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        <title>Frontiers in Stroke | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/stroke</link>
        <description>RSS Feed for Frontiers in Stroke | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-10-28T05:37:38.246+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1981787</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1981787</link>
        <title><![CDATA[Extending telestroke to broader teleneurology in sparsely populated regions: real-world experience from a German network]]></title>
        <pubdate>2026-10-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Maike Kern</author><author>Tim Bastian Braemswig</author><author>Stephan Kinze</author><author>Malgorzata Kotlarz-Böttcher</author><author>Heinrich J. Audebert</author><author>Janina R. Behrens</author>
        <description><![CDATA[IntroductionTelestroke networks provide established infrastructure for specialist neurological care in rural regions, but their real-world use beyond stroke remains insufficiently characterized. We aimed to describe the diagnostic spectrum of acute teleconsultations within a comprehensive teleneurology network in sparsely populated and structurally underserved regions of Northeast Germany and to explore factors associated with the distribution of diagnoses.MethodsWe conducted a retrospective observational analysis of acute teleneurological consultations performed within the ANNOTeM network at 12 continuously participating hospitals between January 2023 and December 2024. Consultations were classified into seven predefined diagnostic categories. Diagnostic distribution was analyzed descriptively; univariable binary and exploratory multinomial logistic regression models were used to examine associations with patient-, hospital-, and regional-level characteristics.ResultsOf 4,697 consultations, 4,207 had a single diagnostic category. Suspected stroke accounted for 60.0%, whereas 40.0% concerned non-stroke presentations, reaching 48.3% at individual hospitals (range 30.8–48.3%). More than 70% of non-stroke cases received another neurological diagnosis rather than a non-neurological diagnosis. Median patient age was 70 years. Increasing age was significantly associated with neurological diagnosis (OR per 10 years 1.09, 95% CI 1.04–1.15; p < 0.001) and suspected stroke (OR 1.42, 95% CI 1.38–1.48; p < 0.001). A higher regional proportion of residents aged 60–80 years was significantly associated with neurological diagnosis (OR 1.04, 95% CI 1.00–1.07; p = 0.039). A higher density of neurology-related outpatient specialists was significantly associated with a lower relative likelihood of another neurological diagnosis compared with suspected stroke (OR 0.94, 95% CI 0.89–0.98; p = 0.008).DiscussionOverall, these findings demonstrate that our network, built on an established telestroke infrastructure, is frequently used for comprehensive acute teleneurology in routine clinical care. The substantial non-stroke workload, consisting mostly of neurological diagnoses, together with its associations with demographic structure and specialist availability, highlights the growing relevance of comprehensive teleneurology in aging and underserved regions. Existing telestroke networks may therefore provide a practical platform for bridging geographical and temporal gaps in neurological specialist care beyond stroke.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1917036</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1917036</link>
        <title><![CDATA[Registry-recorded stroke and transient ischaemic attack diagnoses in Saudi Arabia, 2016–2025: a national descriptive analysis]]></title>
        <pubdate>2026-10-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Aisha M. Alshehri</author><author>Mohammed AlJawadi</author><author>Abdulrahman M. Alsheikh</author><author>Malak E. Aloufi</author><author>Yahya A. AlMazni</author><author>Abrar M. Alasmari</author><author>Amani O. Al Fadhli</author><author>Meral M. Homoud</author><author>Wasaal I. Alquaydhib</author><author>Omar A. Alsuhaibani</author><author>Sarah F. Almuqati</author><author>Shatha M. Alshaibi</author><author>Abdulaziz M. Eskandarani</author><author>Fatima Y. Al Slail</author><author>Mubarak Aldawsari</author><author>Muaddi F. Alharbi</author><author>Mariam M. AlEissa</author><author>Shaker A. Alomary</author><author>Abdullah Assiri</author><author>Mohammed AlAbdulali</author>
        <description><![CDATA[BackgroundStroke is a major cause of death and disability globally, and its prevalence is growing as modifiable risk factors become more prevalent and the population ages. In Saudi Arabia, evidence is mainly from hospital or local data, and national descriptions of cerebrovascular diagnoses recorded in routinely collected health data remain limited in Saudi Arabia.ObjectiveThis study aimed to describe the cumulative registry-recorded burden of adults with a qualifying stroke-related or transient ischemic attack (TIA) diagnosis in the Population Health Observatory (PHO) in Saudi Arabia, using linked national health data from 2016 to 2025. This includes the registry-recorded burden, demographics and characteristics, comorbidities and healthcare utilization.MethodsWe conducted a national retrospective descriptive analysis of de-identified aggregate outputs from linked PHO data for 2016–2025, a descriptive statistical analysis of 68,634 stroke-diagnosed individuals in the Kingdom of Saudi Arabia. The observational study was conducted using PHO data from 2016 to 2025.ResultsThe PHO identified 68,634 unique adults with a qualifying cerebrovascular diagnosis. Stroke burden was disproportionately concentrated in males (64.45%) and in both genders aged 60–69 years (23.27%). The accumulated count corresponded to 0.26% of the 2025 adult population; this is a crude descriptive ratio, not prevalence. Najran had the highest crude regional ratio at 0.38%. BMI was missing/invalid for 39,481 (57.52%). Among 29,153 with valid BMI, 10,494 (36.00%) were overweight and 9,930 (34.06%) were obese. The PHO low-multimorbidity category contained 42,882 individuals (62.48%); it is an administrative stratum, not a validated cardiovascular-risk score; most visits were to outpatient departments.ConclusionSaudi Arabia's recorded stroke burden is concentrated among older males. The findings describe patterns captured by the PHO and should not be interpreted as prevalence, incidence, or causal associations, which indicate the need for better prevention, management of chronic diseases and a robust national surveillance system to inform policies based on evidence to support Saudi Vision 2030.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1946997</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1946997</link>
        <title><![CDATA[Barriers to intravenous thrombolysis in acute ischemic stroke: a retrospective case report series from Honduras]]></title>
        <pubdate>2026-10-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jesús Antonio Rodríguez Santos</author><author>Iván Pineda</author><author>Eliezer Cardona</author><author>Carlos Maradiaga</author><author>Juan Galeano</author><author>Laura Giacaman</author><author>Selvin Z. Reyes-Garcia</author>
        <description><![CDATA[Background and purposeIntravenous (IV) thrombolysis for acute ischemic stroke (AIS) is time-dependent and frequently underused in resource-limited settings. We aimed to characterize patients with AIS who did not receive IV thrombolysis at a national referral center in Honduras and to document the barriers to treatment.MethodsWe conducted a retrospective, single-center, consecutive case report series of all eligible patients with AIS who were not thrombolyzed at Hospital Escuela Universitario between 1 October and 30 November 2025. We gathered demographics, socioeconomic status, admission severity, process-of-care intervals, contraindications, neuroimaging and thrombolytic availability, complications, and discharge outcomes. Contraindications were classified as absolute or relative according to the 2019 American Heart Association and American Stroke Association (AHA/ASA) guidelines. A thrombolysis eligibility cascade was the principal analysis. The study was approved by the institutional review board.ResultsA total of 23 patients were included (median age 70 years; 14 [60.9%] male). Extreme poverty (≥2 unsatisfied basic needs [UBN]) was present in 14 patients (60.9%). All 23 AIS presentations screened during the period were included, and no patient received thrombolysis (institutional thrombolysis rate 0%). The median onset-to-door time was 10.0 h (IQR 7.0–15.0), and only 1 of 22 patients with a recorded time (4.5%) arrived within 4.5 h. Late or unknown onset was the most frequent absolute contraindication (21 [91.3%]); neuroimaging was available in 22 (95.7%) patients, but the thrombolytic agent was unavailable in every patient (availability 0%). In the eligibility cascade, the single patient within the window had no absolute contraindication and could not be treated because no thrombolytic agent was available. The in-hospital mortality rate was 2 (8.7%), and a good functional outcome (modified Rankin Scale [mRS] score 0–2) occurred in 5 of 20 patients with an assessable score.ConclusionNon-administration of thrombolysis reflected late presentation and, above all, the complete unavailability of the thrombolytic agent, whereas imaging and organizational capacity were largely in place. Drug supply was the proximate, modifiable obstacle to reperfusion in this setting.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1952839</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1952839</link>
        <title><![CDATA[Case Report: Flossing intervention for chronic upper limb spasticity after childhood-onset stroke]]></title>
        <pubdate>2026-09-30T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Shuichi Sasaki</author><author>Naonobu Takahira</author><author>Yuzo Ono</author><author>Keiichiro Aoki</author><author>Sora Kurosaki</author><author>Marina Moteki</author><author>Risa Fujita</author><author>Tomonori Kenmoku</author>
        <description><![CDATA[BackgroundUpper limb spastic paralysis after stroke often limits functional use of the affected hand and restricts activities of daily living, particularly in cases with long-standing impairment following childhood-onset stroke. Although various interventions for spasticity have been reported, many require specialized equipment or invasive procedures, which may limit long-term and home-based use. Flossing intervention, which involves compressive wrapping with an elastic band combined with movement, has recently been introduced in musculoskeletal practice; however, its application for post-stroke spasticity remains unclear.Case presentationAn adolescent girl in her teens (female, Asian) presented with long-standing right upper limb spastic paralysis following childhood-onset cerebral infarction associated with moyamoya disease. At baseline, she demonstrated marked distal spasticity, limited active wrist extension, and restricted functional use of the affected hand. A flossing intervention was applied to the distal forearm and elbow region, consisting of compressive wrapping followed by passive twisting and active movements. The intervention was performed both in outpatient therapy and as a home-based program. After 6 months of continuous intervention, Modified Ashworth Scale scores decreased, upper limb motor function assessed using the Fugl–Meyer Assessment improved, and real-world use of the affected hand assessed using the Motor Activity Log increased. Active wrist extension range of motion improved from −20° to 40°, and functional bilateral hand use, including button fastening, became possible. The patient reported improved ease of hand movement and high satisfaction, and functional gains were maintained during follow-up.ConclusionsThis case suggests that flossing intervention may be a feasible, non-invasive, and home-based treatment option for improving upper limb function in patients with long-standing post-stroke spastic paralysis following childhood-onset stroke. Further studies are required to clarify its efficacy and appropriate indications.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1908099</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1908099</link>
        <title><![CDATA[A prospective study evaluating clopidogrel resistance among patients with ischemic cerebrovascular events across different ethnic groups in Israel]]></title>
        <pubdate>2026-09-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Fadi Shbat</author><author>Karine Beiruti Wiegler</author><author>Najib Dally</author><author>Elias Saad</author><author>Saher Srour</author><author>Elizabeth Eshel</author><author>Adi Sharabi Nov</author><author>Radi Shahien</author><author>Ronen Leker</author><author>Naaem Simaan</author>
        <description><![CDATA[IntroductionClopidogrel is commonly used for secondary prevention after ischemic cerebrovascular events, but substantial interindividual variability in pharmacodynamics response has been reported. Individuals demonstrating resistance to clopidogrel face a higher likelihood of recurrent ischemic events. This study evaluated clopidogrel responsiveness among Jewish and Arab patients treated within the same regional healthcare setting.MethodsThis prospective cohort included 102 patients with ischemic cerebrovascular events (acute ischemic stroke or transient ischemic attack) receiving clopidogrel for secondary prevention. Patients received either a loading dose (300 in 62 patients, 600 mg in 1 patient) followed by maintenance therapy or at least 7 days of 75 mg daily maintenance dosing (n = 39) prior to blood sampling. Platelet responsiveness was measured using the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay (PLT VASP/P2Y12, BioCytex, France). Patients were categorized according to VASP platelet reactivity index (PRI) as adequate responders (PRI <50%), intermediate responders (PRI 50%−69%), or patients with high residual platelet reactivity, operationally defined in this study as PRI ≥70%.ResultsThe study included 102 enrolled patients, of whom 57 (55.9%) were Jewish and 45 (44.1%) were Arab. A valid VASP-PRI measurement was available for 101 patients (57 Jewish and 44 Arab); one Arab patient had no evaluable PRI measurement. Therefore, analyses of platelet reactivity were based on 101 patients The median PRI for all patients was 65.5 (49.1–80.3), with no statistically significant differences between Jewish and Arab (p = 0.251). Overall, 42.6% were classified as non-responders, 29.7% as partial responders, and only 27.7% demonstrated adequate platelet inhibition. Jewish patients were significantly older than Arab patients (p = 0.008), whereas Arab patients had a significantly higher BMI (p = 0.019). Other demographic and clinical features were similar across groups.ConclusionsA high proportion of patients demonstrated elevated residual platelet reactivity according to the operational PRI threshold used in this study. No statistically significant ethnic difference in PRI was detected; however, the ethnic comparison was exploratory and the study was not powered to exclude modest between-group differences. Larger prospective studies incorporating CYP2C19 genotyping and longitudinal clinical outcomes are warranted.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1894659</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1894659</link>
        <title><![CDATA[Electrophysiological signature of stroke recovery: investigating EEG biomarkers for prognostic insights]]></title>
        <pubdate>2026-09-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Majid Khalili-Ardali</author><author>Vivek Sharma</author><author>Tarandeep Singh Mandahar</author><author>Francisco Páscoa dos Santos</author><author>Paul Tiesinga</author><author>Nick Ramsey</author>
        <description><![CDATA[IntroductionStroke is a leading cause of long-term disability, often resulting in persistent motor impairments that reflect disruptions in large-scale brain networks. An integrated framework capturing spatiotemporal EEG dynamics would help clarify how these networks change during recovery.MethodsWe analysed resting-state EEG from stroke patients at 1 week (Session 1) and three months (Session 2) post-stroke to investigate electrophysiological biomarkers of motor recovery, indexed by change in the Fugl-Meyer scale (ΔFM). We quantified relative alpha-band power, microstate metrics (mean duration, complexity, and transition probabilities), and measures of metastability and synchrony derived from the Kuramoto Order Parameter.Results:sChange in relative alpha power emerged as the strongest single correlate of motor improvement, accounting for the largest proportion of variance among the EEG measures examined. Metastability and synchrony did not individually reach statistical significance but showed moderate positive correlations with ΔFM, particularly in the alpha and theta bands, and added 26% explained variance in ΔFM when combined with alpha power. Microstate parameters did not explain additional variance once alpha power and network-level dynamics were accounted for. A hierarchical model combining alpha power, metastability/synchrony, and microstates explained over 78% of the variance in ΔFM.DiscussionThese findings indicate that stroke recovery involves restoring balanced alpha oscillations and flexible large-scale brain coordination. Larger samples and more frequent longitudinal assessments are required to confirm the prognostic utility of integrated EEG biomarkers for guiding personalised stroke rehabilitation strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1946990</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1946990</link>
        <title><![CDATA[Sex differences in risk factors, stroke etiology, treatment characteristics, and outcomes after endovascular treatment for anterior circulation ischemic stroke]]></title>
        <pubdate>2026-09-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Marieta Peycheva</author><author>Charlotte Berger</author><author>Marino Costa</author><author>Lee Siegenthaler</author><author>Fiona Huber</author><author>Ismaël Rizzo</author><author>Marina Krasteva</author><author>Morin Beyeler</author><author>Tatiana Bremova-Ertl</author><author>Nedelina Slavova</author><author>Pasquale Mordasini</author><author>Roza M. Umarova</author><author>Philipp Bücke</author><author>Kateryna Antonenko</author><author>Angelika Hoffmann</author><author>Sara Pilgram-Pastor</author><author>Mirjam R. Heldner</author>
        <description><![CDATA[Background and aimsSex-specific differences in vascular risk factors, stroke etiology, and outcomes after endovascular treatment (EVT) remain uncertain. We investigated these differences in a contemporary single-center cohort.MethodsConsecutive patients with acute anterior circulation ischemic stroke undergoing EVT (with-/out intravenous thrombolysis) between February 2015 and March 2023 were included. Sex differences in risk factors, treatment, successful reperfusion, and 3-month outcomes (mRS ≤ 1, ≤ 2, and mortality) were examined; multivariable models included interactions with age, stroke etiology, and bridging therapy.ResultsAmong 1,764 patients (median age 76 years, 48% women), women were older (79.4 vs. 73.3 years, p < 0.001) and more often had atrial fibrillation and chronic kidney disease, while men more frequently had coronary heart disease, diabetes, and smoking history. Cardioembolic stroke was more common in women, whereas large artery atherosclerosis was more frequent in men. Successful reperfusion rates did not differ by sex (overall: 86.2%, p = 0.084). At 3 months, men were more likely to achieve favorable functional outcome (mRS ≤ 2: 47.6% vs. 37.5%, p < 0.001) and excellent functional outcome (mRS ≤ 1: 31.4% vs. 25.6%, p = 0.008), while mortality was higher in women (31.9 vs. 24.9%, p = 0.001). Female sex was not independently associated with successful reperfusion (aOR: 0.79; 95%CI: 0.60–1.06), favorable outcome (0.88; 0.69–1.11), excellent outcome (0.93; 0.73–1.19), or mortality (1.06; 0.83–1.35). A sex-by-age interaction was observed for favorable outcome (p interaction = 0.006), with no evidence of interaction by stroke etiology or bridging therapy.ConclusionWomen and men differ in risk profiles, stroke mechanisms, and unadjusted outcomes after EVT. However, sex was not independently associated with outcomes overall, although age may modify its association with favorable functional outcome.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1850977</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1850977</link>
        <title><![CDATA[Outpatient occupational therapy access for rural stroke survivors: barriers as perceived by therapists]]></title>
        <pubdate>2026-09-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Emily A. Stevens</author><author>Lexie J. Pfeifer</author><author>Matt P. Malcolm</author>
        <description><![CDATA[AimIdentify occupational therapist (OTs) perceived barriers to occupational therapy (OT) access for rural stroke survivors as well as barriers in stroke specific training of therapists.MethodsAn electronic gap analysis survey was developed and distributed via email.ResultsTwenty-six OTs responded. Responses were analyzed utilizing descriptive statistics and summarization of comments. Therapist-perceived barriers included: family/caregiver support, distance to clinic, insurance coverage, health literacy, roles and responsibilities, financial, and transportation. The primary barrier in treating rural stroke survivors identified by OTs was lack of appropriate clinic equipment for neuro-specific interventions.ConclusionsFurther research is needed in a larger sample size to explore the extent to which therapist-perceived barriers agree with the stroke survivor's perspective and facilitate solutions to overcome them.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1978900</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1978900</link>
        <title><![CDATA[Editorial: Stroke research in the elderly: addressing ageism and prognostication]]></title>
        <pubdate>2026-09-22T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Hipólito Nzwalo</author><author>Miguel Barboza</author><author>Nicola Logallo</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1890618</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1890618</link>
        <title><![CDATA[Reframing moyamoya vasculopathy within steno-occlusive disease of the circle of Willis]]></title>
        <pubdate>2026-09-21T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Takahiro Ota</author>
        <description><![CDATA[Moyamoya disease (MMD) is classically defined by progressive steno-occlusion of the terminal internal carotid artery (ICA) with associated basal collateral networks. Historically, however, this condition was conceptualized in Japan as part of a broader anatomical category—steno-occlusive disease of the circle of Willis (SOCW)—which preceded disease-specific nomenclature. Increasing genetic, developmental, and clinical evidence now challenges the strict separation between MMD and moyamoya syndrome (MMS). In this narrative review, we re-examine moyamoya-related conditions within a unified, location-defined framework and propose three advances: (1) an operational definition of SOCW with explicit anatomical boundaries; (2) a spectrum-based classification distinguishing phenotype from etiologic context; and (3) a refined, location-based multi-hit model integrating developmental vulnerability, genetic susceptibility, and acquired triggers. Historical analysis indicates that SOCW was originally defined as an anatomical category, within which moyamoya vasculopathy (MMV) represents the predominant but non-exclusive angiographic phenotype. Genetic studies identify RNF213 as a major susceptibility modifier influencing phenotypic expression and population prevalence, although substantial ethnic heterogeneity and incomplete penetrance indicate that RNF213 is neither necessary nor sufficient for disease development. Additional genetic and environmental factors may further influence disease expression. Developmental factors may contribute to the characteristic localization of disease, although current evidence remains indirect. This SOCW-based framework provides a structured approach to intracranial steno-occlusive disorders, facilitates interpretation of early or atypical presentations, and supports multimodal and longitudinal assessment rather than rigid categorical labeling. By integrating anatomical, genetic, and clinical dimensions, this model offers a pragmatic and biologically grounded basis for future research and refinement of disease classification.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1916617</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1916617</link>
        <title><![CDATA[The Quindío stroke network: impact of an integrated care model on mortality and functional outcomes in a middle-income country]]></title>
        <pubdate>2026-09-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Laura Sofía García-Espinosa</author><author>Ángel Basilio Corredor-Quintero</author><author>Ricardo Andrés Lineros-Franco</author><author>Adriana Hernández-Cardona</author><author>Ivett Natalia Loaiza-Giraldo</author><author>Felipe Torres-Gómez</author><author>Jorge Luis Igirio-Gamero</author>
        <description><![CDATA[IntroductionStroke is a major cause of death and disability worldwide, with low- and middle-income countries bearing the highest burden of this condition. To address regional shortcomings in access to reperfusion therapies-particularly thrombolysis-the Red ACV-Quindío was established as the first integrated network for stroke management in central Colombia.MethodologyThis pre-post quasi-experimental study evaluated the Red ACV-Quindío strategy. The study estimated functional outcomes and in-hospital mortality in patients diagnosed with stroke before and after the implementation of the network.ResultsThe study included a total of 841 cases. Although year-by-year variations in patient volume were detected, linear tests confirmed a homogeneous population across the study period. Baseline clinical characteristics remained stable throughout: most patients presented with minor stroke (47.1%) and low functional dependency at admission (89.0%). At discharge, overall functional independence reached 55.0% (95% CI: 51.6–58.4, p = 0.23) and was associated with favorable safety outcomes. Thrombolyzed patients demonstrated a significantly reduced risk of fatal outcomes (OR = 0.61; 95% CI: 0.38–0.96; p = 0.037). Complications were rare, with hemorrhagic transformation occurring in 4.5% of cases and malignant edema in 3.9%. In-hospital mortality showed minor fluctuations but remained under 10% overall (9.9%, p = 0.39).DiscussionThese findings suggest that regionally integrated stroke care networks represent an effective public health intervention to mitigate stroke-associated disability and mortality in resource-limited settings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1967379</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1967379</link>
        <title><![CDATA[Editorial: Distal, medium vessel occlusion stroke: epidemiology, diagnostics, treatment options, and outcome prediction]]></title>
        <pubdate>2026-09-15T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Gabriel Broocks</author><author>Panagiotis Papanagiotou</author><author>Leonard L. L. Yeo</author><author>Anil Gopinathan</author><author>Eytan Raz</author><author>Lukas Meyer</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1897859</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1897859</link>
        <title><![CDATA[Serum BDNF in subacute stroke: effects of a four-week aerobic exercise intervention in the PHYS-STROKE trial]]></title>
        <pubdate>2026-09-15T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Torsten Rackoll</author><author>Lea Doppelbauer</author><author>Konrad Neumann</author><author>Alexander Heinrich Nave</author>
        <description><![CDATA[IntroductionThe early phase after stroke is considered a period of heightened neuroplasticity and may be responsive to rehabilitation interventions targeting biological recovery. Brain-derived neurotrophic factor is one candidate mediator of post-stroke plasticity, but it remains unclear whether clinically feasible aerobic exercise induces sustained increases in circulating brain-derived neurotrophic factor after stroke.MethodsWe performed a pre-specified secondary biomarker analysis of the multicentre, randomized, endpoint-blinded Physical Fitness Training in Patients with Subacute Stroke trial. Participants were randomized to 4 weeks of moderate-intensity treadmill-based aerobic training or relaxation therapy. Serum brain-derived neurotrophic factor was assessed from baseline to 6 months post-stroke. Models were adjusted for baseline brain-derived neurotrophic factor, age, sex, stroke severity, platelet count, depressive symptoms, smoking status, and study center.ResultsAmong 200 randomized participants, serum brain-derived neurotrophic factor increased modestly from baseline to 3 months and remained stable thereafter. No relevant between-group difference was observed at 6 months after aerobic training compared with relaxation therapy (training: 24.6 ng/mL; 95% CI, 20.2–29.0 vs. relaxation: 24.3 ng/mL; 95% CI, 19.8–28.8; adjusted p = 0.74). Findings were consistent in complete-case and change-score sensitivity analyses. Exploratory analyses showed no robust treatment effect modification by depressive symptoms or intervention dose. A nominal sex-related subgroup finding should be interpreted cautiously.DiscussionModerate-intensity aerobic exercise in early subacute stroke rehabilitation was not associated with sustained serum brain-derived neurotrophic factor increases compared with relaxation therapy. These findings argue against a robust long-term peripheral neurotrophin response, while not excluding acute, higher-intensity, or subgroup-specific effects.Clinical Trial Registration[clinicaltrials.gov/study/NCT01953549], identifier [NCT01953549].]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1903852</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1903852</link>
        <title><![CDATA[Reducing onset-to-door times through the implementation of a prehospital large vessel occlusion bypass protocol: the Oahu experience]]></title>
        <pubdate>2026-09-03T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chung-Huan Sun</author><author>Ian Chun</author><author>Kazuma Nakagawa</author><author>Stacy Brown</author><author>Samuel Tsappidi</author><author>Ferdinand Hui</author><author>Yi Zhang</author><author>Rony Salem</author><author>Guangxiang Zhang</author><author>Daniel Galanis</author><author>Matthew Koenig</author>
        <description><![CDATA[BackgroundThe Oahu large vessel occlusion (LVO) bypass protocol is a real-world island-wide EMS initiative designed to identify patients with suspected LVOs in the field and triage them directly to a Comprehensive Stroke Center (CSC) for endovascular therapy (EVT).MethodsA retrospective preimplementation-postimplementation study was conducted to investigate the impact of the bypass protocol on endovascular treatment times and patient outcomes between January 1, 2017 to January 1, 2023.ResultsA total of 351 patients met inclusion criteria (102 patients pre-bypass vs. 249 patients post-bypass). In an interrupted time series analysis, there was a sustained 66-min reduction in onset-to-CSC door time (p = 0.0046), and a 41-min reduction in onset-to-reperfusion time (p = 0.08) in the post-bypass period with no changes in temporal trends. Interfacility transfers for EVT declined 5-fold (55.9% to 11.6%; p < 0.001) with no delay in onset-to-thrombolytic time (p = 0.13). In multivariate logistic regression modeling, longer onset-to-reperfusion times were independently associated with worse clinical outcomes, where every 30-min delay increased the odds of a higher 90-day mRS score by 6% (OR 1.062, 95% CI 1.001–1.125, p = 0.033). The post-bypass era, itself, however, was not associated with improved 90-day good outcomes (mRS 0–2: 40.2% vs. 44.6%; adjusted OR 0.98 [95% CI, 0.57–1.69]; p = 0.93) or a shift in 90-day mRS disability (adjusted OR 0.93 [0.60–1.41]; p = 0.72), though a nonsignificant trend toward improved 90-day excellent outcomes was observed (mRS 0–1: 23.5% vs. 34.5%; unadjusted OR 1.75 [1.01–2.90], p = 0.045; adjusted OR 1.51 [0.84–2.72], p = 0.17).ConclusionsImplementation of a system-wide EMS LVO bypass protocol successfully reduced onset-to-door and onset-to-reperfusion times within a uniquely closed catchment geography. The impact on clinical outcomes, however, remains to be seen.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1918465</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1918465</link>
        <title><![CDATA[Cardiometabolic drugs after stroke: time to embrace SGLT2 inhibitors and incretin-based therapies?]]></title>
        <pubdate>2026-08-25T00:00:00Z</pubdate>
        <category>Perspective</category>
        <author>Håkon Ihle-Hansen</author><author>Hege Ihle-Hansen</author><author>Rolf A. Blauenfeldt</author><author>Jesse Dawson</author><author>Søren Z. Diederichsen</author><author>Guri Hagberg</author>
        <description><![CDATA[Stroke is a multifactorial cardiovascular disease (CVD), which predominantly affects older adults. Consequently, cardiovascular risk factors and related comorbidities are highly prevalent among people presenting with acute stroke. These conditions, and the stroke event itself, may require specific pharmacological therapies to reduce subsequent risk. Over recent decades, two novel pharmacological drug classes, sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, which were initially developed as glucose-lowering therapies for type 2 diabetes mellitus, have been used for management of related cardiovascular conditions. These agents are not currently included in secondary stroke prevention guidelines, despite growing evidence suggesting that they may directly or indirectly improve long-term, stroke-related outcomes. It is therefore essential that the stroke community remains up-to-date with these developments while awaiting updated clinical guidelines. This will ensure optimal management of coexisting cardiovascular disease and reduce subsequent risk. In this commentary, we summarize and discuss what we consider to be the most relevant and impactful recent studies for contemporary clinical stroke practice.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1913292</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1913292</link>
        <title><![CDATA[Access to stroke rehabilitation services for patients discharged from the Mulago National Referral Hospital Neurology unit, Kampala—Uganda: a mixed-methods study]]></title>
        <pubdate>2026-08-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ronald Bwambale</author><author>Ronald Ssenyonga</author><author>Mark Kaddumukasa</author><author>Martha Sajatovic</author><author>Aggrey David Mukose</author>
        <description><![CDATA[IntroductionRehabilitation is the primary form of therapy for stroke survivors. However, there is a dearth of information regarding access to stroke rehabilitation services following discharge from hospitalization. This study, therefore, examined the level of access and experiences of accessing stroke rehabilitation services following discharge from the Mulago National Referral Hospital (MNRH) Neurology unit, Kampala, Uganda.MethodologyThis was a concurrent mixed-methods study. Quantitative data were collected using a study questionnaire from 120 participants and analyzed with STATA version 15.0. A 17-item multidimensional tool was used to measure access, and participants who scored 80% and above were categorized as having high access. Qualitative data were collected through in-depth, face-to-face interviews with six purposively selected participants and analyzed thematically using ATLAS.ti version 25.ResultsOf the 120 participants, 55.0% (66/120) were female, 55.8% (67/120) were married, and 44.2% (53/120) had attained a primary level of education. The overall mean age [Standard deviation (SD)] was 58.4 years (±14.6). Only 7.5% of the participants had high access to stroke rehabilitation services. Among the dimensions of access, acceptability scored highest (66.4%), followed by accessibility (24.3%), availability (20.6%), accommodation (15.9%), and affordability (3.7%). Key themes for experiences faced while accessing stroke rehabilitation services included transport challenges, high cost of care, adequacy of rehabilitation resources at hospitals, and organization of stroke rehabilitation services.ConclusionAccess to stroke rehabilitation services after hospital discharge remains suboptimal, with only a small proportion of patients achieving high levels of access. The high cost and limited affordability of rehabilitation care are the predominant barriers to service utilization.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1845862</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1845862</link>
        <title><![CDATA[CFAST: a simplified and culturally adapted stroke education tool for Chinese communities]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Haroon Khan</author><author>Yang Wang</author><author>Jing Chen</author><author>Xiao-Bing Xie</author><author>Wei Xu</author><author>Meng Li</author><author>Dong-Ling Huang</author><author>Jiannan Xiao</author><author>Chuan-Cheng Ren</author>
        <description><![CDATA[Background/objectivesRapid recognition of stroke symptoms in Chinese populations is poor, and improving the timely and reliable identification of patients could significantly expedite the administration of stroke therapy. This study aimed to develop and evaluate CFAST (“Zhongfeng, shuo-xiao-dong” meaning “stroke, speech, smile, move”), compare its learning efficiency, comprehension, and 1-h recall with Stroke-120, and validate its performance in a larger pragmatic cohort.MethodsPhase 1 involved a comparison of standardized community sessions using CFAST (n = 192) or Stroke-120 (n = 192). The primary outcome was 1-h recall ability post-training (0–3-point checklist). The secondary outcomes were learning efficiency (time taken to recite the mnemonic) and immediate comprehension (0–3 elements explained correctly). In Phase 2, CFAST was implemented alone among 3,688 participants.ResultsIn Phase 1, all CFAST-trained participants (192/192; 100%) mastered the mnemonic within 5 min, compared to 3.65% (7/192) in the Stroke-120 group after a 30-min training (p < 0.001). When tested for comprehension, 100% of the CFAST group accurately explained the terms “speaking,” “smiling” and “moving,” whereas only 3.65% of the Stroke-120 group correctly identified the meaning of numbers associated with stroke symptoms. Short-term retention tests showed that 100% of CFAST-trained participants could accurately recall all mnemonic elements after 1 h, compared to none in the Stroke-120 group, where only 20.31% (39/192) could recall one or two items. These results were consistently replicated in a larger CFAST cohort (n = 3,688; 100% comprehension and recall, p < 0.001).ConclusionThe newly developed CFAST mnemonic achieved superior short-term comprehension and recall compared with Stroke-120 and demonstrated scalability across communities. Our findings support its feasibility for public stroke education in Chinese populations.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1879025</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1879025</link>
        <title><![CDATA[Quality monitoring in telestroke networks: real-world insights from survey response data and literature review]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ayush Agarwal</author><author>Christine Tunkl</author><author>Alexandra Krauss</author><author>Emily R. Ramage</author><author>Mirjam R. Heldner</author><author>Stefan T. Gerner</author><author>Teresa Ullberg</author><author>Leonardo A. Carbonera</author><author>Jatinder S. Minhas</author><author>Aristeidis Katsanos</author><author>Matias J. Alet</author><author>Abdul H. K. Y. Khan</author><author>Faddi Saleh Valez</author><author>Tamer Roushdy</author><author>Linxin Li</author><author>Bogdan Ciopleias</author><author>Zhe Kang Law</author><author>Radhika Lotlikar</author><author>Susanna M. Zuurbier</author><author>Maria G. Mosconi</author><author>Shirsho Shreyan</author><author>Shakti Shrestha</author><author>Gisele S. Silva</author><author>Annemarei Ranta</author>
        <description><![CDATA[Background and aimsThe objective of telestroke services is to enhance the quality of stroke care delivered to remote locations. The American Heart Association/ American Stroke Association (AHA/ASA) and the European Stroke Organization (ESO) have issued recommendations for quality monitoring in telestroke. To provide real-world insights, our study analyzed data on quality monitoring practices among telestroke networks.MethodologyThis is a secondary analysis of a global telestroke survey previously conducted by our group. The focus of the current analysis was on reported quality metrics. We also reviewed articles from our prior systematic review (SR) of the literature on telestroke networks to extract quality metrics from published data and compared these with those reported in survey responses.ResultsEighty-eight of 254 networks responded to the survey. The SR analyzed 92 studies describing 64 acute telestroke networks across 17 countries. Quality monitoring was performed in 64 of 88 surveyed networks (72%), and it was described in all networks identified in the published literature. The most frequently reported performance indicator across both data sources was thrombolysis rate (93% in survey, 87% in SR). Other recommended indicators were reported less frequently in both the survey and the SR, with recanalization rate reported as 54% vs. 35%, discharge NIHSS as 65% vs. 1%, and in-hospital mortality as 78% vs. 31%, respectively.ConclusionOur study is the first real-world insight into the state of quality monitoring in telestroke, both from peer-reviewed literature and self-reported data. The observed heterogeneity and low uptake of recommended quality indicators highlight the potential need for consensus on a standardized minimal quality monitoring dataset to facilitate feasible quality monitoring and comparison of outcomes across networks.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1847419</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1847419</link>
        <title><![CDATA[Higher allostatic load at hospitalization is linked to worse outcome 90 days after stroke]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Eva Birgitte Aamodt</author><author>Karim Borei</author><author>Thomas Potter</author><author>Farhaan Vahidy</author>
        <description><![CDATA[BackgroundAllostatic load (AL), a marker of cumulative stress-related physiologic burden, may influence acute ischemic stroke (AIS) outcome through multisystem dysregulation.MethodsA total of 4,103 AIS patients were recruited from Houston Methodist Registry of Neurological Endpoint Assessments among Patients with Ischemic and Hemorrhagic Stroke (REINAH). Clinical information was collected at initial hospital stay and AL was created using ten parameters representing the metabolic, inflammatory and vascular systems. No neuroendocrine parameters were available. Length of stay (LOS) at the hospital was collected upon departure from the initial hospitalization, and mortality and dependency (modified Rankin Scale) were collected at 90 days post stroke. Factors independently associated with high AL were examined using a multivariable logistic regression model. Associations between baseline AL and post-stroke outcomes (LOS, mortality, and dependency) were examined using unadjusted and adjusted regression models.ResultsHigh AL was associated with longer LOS, and higher mortality and dependency at 90 days. Factors independently associated with high AL included younger age, Black race, higher area deprivation index, being single, illegal drug use, diabetes mellitus, sepsis, higher Charlson comorbidity index, anticoagulation reversal therapy, antihypertensive therapy, and higher NIHSS at 6 and 24 h post stroke, whereas being a woman, hypercholesterolemia, atrial fibrillation, anticoagulant therapy, intravenous tissue plasminogen activator treatment, and endovascular thrombectomy were associated with moderate-low AL.ConclusionHigh AL is associated with poorer functional and clinical outcomes after AIS and may support future risk stratification work.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1840317</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1840317</link>
        <title><![CDATA[Association between poor blood pressure control and intracranial haemorrhage-related mortality in patients with atrial fibrillation receiving oral anticoagulation: a retrospective observational cohort study]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jin Un Kim</author><author>Zhen Cahilog</author><author>Zehra Kadani</author><author>Teledalase Olajoyegbe</author><author>Darren Fernandes</author><author>Dhiraj Ail</author><author>Karishma Oojageer</author><author>Telma Da Silva</author><author>Saeedur Rahman</author><author>Peter Kabunga</author>
        <description><![CDATA[Study objectiveHypertension is a major modifiable risk factor for intracranial haemorrhage (ICH) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC). We performed a retrospective exploratory analysis of the prevalence of poorly controlled hypertension, as evidenced by hypertensive vasculopathy on neuroimaging, among patients with AF on OAC who died after presenting with ICH at a large district general hospital in England.MethodsBetween December 2020 and April 2024, the death registry data of a large district general hospital in the South East of England, United Kingdom, were analysed to identify patients who were anticoagulated for AF and who had ICH as the primary cause of their death. The confirmatory neuroimaging data were interrogated to assess the likely underlying cause of bleeding.ResultsOf the 5,452 deaths within the study period, 46 patients on OAC for AF were included. The majority of patients (78.3%) had spontaneous ICH compared to traumatic ICH (11.7%). Most patients (84.8%) recorded hypertension (80% in the traumatic group, n = 8 vs. 86.1% in spontaneous ICH, n = 31). In those with spontaneous ICH, 28 (77.8%) demonstrated neuroradiological evidence of bleeding as a result of hypertensive vasculopathy.ConclusionHypertension is not only a major substrate of AF incidence but a cause of additional morbidity and mortality. Within our cohort, hypertensive vasculopathy was a significant underlying aetiology of spontaneous ICH-related mortality. Falls and trauma causing ICH in anticoagulated patients with AF may be overestimated. In line with the recently updated European Society of Cardiology (ESC) guideline, blood pressure should take priority in the management of AF to reduce major bleeding risk.]]></description>
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