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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>
        <generator>Frontiers Feed Generator,version:1</generator>
        <pubDate>2026-07-09T19:48:22.359+00:00</pubDate>
        <ttl>60</ttl>
        <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.2026.1810711</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>
      </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>
      </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.2026.1722772</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>
      </item><item>
        <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>
      </item><item>
        <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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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1816483</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1816483</link>
        <title><![CDATA[Association of hyponatremia and risk of in-hospital mortality in patients with acute stroke: a systematic review and meta-analysis]]></title>
        <pubdate>2026-05-15T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Prachi Sharma</author><author>Anuradha Pawar</author><author>Manabesh Nath</author><author>Deepti Vibha</author><author>Pradeep Kumar</author>
        <description><![CDATA[ObjectiveHyponatremia is among the most common electrolyte disturbances in acute stroke and has been increasingly recognized as a potential predictor of early complications. We aimed to evaluate whether hyponatremia on admission is associated with increased in-hospital mortality in patients with acute ischemic stroke (IS) and hemorrhagic stroke (HS).MethodsWe conducted a comprehensive systematic search of PubMed, Scopus, and Embase to identify relevant studies published between 1st January 2000 and 30th October 2025. Eligible studies included patients with acute stroke, reported admission serum sodium levels, and compared outcomes between hyponatremic and normonatremic groups. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Subgroup analyses were performed based on stroke type.ResultsSeventeen studies involving patients assessed within 24–72 h of stroke onset were included. Hyponatremia on admission was significantly associated with higher in-hospital mortality (RR 1.41, 95% CI 1.14–1.74). The association remained significant in ischemic stroke (RR 1.29, 95% CI 1.16–1.42) and in studies including mixed IS and HS populations (RR 1.59, 95% CI 1.19–2.12). No significant association was observed in hemorrhagic stroke alone (RR 1.47, 95% CI 0.70–3.10). Between-study heterogeneity was moderate (I2 = 58.9%, p < 0.001). Funnel plot assessment suggested no significant publication bias.ConclusionsHyponatremia on admission is associated with increased in-hospital mortality in acute stroke, particularly in ischemic stroke. Early identification and management of hyponatremia may have prognostic and therapeutic relevance in acute stroke care.Systematic Review RegistrationPROSPERO: CRD420251110001.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1733430</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1733430</link>
        <title><![CDATA[Stroke survivors' and carers' experiences of nutritional care after stroke: a qualitative study]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Alex Lang</author><author>Sharon Geva</author><author>Nicholas R. Evans</author><author>Francesca Cavallerio</author><author>Débora Vasconcelos e Sá</author><author>Ali Ali</author><author>Simon Nichols</author><author>Sanjoy K. Deb</author>
        <description><![CDATA[IntroductionImpaired nutritional status is commonly reported following stroke and is associated with poor clinical outcomes. More than 60% of stroke survivors in the UK are supported by informal, unpaid carers who commonly report one or more unmet care needs. This qualitative study explores stroke survivors' and informal carers' experiences of nutritional care across the pathway of stroke rehabilitation and recovery.MethodsTwelve stroke survivors and 12 informal carers were recruited via voluntary stroke organizations. Twelve participants were male. Thirteen were aged 18–34, five were aged 35–54, six were aged 55–74. Ten were of Black British ethnicity, nine White British, two Black other, two Asian and one mixed ethnicity. Median time since stroke was 2 years (range: 4 months to >10 years). Individual, online, semi-structured interviews explored the impact of stroke on nutrition, perceptions of nutritional care received, and suggested improvements. Interviews were transcribed and analyzed using reflexive thematic analysis within a critical realist framework.ResultsFour themes were generated from the data: (1) “overlooked stroke-specific and co-morbid challenges,” recognizing the clinical complexity of post-stroke nutrition (2) “the case for personalized, context-sensitive nutrition,” highlighting the importance of personalized nutrition and consideration of cultural factors (3) “preparedness for discharge home,” which recognizes the importance of the multidisciplinary team in preparing stroke survivors and carers for returning home, (4) “a lack of nutritional information and support,” articulating a strong desire for nutritional information and lack of consistent dietetic support after discharge.ConclusionFindings highlight the importance of preparing stroke survivors and carers effectively prior to discharge through improved access to personalized, culturally sensitive nutrition information, and more consistent dietetic support. Six recommendations are made for improved nutritional care across the stroke pathway. Strategies are needed to identify and address unmet need in relation to post-stroke nutrition and support recovery of stroke survivors.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1783830</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1783830</link>
        <title><![CDATA[Real-world characteristics and outcomes of ischemic stroke: a Peruvian multicenter analysis from the RES-Q registry]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Marla Gallo-Guerrero</author><author>Wilfor Aguirre-Quispe</author><author>Camila Nicole Gallo-Lazarte</author><author>Sofía Stefanie Sanchez-Boluarte</author><author>Antero Peralta-Mestas</author><author>Liliana E. Rodriguez Kadota</author><author>Ivan José Aliaga Cordova</author><author>William Bayona Pancorbo</author><author>Manuel Moquillaza-Valle</author>
        <description><![CDATA[ObjectiveTo characterize and compare clinical profiles, care times, and functional outcomes between thrombolyzed and non-thrombolyzed patients with acute ischemic stroke (IS) within the Peruvian healthcare system using real-world data from the RES-Q registry.MethodsA retrospective multicenter cohort study was conducted. Data from adult patients with acute IS registered between January 2023 and June 2025 across five hospital centers in Peru (Lima, Arequipa, Cusco) were analyzed. The primary exposure was intravenous thrombolysis (IVT). Primary outcomes were functional independence [modified Rankin Scale (mRS) 0–2] at discharge, symptomatic intracranial hemorrhage (sICH), and in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of poor functional outcome and mortality.ResultsOf 1,780 patients with IS, 252 (14.2%) received IVT. Despite presenting with more severe strokes (higher median NIHSS, p < 0.001), the IVT group had a significantly higher rate of functional independence at discharge (50.7% vs. 38.3%, p < 0.001). In multivariable analysis, IVT remained an independent predictor of good functional outcome (adjusted odds ratio for poor outcome: 1.30 for non-IVT group). The median door-to-needle time was 68 minutes. In-hospital mortality did not differ significantly between groups (7.14% vs. 5.76%, p = 0.389). Key independent predictors of poor functional outcome were higher NIHSS (aOR 1.20 per point, 95% CI 1.16–1.24, p < 0.001), age (aOR 1.01 per year, 95% CI 1.00–1.02, p = 0.017), and diabetes (aOR 1.45, 95% CI 1.05–1.99, p = 0.022). For mortality, significant predictors were NIHSS (aOR 1.25, 95% CI 1.19–1.32, p < 0.001) and diabetes (aOR 2.21, 95% CI 1.12–4.38, p = 0.022).ConclusionThis real-world multicenter study in Peru demonstrates that IVT is feasible and effective, associating with significantly better functional outcomes despite treatment of a more severely affected cohort. The study validates the safety profile of IVT in this setting and identifies critical areas for quality improvement, particularly in reducing door-to-needle times and addressing disparities in access to mechanical thrombectomy. Our findings support the expansion and optimization of acute stroke reperfusion protocols in Peru and similar resource-limited healthcare systems.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1762758</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1762758</link>
        <title><![CDATA[NIH Stroke Scale and age predict early post-stroke cognitive impairment]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Faddi Saleh Velez</author><author>Cameron D. Owens</author><author>Jennifer Hotson</author><author>Andrea Loggini</author><author>Ana Luyza Oliveira Santos</author><author>Demian Rudyk</author><author>Daniela Mercado Pena</author><author>Melba Zuniga-Gutierrez</author><author>Maria Cedeno-Bruzual</author><author>Laura Boada Robayo</author><author>Cheyenne Gutierrez</author><author>Kate Singleton</author><author>Zyanna Stuart</author><author>Evgeny Sidorov</author><author>Andriy Yabluchanskiy</author><author>Camila Bonin Pinto</author>
        <description><![CDATA[IntroductionAcute post-stroke cognitive deficits, which may precede formal post-stroke cognitive impairment (PSCI), lacks evidence-based interventions or guidelines. Up to one-third of PSCI patients progress to dementia within 5 years. Deficits often emerge within 2 weeks, underscoring the need for early recognition of risk factors to guide prevention and management. However, predictive value of demographic, clinical, and stroke-specific factors remains inconsistent. We evaluated cognitive outcomes (Montreal Cognitive Assessment) at discharge and identified predictors of low function.MethodsIn this retrospective study at the University of Oklahoma Medical Center, we reviewed 964 stroke patients, with 168 meeting inclusion criteria. Early PSCI was defined as Montreal Cognitive Assessment < 26 at hospital discharge post-stroke. We calculated prevalence, performed univariable logistic regression, and developed multivariable logistic regression models with and without interaction terms.ResultsPatients with Montreal Cognitive Assessment < 26 were older, had longer hospital stays, higher NIH Stroke Scale, and more often discharged to non-home settings. Prevalence of early PSCI was higher with age, longer stays, non-white race, higher NIH Stroke Scale, and non-home discharge. Univariable analyses revealed length of stay, discharge disposition, NIH Stroke Scale, and race as strongest associations. Final multivariable model (NIH Stroke Scale, age, length of stay, discharge disposition) demonstrated NIH Stroke Scale and age as significant predictors, with good discrimination [Receiver Operating Characteristic-Area Under the Curve (ROC-AUC) = 0.79]. Models including interaction terms performed similarly (ROC-AUC = 0.78).ConclusionConsistent with prior work, NIH Stroke Scale and age emerged as the most robust predictors of early PSCI. Length of stay, discharge disposition, and race were associated with early PSCI in univariable analyses and warrant further evaluation in larger prospective studies.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1755828</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1755828</link>
        <title><![CDATA[Collateral status predicts functional outcome in early-treated large-core anterior circulation stroke]]></title>
        <pubdate>2026-04-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Andrés Gallardo</author><author>Pablo M. Lavados</author><author>Pablo Albiña-Palmarola</author><author>Gabriel Cavada</author><author>Andrés Roldán</author><author>Verónica V. Olavarría</author>
        <description><![CDATA[Background and purposeEndovascular therapy (EVT) is increasingly offered to patients with large-core acute ischemic stroke (AIS), yet outcomes remain highly heterogeneous. Collateral circulation may be a key determinant of infarct evolution and recovery, but its role in early-window large-core stroke is not fully defined.MethodsWe retrospectively analyzed consecutive adults from a prospective stroke registry who presented within 6 h with anterior-circulation large-vessel occlusion, NIHSS ≥6, and a large ischemic core (MRI core >50 mL or CT perfusion core >70 mL, up to 150 mL). All patients received reperfusion therapy (intravenous thrombolysis, EVT, or both). Collateral status on baseline single-phase CTA was graded using the Tan scale (0–3); no patients had grade 3. The primary outcome was 90-day modified Rankin Scale (mRS); secondary outcome was NIHSS at discharge.ResultsFifty-four patients met inclusion criteria (Tan 0: n = 24; Tan 1: n = 14; Tan 2: n = 16). Baseline NIHSS, ASPECTS, and core volume were similar across groups. Patients without collaterals (Tan 0) had worse 90-day outcomes (median mRS 4 [IQR 3–6]) compared with those with Tan 1 (2 [IQR 1–3]) or Tan 2 (1 [IQR 1–2]) collaterals (both p < 0.001), whereas Tan 1 and Tan 2 did not differ significantly (p = 0.27). NIHSS at discharge showed a similar gradient. In proportional-odds logistic regression, each one-grade increase in collateral status was associated with lower odds of worse 90-day mRS (adjusted per-grade OR 0.32; 95% CI 0.15–0.68; p = 0.003).ConclusionIn early-treated large-core AIS, even simple CTA-based collateral assessment strongly predicts recovery. Patients with absent collaterals follow a distinctly poorer trajectory, while those with any collateral filling behave more favorably. Incorporating collateral status into routine evaluation may improve prognostic accuracy and support treatment decisions in this challenging subgroup.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1805422</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1805422</link>
        <title><![CDATA[Comparison of primary and secondary stroke outcomes between government and private healthcare institutions: insights from the SPRINT India trial]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Clinical Trial</category>
        <author>Shweta Jain Verma</author><author>Bhavya Nanda</author><author>Paramdeep Kaur</author><author>Arya Devi K. S.</author><author>Deepti Arora</author><author>Aneesh Dhasan</author><author>P. N. Sylaja</author><author>Dheeraj Khurana</author><author>Vijaya Pamidimukkala</author><author>Biman Kanti Ray</author><author>Vivek Nambiar</author><author>Sanjith Aaron</author><author>Gaurav Mittal</author><author>Aparna R. Pai</author><author>Sankar Prasad Gorthi</author><author>Somasundaram Kumaravelu</author><author>Yerasu Muralidhar Reddy</author><author>Sunil Narayan</author><author>Nomal Chandra Borah</author><author>Rupjyoti Das</author><author>Girish Baburao Kulkarni</author><author>Vikram Huded</author><author>Thomas Mathew</author><author>Rohit Bhatia</author><author>Pawan Kumar Ojha</author><author>Jayanta Roy</author><author>Anand Girish Vaishnav</author><author>Arvind Sharma</author><author>Abhishek Pathak</author><author>Sanjeev Kumar Bhoi</author><author>Sudhir Sharma</author><author>Sulena Sulena</author><author>Aralikatte Onkarappa Saroja</author><author>Neetu Ramrakhiani</author><author>Madhusudhan Byadarahalli Kempegowda</author><author>Mahesh Kate</author><author>Tina George</author><author>Ivy Sebastian</author><author>Meenakshi Sharma</author><author>Rupinder Dhaliwal</author><author>Jeyaraj D. Pandian</author>
        <description><![CDATA[IntroductionStroke recurrence and vascular events remain major contributors to post-stroke mortality in India, where care is delivered through heterogeneous government and private healthcare systems. This post-hoc analysis of the Secondary Prevention with a Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial compared primary and secondary stroke outcomes between government and private hospitals.MethodsSPRINT INDIA was a multicentre randomized controlled trial conducted across 31 centers (18 private, 13 government) within the Indian Stroke Clinical Trial Network (INSTRuCT). Adults with sub-acute stroke were randomized to a structured mHealth-supported secondary prevention intervention or standard care and followed for 1 year. The primary outcome was a composite of recurrent stroke, high-risk transient ischemic attack, acute coronary syndrome, and all-cause mortality. Secondary outcomes included functional status (modified Rankin Scale), behavioral risk factors, medication adherence, body mass index, physical activity, and laboratory measures of vascular risk. Outcomes were compared between government and private hospitals using adjusted regression models.ResultsAmong 4,298 randomized patients, 3,038 completed 1-year follow-up (59.8% private; 40.2% government). There was no significant difference was observed in the composite primary outcome between private and government institutions (2.8 vs. 3.7%; p = 0.215). Private hospitals demonstrated non-significantly lower adjusted odds of the primary outcome and higher odds of good functional recovery. The intervention was associated with improved functional outcomes and reductions in systolic blood pressure and fasting blood glucose in government hospitals, while private hospitals showed greater improvements in medication adherence, smoking and alcohol cessation, and body mass index.ConclusionsStroke outcomes at 1 year were broadly comparable across healthcare sectors; however, the intervention demonstrated context-specific benefits, improving risk factors and functional recovery in government hospitals and reinforcing behavioral adherence in private hospitals. These findings highlight the importance of tailoring secondary stroke prevention strategies to healthcare system context.Clinical trial registrationhttp://ctri.nic.in, identifier: CTRI/2017/09/009600.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1814085</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1814085</link>
        <title><![CDATA[Identifying wakeup stroke routine treatments in the emergency departments]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mehari Gebreyohanns</author><author>Sidarrth Prasad</author><author>Kim D. Barker</author><author>Joshua D. E. Amos</author><author>Erica M. Jones</author><author>Lindsay M. Riskey</author><author>Daiwai M. Olson</author><author>Asmiet K. Techan</author><author>Ty A. Johnson</author><author>Nneka L. Ifejika</author>
        <description><![CDATA[BackgroundThe term wake-up stroke refers to an acute ischemic stroke with an unknown time of onset, typically discovered when a patient awakens with symptoms. Wake-up strokes account for up to 25% of all acute ischemic strokes. There is limited understanding of how hospitals vary in their evaluation and treatment of these cases, and institutional protocols, imaging strategies, and therapeutic decision-making for wake-up stroke remain inconsistently defined.MethodsIn this prospective observational study, we surveyed hospitals in Texas and Louisiana to assess institutional approaches to wake-up stroke care including hospital characteristics, imaging protocols, treatment pathways, and decision-making criteria for acute ischemic stroke with unknown onset time.ResultsAmong 54 hospitals in Louisiana (29), and Texas (25), representing 48 unique zip codes, >80% followed a standardized institutional protocol when making decisions for wake-up strokes. Additionally, 75.5% of hospitals ordered MRIs for these cases in the acute setting.ConclusionA coordinated, systems-level approach to wake-up stroke care that integrates a standardized protocol may be valuable in promoting workflow processes.]]></description>
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