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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>2026-05-05T21:06:15.310+00:00</pubDate>
        <ttl>60</ttl>
        <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.2026.1786103</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>
      </item><item>
        <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>
      </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>
      </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.2026.1804177</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.2026.1721769</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.2026.1819703</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.2026.1807072</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.2026.1796559</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.2026.1829539</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.2026.1711050</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.2026.1836134</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.2026.1830391</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.2026.1801372</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.2026.1815354</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.2026.1820699</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>
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