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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>2026-10-05T16:47:08.626+00:00</pubDate>
        <ttl>60</ttl>
        <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.2026.1850977</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.2026.1946990</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.2026.1978900</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.2026.1897859</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.2026.1967379</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.2026.1903852</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>
      </item><item>
        <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>
      </item><item>
        <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.2026.1840317</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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        <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.2026.1915602</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1915602</link>
        <title><![CDATA[Stroke in non-bacterial thrombotic endocarditis: a patient-level systematic review of clinical characteristics, management, and outcomes]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Ahmed Aljabali</author><author>Deema Alhayali</author><author>Hallie Taylor-Wedge</author><author>Todd A. Laffaye</author><author>Majd Al-Ahmed</author><author>Ayham Harahsheh</author><author>Mohammed Alamoush</author><author>Khaled Dweik</author><author>Mayowa A. Osundiji</author><author>Amir A. Mbonde</author><author>Cumara B. O'Carroll</author><author>Bart M. Demaerschalk</author><author>Ehab Harahsheh</author>
        <description><![CDATA[Background and PurposeStroke is a frequent manifestation of non-bacterial thrombotic endocarditis (NBTE), yet current knowledge largely stems from case reports and small case series. This systematic review summarizes stroke presentation, imaging features, management, and outcomes in patients with NBTE-related stroke.MethodsWe conducted a patient-level systematic review of published case reports and case series. PubMed, MEDLINE, Embase, Web of Science, and PsycINFO were searched from inception through August 2025 for studies reporting individual patients with NBTE-related stroke. Extracted data included demographics, vascular risk factors, stroke presentation, imaging features, NBTE etiology, treatment (unfractionated heparin/low-molecular-weight heparin [UFH/LMWH], vitamin K antagonists [VKA], direct oral anticoagulants [DOACs], and/or valvular surgery), and outcomes. Multivariable regression was used to explore factors associated with recurrent stroke and mortality.ResultsWe included 236 patients with NBTE and stroke from 218 studies (median age 56 years [IQR: 43–63], 63% female). Left hemispheric stroke syndromes predominated among clinical presentations (27%), and multi-vessel territory ischemic infarcts (>2 territories) were observed in 65%. Conventional vascular risk factors were infrequent (0%−21%), whereas deep vein thrombosis (43%) and systemic embolism (41%) frequently preceded or coincided with stroke onset. Malignancy (70%) and autoimmune disease (25%) were the main NBTE etiologies. Anticoagulation was initiated in 70%, and 21% underwent valvular surgery. Over a median follow-up of 2.0 months, stroke recurred in 43% and death occurred in 49% of patients. Malignant etiology (aOR 10.3, P < 0.001) and metastases (aOR 3.9, P < 0.001) were associated with increased mortality, while VKA use (aOR 0.08, P < 0.001) and autoimmune etiology (aOR 0.1, P < 0.001) were associated with lower mortality. Malignancy (aOR 2.8, P < 0.001) and DOAC use (aOR 5.2, P = 0.012) were associated with increased risk of recurrent stroke.ConclusionNBTE should be considered in stroke patients lacking conventional vascular risk factors, particularly those with malignancy or autoimmune disease. Malignancy and DOAC use were associated with higher recurrent stroke risk, while VKA use was associated with lower mortality; however, these anticoagulant-class findings should be considered hypothesis-generating and interpreted cautiously given the case-report evidence base, small treatment subgroups, potential confounding, and limited follow-up.What this study addsBy synthesizing patient-level data from published case reports and case series, this review provides a stroke-focused characterization of NBTE, including clinical presentation, infarct topography, underlying etiologies, management strategies, recurrent cerebrovascular events, and mortality. The findings highlight multifocal infarction, malignancy-associated NBTE, and recurrent stroke despite anticoagulation as key clinical concerns, while emphasizing that observed associations with anticoagulant class should be viewed as hypothesis-generating rather than definitive treatment guidance]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1800285</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1800285</link>
        <title><![CDATA[Admission direct bilirubin and direct bilirubin-to-lymphocyte ratio as exploratory markers of early severity and in-hospital functional status in acute ischemic stroke]]></title>
        <pubdate>2026-08-07T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yingxia Li</author><author>Ruixing Zhang</author><author>Yang Luo</author><author>Youquan Gu</author>
        <description><![CDATA[ObjectivesTo investigate the correlation between direct bilirubin (DBIL), direct bilirubin-lymphocyte ratio (DBLR), and the severity of acute ischemic stroke (AIS), and to evaluate their potential as auxiliary biomarkers for early severity assessment and short-term in-hospital functional outcome of AIS.MethodsA retrospective study was conducted to enroll 234 patients with AIS who presented within 24 h of admission to The First Hospital of Lanzhou University as the AIS Group, and 180 healthy individuals who underwent a health checkup at the same time were randomly selected as the Control Group. The patients' general information, National Institute of Health Stroke Scale (NIHSS) scores, and laboratory indicators at admission were collected with DBLR calculated as DBIL divided by lymphocyte (LYM) count. The AIS Group was divided into Mild Group (NIHSS ≤ 6, n = 91), Moderate Group (6 < NIHSS < 15, n = 82), and Severe Group (NIHSS ≥ 15, n = 61) according to the NIHSS scores at admission. The AIS Group was further divided into Good early functional outcome Group (mRS < 3, n = 133) and Poor early functional outcome Group (mRS ≥ 3, n = 101) according to the Modified Rankin Scale (mRS) scores at 7 ± 2 days of treatment. The differences in past medical history, general clinical data, and laboratory indicators between the AIS Group and the Control Group were compared, and the differences in laboratory indicators between the different subgroups were analyzed respectively.ResultsCompared to the Control Group; the AIS Group exhibited significantly higher direct bilirubin (DBIL) levels and a lower lymphocyte (LYM) count (P < 0.05). Both the Moderate and Severe Groups presented elevated direct bilirubin (DBIL) levels (P < 0.001), indirect bilirubin (IBIL) levels (P = 0.021), and direct bilirubin ratio (DBLR) (P < 0.001). Notably, DBIL (r = 0.269, P < 0.001) and DBLR (r = 0.321, P < 0.001) were positively correlated with the extent of neurological deficit, while LYM count (r = −0.274, P < 0.001) exhibited a negative correlation with neurological deficit severity. At the time of admission, DBIL and DBLR were identified as risk factors for neurological deficits. This study performed receiver operating characteristic (ROC) curve analysis on DBLR and DBIL among patients with severe strokes. The area under the curve (AUC) for DBLR was 0.612, with an optimal diagnostic threshold of 2.82, yielding a sensitivity of 47.2% and a specificity of 79.4% (P = 0.005, 95% CI: 0.537–0.686). For DBIL, the AUC was 0.596, the optimal diagnostic threshold was 2.85, with a sensitivity of 72.7% and a specificity of 43.5% (P = 0.017, 95% CI: 0.521–0.671), and the difference was statistically significant (P < 0.05). In comparison to the Good early functional outcome Group, the Poor early functional outcome Group showed higher DBIL and DBLR levels, along with a lower LYM count. Moreover, DBIL and DBLR were positively correlated with the Modified Rankin Scale (mRS) scores at 7 ± 2 days. The AUC for DBLR was 0.650, with an optimal diagnostic threshold of 2.86, a sensitivity of 69.8%, and a specificity of 58.5% (P < 0.001, 95% CI: 0.581–0.719). The AUC for DBIL was 0.582, with an optimal diagnostic threshold of 2.55, a sensitivity of 80.8%, and a specificity of 36.6% (P = 0.031, 95% CI: 0.509–0.654), with a statistically significant difference (P < 0.05). Additionally, elevated continuous DBLR was independently associated with poor early functional outcome, and the exploratory cutoff of DBLR > 2.86 indicated a higher risk of poor short-term functional status.ConclusionsAdmission levels of DBIL and DBLR are significantly correlated with the degree of neurological impairment and short-term (7 ± 2 days) in-hospital functional status in AIS patients, where higher values indicate more severe acute neurological deficits and poorer early outcomes. Elevated DBLR is independently associated with poor short-term functional status, and the exploratory cutoff of DBLR > 2.86 (OR = 5.169, 95% CI: 1.623–16.461, P = 0.005) may assist in early risk stratification. However, their independent predictive ability is limited (all AUCs < 0.7). Therefore, these biomarkers should only be used as auxiliary tools in combination with clinical scores such as the NIHSS, and their clinical value should not be overinterpreted.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1861562</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1861562</link>
        <title><![CDATA[Post-stroke glymphatic and meningeal lymphatic dysfunction: mechanisms, imaging evidence, and translational challenges]]></title>
        <pubdate>2026-07-31T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Jin Yang</author><author>Ting Wang</author><author>Yaoyue Hu</author><author>Cuiying Liu</author><author>Tianliang Shi</author><author>Heng Zhao</author>
        <description><![CDATA[Stroke may disrupt brain fluid and waste clearance pathways, including the glymphatic and meningeal lymphatic systems, across ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. This review synthesizes current evidence on post-stroke alterations in these pathways, with emphasis on subtype-specific mechanisms, the distinction between experimental and human evidence, and the strengths and limitations of available imaging approaches. Experimental studies suggest that ischemic stroke may involve hyperacute perivascular cerebrospinal fluid influx followed by impaired glymphatic transport, that intracerebral hemorrhage is more closely linked to blood-product-related disruption of glymphatic and meningeal lymphatic drainage, and that subarachnoid hemorrhage may involve combined glymphatic and meningeal lymphatic failure. We further review in vivo imaging methods, particularly magnetic resonance imaging (MRI) approaches such as dynamic contrast-enhanced MRI, diffusion tensor image analysis along the perivascular space, and structural perivascular space imaging, and we discuss their biological directness and translational limitations. Across modalities, the most direct evidence still comes mainly from experimental tracer-based MRI and selected intrathecal contrast-enhanced MRI studies in humans. Among stroke subtypes, subarachnoid hemorrhage currently provides the most direct human MRI evidence of combined clearance-pathway dysfunction, whereas most other human stroke data rely on indirect surrogate markers, especially diffusion tensor image analysis along the perivascular space. Accordingly, current clearance-pathway imaging should be regarded primarily as a mechanistic and early translational research tool rather than a validated clinical biomarker. Importantly, most proposed links between molecular mechanisms, imaging readouts, and clinical outcomes remain inferential and require prospective validation in human stroke cohorts. Prospective human studies are needed to test whether targeting brain clearance pathways improves post-stroke recovery and cognition.]]></description>
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