-05-07T00:00:00Z</pubdate>
        <category>Clinical Trial</category>
        <author>Wai Kwong Tang</author><author>Hanna Lu</author><author>Thomas Wai Hong Leung</author><author>Kenneth Nai Kuen Fong</author><author>Selina Kit Yi Chan</author><author>Vivien Wei Jun Liew</author>
        <description><![CDATA[RationalePost-stroke fatigue (PSF) is an issue among stroke survivors that often impedes their rehabilitation progress. Treating PSF is challenging, and pharmacological interventions often prove ineffective.AimsThe aim of this study was to examine the effect of tDCS on PSF.Sample sizeThirty-four participants aged 30 to 80 with chronic stroke were recruited and randomly assigned to one of two groups, with 17 participants in each group.Methods and designThis study was a double-blind randomized controlled trial. The sham group received sham tDCS, while the treatment group received active tDCS. The active tDCS treatment consisted of applying a constant 2-mA current through a 5 cm × 5 cm anodal electrode placed over the C3 or C4 positions (motor cortex) of the contralateral hemisphere of the scalp, with the cathodal electrode placed on the ipsilateral arm. The participants received two 20-min sessions of this treatment, separated by a 10-min interval, each day for 5 consecutive days. Sham tDCS involved the same setup but with only 30 s of constant current at the beginning and end of each 20-min session. Follow-up assessments were conducted over an 8-week period. The effects of tDCS were calibrated using an analysis of covariance approach, with baseline Modified Fatigue Impact Scale (MFIS) scores, age, and education as covariates. The inclusion criteria were (1) either sex; (2) age 30–80 years; (3) prior stroke diagnosis verified through brain imaging (computed tomography scan/magnetic resonance imaging); (4) Chinese ethnicity and Cantonese proficiency; (5) willingness and ability to provide informed consent; (6) presence of PSF (Fatigue Severity Scale score ≥ 4.0); and (7) at least 6 months post-stroke.Study outcomeThe primary outcome was the change in fatigue severity, assessed using the MFIS.ResultsOne participant in the sham group dropped out. After the intervention, no significant changes were observed in MFIS scores at any of the follow-up timepoints (p > 0.05).ConclusionWe found no evidence that the use of tDCS improves PSF. Further research is needed to explore the potential of this non-invasive brain stimulation method for the treatment of PSF.Clinical trial registrationhttps://clinicaltrials.gov/, identifier NCT04238260; https://www.chictr.org.cn/, identifier ChiCTR2100052515.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1833721</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1833721</link>
        <title><![CDATA[Commentary: Preliminary comparison of efficacy and safety between direct bypass surgery and endovascular recanalization therapy in adult ischemic moyamoya disease]]></title>
        <pubdate>2026-05-07T00:00:00Z</pubdate>
        <category>General Commentary</category>
        <author>Hao Chen</author><author>Yichun Zou</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1834657</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1834657</link>
        <title><![CDATA[Blood pressure variability plays a critical role in determining the prognosis of acute ischemic stroke combined with hypertension]]></title>
        <pubdate>2026-05-05T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Keqiong Yan</author><author>Lan Ye</author><author>Mei Wu</author><author>Jun Yang</author>
        <description><![CDATA[BackgroundIndividuals with hypertension exhibit high blood pressure variability (BPV), which is associated with an increased risk of acute ischemic stroke (AIS) and poor post-stroke outcomes. Therefore, managing BPV may help reduce the incidence of AIS and improve patient prognosis.AimThis prospective cohort study investigated the effects of BPV regulation on the prognosis of patients with AIS and hypertension, using modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores as primary outcomes to inform individualized treatment strategies.MethodsPatients with AIS from December 2021 to June 2024 were included in the study and divided into two groups based on systolic BPV (SBPV) measured more than 24 h after symptom onset: the control group (SBPV 10–20%) and the observation group (SBPV outside 10–20%). The observation group received antihypertensive regimen adjustments based on 24-h ambulatory blood pressure monitoring (ABPM) during hospitalization, and the group was subsequently stratified into Groups 1 and 2 according to the improvement in SBPV assessed at the two-week outpatient follow-up after the intervention. Additionally, modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores were collected during the acute phase and again after 90 days.ResultsA total of 75 patients were included. The observation group had higher acute-phase diastolic BPV (p < 0.05) and worse 90-day mRS and NIHSS scores (p < 0.05) than the control group. Despite similar baseline scores within the observation group, patients with improved SBPV (Group 1) showed better 90-day outcomes than those without improvement (Group 2) (p < 0.05).ConclusionDespite the small sample, our findings suggest that BPV may serve as a prognostic marker for functional outcomes in AIS. Tailored antihypertensive therapy aimed at reducing BPV showed a preliminary association with improved patient prognosis.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1804177</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1804177</link>
        <title><![CDATA[Transition to tenecteplase is associated with shorter door-to-puncture times: a retrospective study from the Lone Star Stroke consortium TNK registry]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Anqi Luo</author><author>Sujani Bandela</author><author>Gretchel Gealogo-Brown</author><author>Mark P. Goldberg</author><author>Andrew Slusher</author><author>Reza Behrouz</author><author>Alibay Jafarli</author><author>Siddarth Prasad</author><author>DaiWai Olson</author><author>Maria Denbow</author><author>Mehari Gebreyohanns</author><author>Asmiet Techan</author><author>Chethan P. Venkatasubba Rao</author><author>Jane A. Anderson</author><author>Barbara Kimmel</author><author>Anette Ovalle</author><author>Michele Patterson</author><author>Sean I. Savitz</author><author>Salvador Cruz-Flores</author><author>Steven Warach</author><author>Lee Birnbaum</author>
        <description><![CDATA[BackgroundIntravenous thrombolytic (IVT) and mechanical thrombectomy (MT) therapies are the current standard of care for large vessel occlusion (LVO) stroke. Multiple studies emphasized the impact of time metrics on patient outcomes, particularly door-to-needle (DTN) and door-to-puncture (DTP) times. Tenecteplase (TNK) offers potential advantages over alteplase (ALT), including a simplified one-time bolus administration, which may reduce DTP time. Results suggest TNK is non-inferior to ALT in terms of clinical outcomes, but few large cohort studies have compared DTP time for patients receiving TNK vs. ALT prior to thrombectomy. This real-world study aimed to compare DTP times and discharge outcomes in patients treated with TNK vs. ALT before thrombectomy.MethodsRetrospective data were collected from three comprehensive stroke centers (CSCs) in Texas from October 2019 to November 2024 and included subjects that received both IVT and MT. Data were analyzed for DTP times and other time metrics.ResultsAmong 50 ALT and 89 TNK patients in our study cohort, the TNK group had significantly shorter DTP times of 80 min (62–96) compared to ALT times of 101.5 min (80–121), P < 0.001. No significant differences were found for door-to-imaging and imaging-to-needle times; however, needle-to-puncture times were significantly shorter with TNK 39 min (29–51) compared to ALT 55 min (43–77), P < 0.001. Both groups had similar favorable outcomes at discharge.ConclusionsOur Lone Star Stroke (LSS) TNK registry represents the real-world experience of academic CSCs in Texas. We demonstrated that transitioning to TNK is associated with shorter DTP times compared to ALT. These results are primarily due to shorter needle-to-puncture times and may be attributable to TNK's simplified single-bolus administration. Both TNK and ALT groups demonstrated high rates of favorable outcomes at discharge, but given its faster DTP time, TNK is likely a preferable option for LVO stroke patients requiring both IVT and MT.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1817627</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1817627</link>
        <title><![CDATA[Cardiometabolic index and modified cardiometabolic index are associated with early neurological deterioration in patients with acute ischemic stroke]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Li Xu</author><author>Fan Liu</author><author>Xiaoran Zhang</author><author>Zhe Xie</author><author>Wenwei Zou</author><author>Mengchao Wang</author><author>Zhongwen Zhi</author><author>Yufeng Liu</author><author>Liandong Zhao</author>
        <description><![CDATA[BackgroundEarly neurological deterioration (END) in patients with acute ischemic stroke (AIS) leads to a poor prognosis. Previous studies suggest a high risk of END associated with obesity and metabolic abnormalities. The primary aim of this study was to determine if cardiometabolic index (CMI) and modified CMI (MCMI) are linked to END in patients with AIS.MethodsThis study retrospectively included 563 patients with AIS who had not received reperfusion therapy. Among the participants, 215 (38.2%) were female, with a median age of 69 years (interquartile range: 60–75) and a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 2 (interquartile range: 1–3). According to the TOAST classification, 317 cases (56.3%) were identified as large artery atherosclerosis, 58 cases (10.3%) as cardioembolism, and 188 cases (33.4%) as small-artery occlusion. Patients were classified as experiencing END if their total NIHSS score increased by ≥ 2 points or the motor NIHSS score increased by ≥ 1 point within the first 72 h following admission. Multivariate Logistic regression was used to evaluate whether CMI and MCMI were independently associated with the occurrence of END in AIS patients. Restricted cubic spline (RCS) regression analyzed the nonlinear relationship between CMI, MCMI, and END. Additionally, subgroup analyses were conducted to evaluate the applicability of the findings in different populations.ResultsA total of 123 subjects were identified as having combined END during hospitalization. The CMI and MCMI levels in the END group were significantly elevated compared to the non-END group (p < 0.001). Multivariate logistic regression analysis indicated that both high-level CMI and MCMI, when treated as categorical or continuous variables, are independent risk factors for END in AIS patients (all p < 0.05). Moreover, subgroup analysis showed that this association was stable in different populations (all p for interaction >0.05). The RCS curve showed nonlinear associations between CMI (p for nonlinear = 0.048), MCMI (p for nonlinear <0.001) and END. The areas under the curves of CMI and MCMI were 0.643 (95% Confidence interval (CI): 0.601–0.682) and 0.665 (95%CI: 0.625–0.704), respectively.ConclusionOur study showed that CMI and MCMI at admission were independently associated with END in AIS patients, which could be helpful for early risk stratification of stroke patients.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1773323</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1773323</link>
        <title><![CDATA[Association of uric acid levels with the risk of severe CED in LVO-AIS patients after mechanical thrombectomy]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mayila Abuduaini</author><author>Xinli Xiong</author><author>Gang Li</author><author>Tianrui Zhu</author><author>Yaling Zheng</author><author>Qi Wang</author><author>Zhengyu Huang</author><author>Yue Zhang</author>
        <description><![CDATA[ObjectivesCerebral edema (CED) significantly exacerbates mortality in patients with acute ischemic stroke (AIS) and can offset the benefits of endovascular therapy. Uric acid (UA) is recognized for its potential neuroprotective properties. This study aimed to investigate the association between serum UA levels and moderate-to-severe CED in large-vessel occlusion (LVO-AIS) patients following mechanical thrombectomy (MT).MethodsWe retrospectively analyzed 272 patients with anterior circulation LVO-AIS who achieved successful reperfusion (mTICI grade 2b-3) after MT. Patients were categorized into mild and moderate-to-severe CED groups, Multivariate logistic regression and interaction analyses were employed to determine the relationship between UA levels and the risk of moderate-to-severe CED.ResultsPatients in the no-to-mild CED group exhibited significantly higher UA levels compared to the moderate-to-severe CED group (median 310.0 vs. 302.0 μmol/L; p < 0.05). After adjusting for confounders (hypertension history, NIHSS, TICI, and ASPECT scores), higher UA levels were inversely correlated with moderate-to-severe CED risk (adjusted OR: 0.74; 95% CI: 0.56–0.99; p = 0.044). Interaction analysis revealed that this protective effect was more pronounced in patients with lower admission blood glucose (<7.5 mmol/L), higher mTICI grades (grade 3), and a history of hypertension (all P-interaction<0.06). Specifically, among patients with glucose<7.5 mmol/L, those with UA ≥ 360 μmol/L had a 76% lower risk of moderate-to-severe CED (aOR: 0.24; 95% CI: 0.09–0.69; p = 0.033).ConclusionHigher serum UA levels may serve as a protective factor against moderate-to-severe CED following MT in LVO-AIS patients. This association is particularly significant in patients with lower glucose levels, optimal reperfusion (mTICI 3), and a history of hypertension.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1823316</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1823316</link>
        <title><![CDATA[Efficacy and safety of tirofiban for acute ischemic stroke without large and medium vessel occlusion: a systematic review and meta-analysis]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Jiaqi Jiao</author><author>Jiawei Zhang</author><author>Xuehui Lan</author><author>Junhong Guo</author><author>Shaoshuai Wang</author>
        <description><![CDATA[BackgroundEarly and effective intervention is crucial in the management of acute ischemic stroke (AIS) without large- or medium-vessel occlusion (non-LVO/MVO), which accounts for approximately 60–70% of all AIS cases. Tirofiban has been investigated as a therapeutic option for non-LVO/MVO AIS. However, existing studies have reported inconsistent findings regarding its efficacy and safety, and high-level evidence derived from large-scale pooled analyses remains lacking.AimsThis study aimed to conduct a systematic review and meta-analysis to assess the efficacy and safety of tirofiban in patients with non-LVO/MVO AIS, and to further explore the influence of intravenous thrombolysis (IVT) status and study design on treatment outcomes.Summary of reviewPubMed, Web of Science, Embase, and the Cochrane Library were systematically searched from inception to December 2025. Eligible studies included patients with non-LVO/MVO AIS, compared tirofiban with conventional antiplatelet therapy, and reported original data on functional or safety outcomes. The primary efficacy outcomes were excellent functional outcome at 90 days (modified Rankin Scale [mRS] score 0–1) and favorable functional outcome (mRS score 0–2). Safety outcomes included symptomatic intracerebral hemorrhage (sICH), 90-day mortality, and peripheral bleeding. Subgroup analyses were conducted according to IVT status and study design. A total of 1,678 records were identified, of which nine studies met the inclusion criteria, encompassing 3,225 patients. Tirofiban was associated with a significantly higher likelihood of achieving a 90-day excellent functional outcome (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.34–2.06; p < 0.001; I2 = 26%) and favorable functional outcome (OR 1.79, 95% CI 1.30–2.47; p < 0.001; I2 = 58%). Regarding safety, tirofiban did not significantly increase the risk of sICH (OR 4.02, 95% CI 0.91–17.70; p = 0.07; I2 = 5%) or 90-day mortality (OR 1.06, 95% CI 0.53–2.12; p = 0.87; I2 = 37%). However, it was associated with a significantly higher risk of peripheral bleeding (OR 1.87, 95% CI 1.32–2.66; p < 0.001; I2 = 0%). Subgroup analyses demonstrated tirofiban conferred significant functional benefits exclusively in non-IVT patients, whereas no such improvement was observed in patients with prior IVT. However, particularly robust and homogeneous effects observed in the randomized controlled trial (RCT) subgroup (I2 = 0% for mRS 0–1).ConclusionTirofiban significantly improves 90-day functional outcomes in patients with non-LVO/MVO acute ischemic stroke, with primarily observed in patients without prior IVT. The clinical utility of adding tirofiban post-IVT remains unproven. Although its use was not associated with an increased risk of severe bleeding or mortality, the higher incidence of peripheral bleeding warrants careful monitoring in clinical practice.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneur.2026.1786103</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneur.2026.1786103</link>
        <title><![CDATA[Effectiveness of transcutaneous auricular vagus nerve stimulation in stroke rehabilitation: a systematic review and meta-analysis of randomized clinical trials]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Shuaijing Wan</author><author>Xiaolu Liu</author><author>Wenjing Jiang</author><author>Zesen Li</author><author>Zhexuan Yan</author><author>Weibo Li</author><author>Yu Yin</author>
        <description><![CDATA[Background and aimTranscutaneous auricular vagus nerve stimulation (taVNS) has demonstrated potential efficacy in post-stroke functional recovery. This study aimed to systematically synthesize data evaluating the effects of taVNS in terms of improving motor function, mental health, and activities of daily living (ADL) in patients experiencing stroke following intervention.MethodsElectronic databases including EMBASE, Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP were searched from their inception to September 2025. All randomized controlled trials that applied taVNS to patients experiencing stroke were included.ResultsTen randomized controlled trials (RCTs) involving 512 patients were included in the analysis. The results showed that compared with the control group, the taVNS group demonstrated significantly increased motor function scores [standardized mean difference (SMD) = 1.21; 95% CI: 0.88–1.55; p < 0.001], significantly improved mental health scores (SMD = 0.84, 95% CI: 1.19,–0.49; p < 0.001), significantly increased scores in ADL (SMD = 0.94; 95% CI: 0.72–1.17; p < 0.001), and significantly different neurophysiological indicators (SMD = 1.60, 95% CI: 0.70–2.51; p = 0.0005). Subgroup analysis revealed superior outcomes in patients with stroke who received 20 Hz taVNS with ≥10 sessions.ConclusiontaVNS improves motor function, mental health, and ADL outcomes in patients experiencing stroke. The combination of taVNS stimulation frequency, current intensity, and intervention duration constitutes a key modulator influencing treatment efficacy.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42025633212, identifier PROSPERO (CRD42025633212).]]></description>
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        <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.2026.1819703</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>
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        <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>
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        <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>
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        <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>
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        <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>
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