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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>2026-08-01T08:06:01.557+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <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>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1904901</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1904901</link>
        <title><![CDATA[Sex differences in location of initial diagnosis and discharge destination among medicare fee-for-service beneficiaries with post-stroke aphasia]]></title>
        <pubdate>2026-07-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Molly M. Jacobs</author><author>Charles Ellis</author>
        <description><![CDATA[ObjectiveTo characterize sex differences in the clinical setting of initial aphasia diagnosis and the discharge destination of fee-for-service (FFS) Medicare beneficiaries diagnosed with post-stroke aphasia.MethodsData for this project were obtained from 100% of FFS Medicare claims and included all beneficiaries who incurred an inpatient claim between January 2016 and October 2019 listing stroke as the primary diagnosis and had a claim listing aphasia diagnosis within 90 days of stroke.ResultsAmong those diagnosed with stroke (745,917), 14.5% (N = 107,753) were also diagnosed with aphasia within 90 days. Approximately 60.96% of men and 56.47% of women had their initial aphasia-related claim in an inpatient facility; 15.12% of men and 19.47% of women in a skilled nursing facility; and 8.44% of men and 7.03% of women in an outpatient facility. Roughly 14.99% of men and 11.50% of women with aphasia were discharged home; 25.38% of men and 31.37% of women were discharged to a skilled nursing facility; and 42.94% of men and 38.24% of women were discharged to a long-term care or rehabilitation facility (χ2 =904.70, p < 0.0001). Relative to men, women were significantly more likely to be discharged to a skilled nursing facility (OR = 1.35, 95% CI = 1.31, 1.39), but less likely to be discharged to a long-term care or rehabilitation facility (OR = 0.83, 95% CI = 0.81, 0.86).DiscussionSex differences existed in the location of aphasia diagnosis and their destination following acute care discharge. However, the cause of these differences is unknown or how they related to quality-of-care.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1859301</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1859301</link>
        <title><![CDATA[Anemia impacts short-term and long-term mortality risk after acute ischemic stroke]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chen Ee Low</author><author>Hon Jen Wong</author><author>Chun En Yau</author><author>Jia Yang Tan</author><author>Yao Neng Teo</author><author>Yao Hao Teo</author><author>Jasper R. Senff</author><author>Reinier Tack</author><author>Andrew F. W. Ho</author><author>Bernard P. L. Chan</author><author>Leonard L. L. Yeo</author><author>Joshua Y. P. Yeo</author><author>Ching-Hui Sia</author><author>Benjamin Y. Q. Tan</author>
        <description><![CDATA[BackgroundThe relationship between hemoglobin concentration and all-cause mortality in acute ischemic stroke (AIS) patients remains unclear due to conflicting findings. This study aims to evaluate the impact of hemoglobin concentration on the risk of both short-term and long-term all-cause mortality in AIS patients from a nationwide stroke registry.MethodWe utilized data from the Singapore Stroke Registry (SSR), including patients >18years old at first AIS onset, and received treatment at a local hospital between 2005 and 2020. Patients were stratified according to sex-specific hemoglobin concentration cut-offs on anemia severity and polycythemia from the World Health Organization. Multivariate logistic regression and Cox proportional hazards modeling were performed, adjusting for demographics and cardiovascular risk factors.ResultsA total of 56,884 ischemic stroke patients were included, of which 66.8% had no anemia, 15.7% had mild anemia, 12.2% had severe anemia, and 5.3% had polycythemia. The cohort was predominantly male (57%), with a median age of 68 years. The median follow-up duration was 10-years (IQR 7–13). Compared to patients with normal-range hemoglobin, both mild and severe anemia was associated with elevated short-term and long-term risks of all-cause mortality. Severe anemia was associated with the highest risk of all-cause mortality, with hazard ratios of 1.99 (95%CI:1.92–2.06) at 30-days, 1.73 (95%CI:1.66–1.81) at 1-year, and 1.52 (95%CI:1.41–1.64) at 5-years. However, the excess risk associated with severe anemia appeared to attenuate at 10-years, whilst the elevated risk persisted among patients with mild anemia.ConclusionIn this nationwide stroke registry, anemia is prevalent among AIS patients and is significantly associated with both short-term and long-term mortality.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1807741</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1807741</link>
        <title><![CDATA[Associations between hearing difficulty, labor force status, and health burden in young stroke survivors]]></title>
        <pubdate>2026-07-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Elizabeth Tobener</author><author>Molly Jacobs</author><author>Charles Ellis</author>
        <description><![CDATA[BackgroundYoung adults with stroke often experience functional impairments, which may be exacerbated by hearing loss. This study examined associations between employment disruptions and functional, physical, and mental health limitations among young stroke survivors with and without self-reported hearing difficulty.MethodsThis analysis used data from the 2020 to 2023 Behavioral Risk Factor Surveillance System (BRFSS) for adults aged 18–49 with self-reported stroke. Outcome measures included functional limitations—including concentration/memory, mobility/walking, dressing/bathing, and completing errands—and the number of days with poor physical, mental, and overall health. Logistic and negative binomial regressions examined the associations between these outcomes, employment status, and hearing difficulty, controlling for sample heterogeneity. Interactions between hearing difficulty and employment status were assessed to examine potential differential effects.ResultsRespondents who reported hearing difficulty had significantly greater odds of functional limitations, including difficulty concentrating (OR = 2.60, 95% CI: 1.56–4.35), doing errands independently (OR = 3.71, 95% CI: 2.22–6.21), dressing or bathing (OR = 6.09, 95% CI: 3.30–11.24), and walking or climbing stairs (OR = 3.66, 95% CI: 1.89–7.09). Hearing difficulty was also independently associated with a greater number of poor physical health days (IRR = 1.39, 95% CI: 1.02–1.89) and poor mental health days (IRR = 1.67, 95% CI: 1.30–2.14). Being out of work or out of the labor force was independently associated with poorer functional, physical, and mental health outcomes.ConclusionsThese findings underscore the need for integrated post-stroke rehabilitation strategies that address sensory, cognitive, and social dimensions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1887056</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1887056</link>
        <title><![CDATA[Clinical characteristics and frequent risk factors in young adult patients with stroke at a tertiary care hospital in Honduras]]></title>
        <pubdate>2026-07-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Kivian Obed Matamoros Padilla</author><author>Roberto Daniel Padilla Valeriano</author><author>Eleonora Espinoza-Turcio</author><author>Henry Noel Castro-Ramos</author><author>Lysien Ivania Zambrano</author><author>Selvin Z. Reyes-Garcia</author>
        <description><![CDATA[BackgroundStroke has become the third leading cause of death, accounting for 10% of all deaths. The prevalence of intracranial hemorrhage, subarachnoid hemorrhage, and ischemic stroke has increased by 20.5%, 11.5%, and 7.4%, respectively, in the 20–54 age group, making it a worldwide problem for the young adult population.AimTo describe the clinical characteristics, diagnostic findings, stroke subtypes, and frequent risk factors among young adult patients with stroke treated at a tertiary care hospital in Honduras.MethodsCross-sectional, non-probability convenience sample study of 70 patients aged 18–55 years. An ethical opinion was obtained (079-2024). The information was supplemented with clinical examinations, laboratory tests, neuroimaging, carotid Doppler, and transcranial Doppler with bubble test. Descriptive statistics were obtained.ResultsYoung adults accounted for 30.0% of stroke cases evaluated. The mean age was 43.4 ± 9.1 years. The 61.4% were women, 55.7% had a history of hypertension, 31.4% had type 2 diabetes mellitus, and 24.3% had migraines. A total of 21.4% were smokers, and 15.7% of women used oral contraceptives. Ischemic stroke occurred in 71.4% of cases, with a cardioembolic etiology in 21.4%. A patent foramen ovale (PFO) was identified in 5 of 17 cases, corresponding to 29.4% of the tested subgroup and 7.1% of the total sample and mortality was 15.7%.ConclusionsA high proportion of strokes were observed in women, with a predominance of ischemic strokes of cardioembolic etiology. Modifiable factors associated with stroke were identified, which can be controlled, contributing to a decrease in morbidity and mortality from this pathology.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1769395</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1769395</link>
        <title><![CDATA[Autophagy in ischemic stroke: pathophysiology, therapeutics, and challenges ahead]]></title>
        <pubdate>2026-07-20T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Tshibambe N. Tshimbombu</author><author>Arsene Daniel Nyalundja</author><author>Gates Mulume Iragi</author><author>Josué Aganze Mwambali</author><author>Samira Braimah Shardow</author><author>Melissa Ewurakua Amoako</author><author>Kyle E. Thurmann</author><author>Daniel I. Gonzalez</author><author>Paige Banyas</author><author>Judea Wiggins</author><author>Supreet Kaur</author>
        <description><![CDATA[Autophagy is a fundamental cellular homeostatic process that exerts a dual, context-dependent influence on the pathophysiology of ischemic stroke. Functioning as both a neuroprotective survival mechanism and a neurotoxic pathway, autophagy presents a complex therapeutic challenge as well as a potential target for molecular intervention. This narrative review synthesizes preclinical and emerging clinical evidence to summarize key mechanisms regulating autophagy in ischemic injury, evaluate therapeutic strategies, and identify promising molecular pathways and druggable targets for translational development. In the early ischemic phase, moderate autophagic activation facilitates neuronal survival by clearing damaged mitochondria and protein aggregates, thereby reducing oxidative stress and modulating neuroinflammation. This protective response is primarily mediated by regulators such as Beclin-1, the conversion of LC3-I to LC3-II, and the energy-sensing AMP-activated protein kinase pathway. Conversely, sustained or excessive autophagy, particularly during late-stage reperfusion, exacerbates neuronal injury through impaired lysosomal fusion, autophagosome accumulation, and the triggering of autophagic cell death and ferroptosis. Preclinical evidence highlights a critical Goldilocks zone of activation, suggesting that therapeutic success hinges on maintaining autophagic flux within narrow physiological limits. Advancing these therapies into clinical practice requires precise spatiotemporal modulation, potentially as an adjunct to mechanical thrombectomy, as well as the development of robust, real-time biomarkers. A comprehensive understanding of the molecular and genetic determinants of autophagy, including sex-specific responses, is essential to bridge the translational gap and establish autophagy as a viable target for precision stroke medicine.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1838151</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1838151</link>
        <title><![CDATA[Impaired left atrial strain is associated with acute ischemic stroke in patients without atrial fibrillation]]></title>
        <pubdate>2026-07-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Robert Trueick</author><author>Jonathan Shpigelman</author><author>Omar Dabash</author><author>John McCallig</author><author>Muhammad Ahmad Ashfaque</author><author>Muneeb Quidwai</author><author>Lisa Donaghy</author><author>Patricia Guilfoyle</author><author>Lavanya Saiva</author><author>James O'Neill</author><author>Michael J. Daly</author>
        <description><![CDATA[BackgroundCryptogenic stroke, defined as a stroke with an unknown cause, poses a significant clinical challenge in cardiology and neurology. Left atrial (LA) dysfunction, as measured by left atrial strain (LAS), may identify patients who are at high risk for acute ischemic stroke (AIS), even if they do not have documented atrial fibrillation (AF).MethodsThis retrospective, cross-sectional and cohort study (known as the ASSISTANT Study) was conducted at a single, tertiary-care referral center. The study included patients who tested positive on the Face Arm Speech Test (FAST) and who did not have high-risk stroke mechanisms. These patients presented acutely and underwent a transthoracic echocardiogram. Speckle-tracking echocardiography was used to measure LAS in three phases: reservoir (LASr), conduit (LAScd), and contractile (LASct). The associations of LAS with imaging-confirmed acute ischemic stroke (AIS) at presentation and incident AIS during follow-up were evaluated using multivariable logistic and Cox regression analyses, respectively.ResultsAmong the 415 patients (251 cases and 164 controls), LASr and LAScd were both independently associated with AIS at presentation [OR per 5% increase: 0.789 (95% CI, 0.674–0.920) and 0.573 (95% CI, 0.450–0.718), respectively]. During a median follow-up of 3.59 years, 31 patients developed incident AIS. The incidence of AIS increased as the tertiles of LASr (Ptrend = 0.021) and LAScd (Ptrend < 0.001) worsened. Only LAScd remained independently associated with incident AIS [HR per 5% increase: 0.682 (95% CI, 0.478–0.953)].ConclusionImpaired LAScd is independently associated with prevalent and incident AIS in patients without identified high-risk stroke mechanisms. Prospective studies are needed to determine whether LAScd can guide risk stratification and preventive strategies in this patient population.Trial RegistrationClinicalTrials.gov (NCT07102693).]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1847066</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1847066</link>
        <title><![CDATA[Association between educational attainment and discharge disposition following incident stroke hospitalization: the Atherosclerosis Risk in Communities study]]></title>
        <pubdate>2026-07-08T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Ning Li</author><author>Erin L. Abner</author><author>Silvia Koton</author><author>Lena Mathews</author><author>Kunihiro Matsushita</author><author>Anna M. Kucharska-Newton</author>
        <description><![CDATA[BackgroundThe relationship between educational attainment and discharge disposition after stroke hospitalization remains unclear. This study examined whether educational attainment is associated with discharge disposition after incident stroke and whether stroke severity modifies this association.MethodsThe study included Atherosclerosis Risk in Communities (ARIC) participants with an incident stroke hospitalization from 1991 to 2020 who were enrolled in fee-for-service (FFS) Medicare at discharge. Discharge disposition was obtained from hospitalization claims. Educational attainment was categorized as “less than high school” vs. “high school or more.” Multivariable logistic regression models were used to estimate associations between educational attainment and discharge disposition, adjusting for age at stroke, sex, race, and study center. Stroke severity was measured using the Stroke Administrative Severity Index (SASI) derived from Medicare discharge diagnosis codes and assessed as an effect modifier.ResultsAmong 976 stroke survivors (mean age 75.5 years; 56.6% women; 31.8% Black), the mean hospital stay was 9.3 days, and 30.1% had an intensive care unit (ICU) stay. Overall, 58.9% were discharged home. The median Elixhauser Comorbidity Index was 3, and 55.5% had a SASI score of zero. Compared with those with at least a high-school education, participants with less than high-school education had similar odds of being discharged home (AOR 0.95; 95% CI: 0.7–1.28). Stroke severity did not significantly modify the association.ConclusionEducational attainment was not significantly associated with discharge disposition after incident stroke hospitalization in this cohort, although sample size limits the ability to rule out associations.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1807730</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1807730</link>
        <title><![CDATA[Age, race, and education as moderators of post-stroke cognitive decline following dental care]]></title>
        <pubdate>2026-07-07T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Michael H. Parrish</author><author>Leonardo Bonilha</author><author>Karly Pikel</author><author>Caitlin Scott</author><author>Stefanie Wood</author><author>Haley N. VerKuilen</author><author>Souvik Sen</author>
        <description><![CDATA[Post-stroke cognitive decline (PSCD) poses a significant challenge to long-term recovery and quality of life following stroke, influenced by both fixed biological factors and modifiable health behaviors such as oral and dental care. In this data-driven exploratory analysis of the PREMIERS Phase II randomized trial (ClinicalTrials.gov NCT#02541032), we examined the moderating effects of clinical, biological, and demographic characteristics on the relationship between dental care and PSCD over a 12-month period. The study included 280 stroke/transient ischemic attack (TIA) survivors who received either intensive or standard dental care. Cognitive outcomes were assessed using the Montreal Cognitive Assessment (MoCA) at baseline and follow-up, with change in MoCA score as the primary outcome. Lasso regression was applied for empirically based feature selection of moderators, and bootstrapped multiple linear regression demonstrated that increased dental visits predicted relatively better cognitive outcomes in older adults (age interaction-term b = −0.664, p < 0.001), Black participants (race interaction-term b = −0.475, p < 0.05), and those with low-intermediate education levels (education interaction-term b = 0.413, p < 0.05). Exploratory graphs revealed that older adults, Black adults, and adults with low-intermediate education showed greater cognitive improvement with higher dental visit frequency, with the final model (including selected moderators) significantly predicting PSCD [F(11, 268) = 10.51, p < 0.001]. These findings highlight the potential of equity-focused, precision-medicine interventions that incorporate dental care to mitigate PSCD in vulnerable stroke populations.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1917786</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1917786</link>
        <title><![CDATA[Correction: Comparison of admitting neutrophil/lymphocyte ratio with baseline NIH stroke scale score in discriminating poor 30-day stroke outcome among Nigerian Africans]]></title>
        <pubdate>2026-07-06T00:00:00Z</pubdate>
        <category>Correction</category>
        <author>Oladotun V. Olalusi</author><author>Joseph Yaria</author><author>Akintomiwa Makanjuola</author><author>Rufus Akinyemi</author><author>Mayowa Owolabi</author><author>Adesola Ogunniyi</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1759945</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1759945</link>
        <title><![CDATA[Acute treatment of ischemic stroke in 19 Sámi language administrative municipalities in the rural inland of Northern Sweden]]></title>
        <pubdate>2026-07-01T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Elisabeth Ronne Engström</author><author>Christoffer Nyberg</author><author>Mia von Euler</author>
        <description><![CDATA[ObjectsThe effective treatment of acute stroke requires a series of events, including the recognition of stroke symptoms, following known action plans, and the rapid transfer to a hospital with sufficient medical competence. This is challenging in rural areas with long distances between hospitals with emergency departments. We studied the availability and effectiveness of acute stroke treatment in the most rural parts of northern Sweden. Some of the population in the study area belong to the Sámi, Sweden's indigenous people. Our aim was to study the yearly incidence of ischemic stroke, time window from start of symptoms to arrival at first hospital, and rate of revascularization treatment in the study population and compare to the rest of Sweden.MethodsStatistics Sweden defined the study group which was 142,127 individuals registered as living in the study area sometimes during 2019–2021. We used data from the National Board of Health and Welfare (NBHWF) regarding incidence and from the Swedish Stroke Register (Riksstroke, RS), for time windows and treatments. The study area was compared with the Swedish national data. Transfer times between municipalities, first hospitals, and thrombectomy centers were assessed using open data.ResultsThe incidence of ischemic stroke in the study group was 280/100.000/year which was significantly higher than national data for the same age group. 1,153 stroke incidents were registered in RS. In the study group 21.1% arrived at the first hospital >24 h from start of symptoms compared to 4.5% in national data. Three percent were treated with thrombectomy and 11.1% with thrombolysis. The numbers were small but those with the lowest percentage of arrival < 3 h, and of reperfusion treatment, all had the longest distances to the first hospital. 26.1 and 17.9% in two municipalities had an unknown time window from start of symptoms. A majority of the population would have shorter distances to thrombectomy centers outside Sweden.ConclusionOur data shows a higher incidence of ischemic stroke in the study area in the rural northern Sweden. Persons with stroke in this area are unlikely to receive acute care in accordance with the Swedish national stroke guidelines.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1877826</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1877826</link>
        <title><![CDATA[Application of TOAST criteria, comorbidities and outcomes in patients with ischemic stroke: multicenter collaboration in the Dominican Republic]]></title>
        <pubdate>2026-06-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ryna Then</author><author>Maria Muñoz</author><author>Cristina Ramos</author><author>Marcos Mota</author><author>Priscilla Sepulveda</author><author>Lisa José</author><author>Luis Suazo</author><author>Francisco Mendez</author><author>Yahaira Franco</author><author>Cosme González Villamán</author><author>Acela Gonell</author><author>Violiza Inoa</author><author>Gillian Gordon Perue</author><author>Manuel Colomé-Hidalgo</author><author>Nadja García</author>
        <description><![CDATA[IntroductionStroke is a leading cause of neurological-related death in the Caribbean. The Dominican Republic has among the highest stroke-related mortality rates in the Americas. We aimed to determine ischemic stroke etiologies, characterize comorbidities, and describe outcomes in the Dominican Republic using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.MethodsWe analyzed a multicenter quality registry between January 2022 and October 2024. Statistical analyses included Mann–Whitney U and Kruskal–Wallis tests with Bonferroni correction, chi-square tests, and Spearman correlation.ResultsThe most common stroke subtype was undetermined etiology (54.8%), followed by large artery atherosclerosis (17.2%) and cardioembolism (16.5%). Hypertension (73.8%), diabetes mellitus (47.2%), and prior stroke (19.9%) were the most prevalent risk factors. Cardioembolic stroke had the highest median NIHSS score (6). Prior stroke was associated with increased odds of large artery atherosclerosis (OR 1.53, p < 0.05). Hyperlipidemia was associated with small vessel occlusion (OR 2.14), and atrial flutter/fibrillation with cardioembolic stroke (OR 19.6). Reperfusion therapy was administered to 162 patients (16.6%): intravenous thrombolysis (57%), thrombectomy (33%), and bridging therapy (10%). Inpatient rehabilitation access was limited. Physical therapy was the most common. Modified Rankin Scale scores at discharge increased significantly across all etiologies (p < 0.001), with the greatest worsening in cardioembolic stroke (+2).ConclusionsMost ischemic strokes were of undetermined etiology, with higher severity observed in cardioembolic stroke. Limited diagnostic workup, reperfusion therapies, and rehabilitation access highlight critical gaps in stroke care. These findings provide baseline data to inform targeted prevention and health system interventions in the Dominican Republic and similar settings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1835562</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1835562</link>
        <title><![CDATA[Acute cerebrovascular disease in the Philippine Neurological Association One Database (PNA1DB)—patient profiles and disparities between public and private hospitals]]></title>
        <pubdate>2026-06-29T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Robert N. Gan</author><author>Jose Leonard R. Pascual V</author><author>Maria Epifania V. Collantes</author><author>John Harold B. Hiyadan</author><author>Dan Neftalie A. Juangco</author><author>Ma. Cristina Z. Macrohon-Valdez</author><author>Cyrus G. Escabillas</author><author>Christian Oliver C. Co</author><author>Gemmalynn B. Sarapuddin</author><author>Maria Teresa A. Cañete</author><author>Raquel M. Alvarez</author><author>Belinda L. Mesina-Nepomuceno</author><author>Johnny K. Lokin</author><author>Marie Charmaine Sy Lukban</author><author>Rosalina E. Picar</author>
        <description><![CDATA[BackgroundStroke is a leading cause of death in the Philippines, yet data on epidemiology, care, and outcomes remain scarce. We aimed to describe the caseload, patient profile, management, and outcomes of acute cerebrovascular events, and to assess disparities between publicly funded and privately funded tertiary hospitals in the Philippines.MethodsThe PNA1DB-Stroke project is a prospective, multicenter, registry of consecutive patients aged ≥18 years admitted with transient ischemic attack (TIA), ischemic stroke, hemorrhagic stroke, or cerebral venous thrombosis (CVT) in 11 (five publicly-funded, six privately-funded) accredited neurology training tertiary hospitals across the Philippines. Data on socio-demographics, medical history, event type, clinical assessments, diagnostic procedures, treatments and discharge outcomes were collected from June 1, 2021, to August 31, 2024.ResultsAmong the 15,230 cases included, mean age 58.0 ± 14.2 years, 6,726 (44.2%) women, hemorrhagic strokes accounted for 38.6%. A total of 10,974 (72.1%) cases were admitted in public hospitals with a larger proportion of hemorrhagic strokes compared to private hospitals (p < 0.001). Public hospitals cases were younger, socioeconomically disadvantaged, and more often have lifestyle risk factors. Only 620 (9.3%) ischemic stroke cases underwent revascularization. While relatively more cases received thrombolysis in public hospitals, major diagnostic and therapeutic procedures were performed less compared to private hospitals. Overall, in-hospital fatality was 16.4%, higher in public hospitals (20.5%) with worse neurological outcomes at discharge than in private hospitals.ConclusionsOur registry demonstrated a high burden of hemorrhagic stroke, delayed hospital arrival, underutilization of reperfusion therapies, and striking disparities between public and private hospitals in the PNA1DB. Study Registration: ClinicalTrials.gov NCT04972058.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1810711</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1810711</link>
        <title><![CDATA[Sex differences in imaging features including cerebral amyloid angiopathy markers in intracerebral hemorrhage]]></title>
        <pubdate>2026-06-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Trine Apostolaki-Hansson</author><author>Christine Kremer</author><author>Amir Hillal</author><author>Cheryl Carcel</author><author>Teresa Ullberg</author><author>Bo Norrving</author><author>Jesper Petersson</author>
        <description><![CDATA[BackgroundReports on sex differences in radiological characteristics of intracerebral hemorrhage (ICH) are few. Sex-related differences in hematoma location, volume, and imaging markers may contribute to variations in clinical presentation and outcome. We aimed to assess sex differences in non-contrast computed tomography (NCCT) features in an unselected ICH cohort.MethodsThis observational study included 1,398 patients with spontaneous supratentorial ICH from the Skåne Hospital Region, Sweden (2016–2021), registered in Riksstroke. Radiological characteristics were compared between males and females. Multivariable logistic regression, adjusted for confounders, analyzed sex differences overall and stratified by hematoma location (deep/lobar). CAA probability was assessed using the simplified Edinburgh CT criteria.ResultsAmong 785 males and 613 females, hematoma volume, location, and antithrombotic use were similar. Women were older (79 vs. 73 years; p < 0.001), more often had severe white matter changes on baseline NCCT, with overall differences in white matter change distribution between sexes (p = 0.006), intraventricular hemorrhage (45.2% vs. 38.7%; p = 0.02), finger-like projections (18.1% vs. 10.6%; p < 0.001), subarachnoid extension (25.1% vs. 15.7%; p < 0.001), and hydrocephalus (16.6% vs. 10.0%; p = 0.001). In lobar ICH (n = 666), high CAA probability was more common in women (28.8% vs. 15.0%, p < 0.001), and in multivariable analysis, female sex was independently associated with subarachnoid extension (OR 1.89 95%CI 1.29–2.77).ConclusionIn this large, unselected cohort of supratentorial ICH, no sex differences were observed in hematoma volume, location, or intraventricular extension. However, in lobar ICH, female sex was independently associated with subarachnoid extension and CT features suggestive of higher CAA probability. These findings indicate similar hemorrhage severity between sexes but differences in lobar hemorrhage morphology that require further validation and explanation.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1722772</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1722772</link>
        <title><![CDATA[Attributable risk and time trend in hemorrhagic and ischemic stroke mortality due to high sodium intake in Zhenjiang City from 2010 to 2021: an Age-Period-Cohort (APC) analysis]]></title>
        <pubdate>2026-06-25T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xiaoyong Gu</author><author>Yuelan Zhu</author><author>Hongyu Wang</author><author>Lu Xu</author><author>Jiajia He</author>
        <description><![CDATA[IntroductionGBD studies have showed high sodium intake's attributable burden on stroke mortality, while existing risk data remain predominantly global, national, or provincial-level, lacking representativeness for specific cities or regional areas. By associating salt intake with elevated systolic blood pressure, it becomes feasible to conduct risk analysis attributing high sodium intake to specific population groups.ObjectiveTo determine the attributable risk of stroke mortality due to high sodium intake in Zhenjiang City, Jiangsu Province, China, from 2010 to 2021, and analyze time trends in hemorrhagic and ischemic stroke mortality rates associated with high sodium intake, to provide a scientific basis for evaluating and improving the effectiveness of local dietary salt reduction policies.MethodsUsing GBD data and Zhenjiang chronic disease surveillance records, this study calculated the attributable burden of hemorrhagic and ischemic stroke mortality caused by high sodium intake through a sodium intake-increase of SBP correlation method, referencing the death risk of elevated SBP leads to hemorrhagic and ischemic stroke. Joinpoint regression was employed to analyze mortality trend amplitude and direction, while an APC model evaluated age, period and cohort effects.ResultsFrom 2010 to 2021, the PAFs for hemorrhagic and ischemic stroke death due to high sodium intake ranged between 12.0% and 19.3%, showing a yearly decreasing trend with higher amplitude observed in males than females. The AAPC of ASMR for hemorrhagic and ischemic stroke was −8.10% (95% CI: −12.00% to −3.90%), with hemorrhagic stroke was −11.10% (95% CI: −13.30% to −8.90%), and ischemic stroke ASMR demonstrated a downward trend after 2013, with its AAPC was −12.30% (95% CI: −14.80% to −9.70%). The overall net drift of mortality for hemorrhagic and ischemic stroke due to high sodium intake was below 0, with hemorrhagic stroke showing greater decline amplitude than ischemic stroke. The value of local drifts with age showed a trend that initially stabilizes and shifted to decreasing and then increasing. Although the age effects on female ischemic stroke mortality due to high sodium intake increased after age 85, both period and cohort effects show a downward trend in stroke mortality risks, the favorable and unfavorable cohort effects on different stroke mortality in different genders deserved more attention.ConclusionIn Zhenjiang City, the attributable risk of hemorrhagic and ischemic stroke mortality due to high sodium intake has shown a downward trend. Priority should be given to women and elderly populations, with continued implementation of salt-reduction-focused stroke prevention strategies to mitigate the health impacts of excessive sodium intake.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1849877</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1849877</link>
        <title><![CDATA[Treatment of carotid stenosis: an updated review]]></title>
        <pubdate>2026-06-24T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Antônio Vinícius Pimentel Lima</author><author>Maria Victória Pimentel Lima</author><author>Marina Trombin Marques</author><author>Vivian Dias Batista Gagliardi</author><author>Rubens Jose Gagliardi</author>
        <description><![CDATA[IntroductionAtherosclerotic carotid stenosis represents one of the main treatable causes of ischemic stroke, accounting for approximately 10%−15% of all cerebrovascular events. Treatment of this condition has evolved significantly over the past decades, shifting from exclusively surgical approaches to a paradigm that includes optimized medical treatment, carotid endarterectomy, and stenting. Recent 2025 publications, including CREST-2 and ECST-2, have brought paradigm-shifting data that challenge previously established concepts.ObjectiveTo provide an extensive and rigorous narrative review on the treatment of carotid stenosis, including common and internal carotid arteries.MethodsThis narrative review was carried out using the PubMed/MEDLINE, LILACS-VHL, Google Scholar, and SciELO databases. DeCS and MeSH descriptors were employed to identify articles published from 2020 to 2025, without restrictions regarding language or geography.ResultsIn the CREST-2 stenting trial, adding carotid stenting to optimal medical therapy (OMT) was superior to OMT alone for the 4-year composite primary endpoint (any periprocedural stroke or death, or subsequent ipsilateral ischemic stroke): 2.8% vs. 6.0% (p = 0.02; number needed to treat = 31). This net benefit was driven by a lower rate of ipsilateral stroke beyond the periprocedural window and was obtained despite a higher upfront periprocedural risk in the stenting arm. In the parallel endarterectomy trial, adding endarterectomy to OMT did not reach statistical significance (3.7% vs. 5.3%; p = 0.24). ECST-2, in its 2-year interim analysis of asymptomatic or low-to-intermediate-risk symptomatic patients, showed no benefit of revascularization added to OMT.ConclusionContemporary data indicate a paradigm shift in the management of carotid stenosis. Optimal medical therapy (OMT), intensified by increasingly stringent LDL-c and blood-pressure targets, is the cornerstone of management for all patients and the principal driver of the marked decline in stroke risk observed over the past two decades. Against this strengthened medical background, the role of revascularization has become more selective: in high-grade asymptomatic stenosis, adding carotid stenting to OMT conferred a modest absolute benefit over OMT alone, whereas carotid endarterectomy (the long-standing gold standard) did not show a statistically significant benefit. These findings support an individualized, plaque- and risk-based strategy in which OMT is universal and revascularization (preferentially by stenting when an intervention is chosen) is reserved for selected patients, with timing and modality guided by stenosis severity, plaque vulnerability, life expectancy, and patient preference.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1802085</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1802085</link>
        <title><![CDATA[Beneficial effects of the novel first-in-class compound DX243 on ischemic outcomes following in vitro and in vivo models of stroke]]></title>
        <pubdate>2026-06-19T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Quentin Marlier</author><author>Alexia Boreux</author><author>Arnaud Rives</author><author>Dario Mosca</author><author>Helene Michaux</author><author>Louisa Schmitz</author><author>Pierre Attali</author><author>Stéphane Silvente</author><author>Philippe Lefebvre</author><author>Brigitte Malgrange</author><author>Nicolas Caron</author>
        <description><![CDATA[IntroductionNew therapeutic strategies to mitigate the devastating consequences of stroke are urgently needed, as restoration of blood flow is currently the only and limited available treatment.MethodsIn our study, we employed a comprehensive combination of in vitro and in vivo stroke models to investigate the therapeutic potential of the DX243. Specifically, we used glutamate and oxygen-glucose deprivation/reoxygenation (OGD) treatment models to mimic ischemic conditions in vitro. To transpose these data in vivo, we used the middle cerebral artery occlusion (MCAO) model to induce an ischemic stroke in male C57BL/6J mice.ResultsOur results demonstrated that DX243 significantly increased ATP production following glutamate treatment and neuronal viability following OGD.Forty-eight hours after 1 h of MCAO, mice that received one subcutaneous injection of DX243 presented a reduced infarct volume and preserved motor coordination on the rotarod, while effects on open field locomotion were not statistically significant.ConclusionThese results highlight the promising neurorestorative properties of this new molecule and suggest its potential as a therapeutic agent for stroke patients. Further investigations in preclinical and clinical settings are warranted to elucidate its full therapeutic potential.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1818548</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1818548</link>
        <title><![CDATA[Closing the stroke care gap: a collaborative, self-sustainable telemedicine enabled model from rural Nepal]]></title>
        <pubdate>2026-06-08T00:00:00Z</pubdate>
        <category>Community Case Study</category>
        <author>Khechar Nath Paudel</author><author>Mahesh Kumar Khanal</author><author>Lekhjung Thapa</author><author>Raju Paudel</author><author>Christoph Gumbinger</author><author>Apsara Hamal</author><author>Christine Tunkl</author>
        <description><![CDATA[BackgroundStroke is a challenging global public health concern, disproportionately affecting people in rural communities. Stroke care is challenging in low and middle-income countries as it requires a coordinated multidisciplinary approach integrating pre-hospital recognition; acute stroke care, and long-term rehabilitation. Multiple barriers exist in LMICs: lack of community awareness; geographical and financial barriers; poor health systems; absence of standardized care pathways; and inadequate training among primary health care workers. Based on this background, this descriptive implementation-focused retrospective program evaluation describes the implementation and early impact of a collaborative, telemedicine supported multi-component health system intervention for stroke care in a rural government hospital in Nepal.MethodsA non-government organization “Nepal Stroke Project (NSP)” partnered with Province Hospital Surkhet (PHS), a community-based tertiary center in remote western Nepal strengthening the stroke care capacity in the region via formation of a multidisciplinary stroke team, infrastructure development and capacity strengthening. NSP experts also provided telemedicine supported clinical guidance to the local stroke team through free digital platform such as WhatsApp. The program evaluation was guided by the RE-AIM framework and interpreted through a health systems strengthening perspective.ResultsBaseline assessment identified major system-level barriers, including the absence of a dedicated stroke pathway, thrombolysis services, stroke-specific infrastructure, and specialist support. Following implementation, annual stroke admissions increased from 154 to 178 cases per year, and 10 healthcare personnel were trained. Intravenous thrombolysis, previously unavailable, was successfully administered to two patients, supported by telemedicine-guided decision-making and subsequent ICU transfer. Over the implementation period, 20 stroke patients received telemedicine consultations, routine stroke pathway activation was achieved for thrombolysis cases, and NIHSS documentation improved from absent at baseline to approximately 50% of cases. Service readiness was further strengthened through establishment of two dedicated stroke beds and provision of essential monitoring equipment.DiscussionThe collaborative model has a potential for sustainable impact by strengthening long term capacity building, and enabling the local team to deliver comprehensive stroke care independently. This implementation model highlights the importance of maximizing existing resources through task-shifting, integrating stroke care within existing health systems, and fostering local ownership to ensure sustainability.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1775674</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1775674</link>
        <title><![CDATA[Flow diverters for intracranial aneurysm embolization with coil embolization in children with ruptured aneurysm: two cases reports]]></title>
        <pubdate>2026-06-04T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Quan Zhou</author><author>Shixin Jiang</author><author>Bingbing Wang</author><author>Feng Guo</author>
        <description><![CDATA[Pediatric intracranial aneurysms are relatively rare and exhibit distinct characteristics compared with those in adults, particularly in terms of sex distribution, incidence, anatomical location, morphology, and underlying etiology. Notably, the risk of rupture and hemorrhage is substantially higher in the pediatric population. Among children younger than five years, approximately 85% of intracranial aneurysms initially present with rupture and bleeding, whereas this proportion decreases to 45% in those older than five years, still significantly exceeding the hemorrhagic risk observed in adults. Current standard treatment modalities for intracranial aneurysms include microsurgical clipping, stent-assisted coil embolization, and flow diverter implantation. However, there are relatively few reports on the use of flow diverters in pediatric patients, and the optimal antiplatelet regimen following endovascular treatment in this population remains controversial. In this study, we report two cases of ruptured giant intracranial aneurysms in children treated with flow diverter placement combined with dense coil embolization. One patient presented with a space-occupying intracerebral hematoma and subsequently developed intracranial hypertension with cerebral herniation after the procedure, necessitating decompressive craniectomy. Different antiplatelet strategies were employed in the two cases. Both patients survived and were discharged in stable condition. At 6-month follow-up, imaging demonstrated no evidence of aneurysm recurrence, and both children had a favorable quality of life.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1825941</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1825941</link>
        <title><![CDATA[Improving stroke outcomes through progressive implementation of stroke unit care in Brazil: a longitudinal observational study]]></title>
        <pubdate>2026-05-25T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Giovani Noll</author><author>Artur Francisco Schumacher Schuh</author><author>Lenise Valler</author><author>Andrea Garcia de Almeida</author><author>Rosane Brondani</author><author>Magda Carla Ouriques Martins</author><author>Gustavo Weiss</author><author>Angélica Dal Pizzol</author><author>Letícia Costa Rebello</author><author>Luiz Antônio Nasi</author><author>Sheila Cristina Ouriques Martins</author>
        <description><![CDATA[IntroductionStroke remains a leading cause of death and disability worldwide, with a disproportionate burden in low- and middle-income countries (LMICs). Although stroke unit (SU) care improves outcomes, evidence from LMIC settings is still limited. We evaluated the impact of three sequential stroke-care models implemented in a Brazilian public university hospital.Patients and methodsThis longitudinal observational study included 1,889 patients with ischemic or hemorrhagic stroke across three care models: before stroke unit (BSU), acute stroke unit (ASU), and comprehensive stroke unit (CSU). Demographic characteristics, stroke subtype, baseline severity, imaging metrics, and outcomes were collected using retrospective and prospective approaches. Primary outcomes were 90-day case fatality and functional status assessed by the modified Rankin scale (mRS). Secondary outcomes included door-to-CT time, thrombolysis rates, pneumonia, access to rehabilitation, and length of stay. Multivariable logistic regression was used to identify predictors of mortality and excellent functional outcome (mRS 0–1).ResultsThe implementation of structured stroke-care models was associated with significant improvements in outcomes. Functional independence at 90 days (mRS 0–2) increased from 45.6% (BSU) to 60.3% (ASU) and 56.3% (CSU) (p < 0.001), while case fatality declined from 24.3 to 10.2% and 7.7%, respectively (p < 0.001). Key quality indicators improved substantially: mean door-to-CT time decreased from 527 to 170 and 107 min (p < 0.001), thrombolysis rates increased from 0 to 14.1% and 22.2% (p < 0.001), and post-stroke pneumonia rates declined from 29.4 to 16.3% and 12.5% (p < 0.001). In multivariable analyses, older age and higher baseline NIHSS were independently associated with increased mortality, whereas intravenous thrombolysis and SU care were associated with reduced odds of death. SU care was associated with more than a threefold increase in the likelihood of excellent functional outcome, while thrombolysis remained the strongest predictor (OR 6.19).ConclusionStepwise implementation of structured stroke-care models significantly reduced mortality and improved functional outcomes in this LMIC setting. These findings support the effectiveness and scalability of SU—particularly comprehensive models—as key strategies to strengthen stroke systems of care.]]></description>
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