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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>2026-09-13T04:00:16.354+00:00</pubDate>
        <ttl>60</ttl>
        <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.2026.1879025</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>
      </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>
      </item><item>
        <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.2026.1840317</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>
      </item><item>
        <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>
      </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>
      </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>
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