2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T7b9,During acute ischemic stroke, cerebral tissue undergoes different stages of ischemic damage and evolves towards irreversible injury at a varying pace depending on local perfusion and metabolic factors. This complex ischemic pathological process represents a dynamic continuum that has been historically conceptualized as a binary ischemic core-penumbra model. Although this simplification has proven useful for explaining the evolution of tissue damage in acute stroke, important nuances with clinical implications might be underappreciated. In this review, we critically appraise the pathophysiology and conventional clinical concepts adopted to explain infarct evolution in the early phases of ischemic stroke. We discuss recent mounting evidence that challenges the traditional compartmentalization of the ischemic core, penumbra, and oligemia, calling for more nuanced pathophysiological tissue concepts. For example, clinical benefits and the harmful hemorrhagic transformation associated with reperfusion therapies are observed across a spectrum of core volumes, challenging the deterministic assumptions of the core-penumbra hypothesis. Automated image processing systems reinforce this simplification of stroke pathophysiology, leading to misinterpretation of the range of truth in human imaging. We propose a modified definition of the core-penumbra-oligemia continuum that includes 6 levels of ischemic progression and their corresponding clinical implications: (1) benign oligemia, (2) vulnerable oligemia, (3) durable penumbra, (4) critical penumbra, (5) nonleaky core, and (6) leaky core. This more granular classification could better reflect the continuum of pathological ischemic changes and vulnerability. The proposed 6 levels can provide a framework for future neuroimaging efforts to better understand tissue fate and infarct evolution in ischemic stroke, ultimately informing treatment decision-making and refining targeting for new therapeutic approaches.31:T829, During acute ischemic stroke, cerebral tissue undergoes different stages of ischemic damage and evolves towards irreversible injury at a varying pace depending on local perfusion and metabolic factors. This complex ischemic pathological process represents a dynamic continuum that has been historically conceptualized as a binary ischemic core-penumbra model. Although this simplification has proven useful for explaining the evolution of tissue damage in acute stroke, important nuances with clinical implications might be underappreciated. In this review, we critically appraise the pathophysiology and conventional clinical concepts adopted to explain infarct evolution in the early phases of ischemic stroke. We discuss recent mounting evidence that challenges the traditional compartmentalization of the ischemic core, penumbra, and oligemia, calling for more nuanced pathophysiological tissue concepts. For example, clinical benefits and the harmful hemorrhagic transformation associated with reperfusion therapies are observed across a spectrum of core volumes, challenging the deterministic assumptions of the core-penumbra hypothesis. Automated image processing systems reinforce this simplification of stroke pathophysiology, leading to misinterpretation of the range of truth in human imaging. We propose a modified definition of the core-penumbra-oligemia continuum that includes 6 levels of ischemic progression and their corresponding clinical implications: (1) benign oligemia, (2) vulnerable oligemia, (3) durable penumbra, (4) critical penumbra, (5) nonleaky core, and (6) leaky core. This more granular classification could better reflect the continuum of pathological ischemic changes and vulnerability. The proposed 6 levels can provide a framework for future neuroimaging efforts to better understand tissue fate and infarct evolution in ischemic stroke, ultimately informing treatment decision-making and refining targeting for new therapeutic approaches. 32:T764,Multimodal imaging has expanded treatment for patients with acute ischemic stroke with large vessel occlusion. Blood-brain barrier (BBB) disruption measured in the ischemic core is associated with hemorrhagic transformation. However, the associations between core BBB disruption (cBBBD) and baseline clinical/imaging variables, as well as 3-month outcome, have not been explored. This is a retrospective multicenter analysis of consecutive anterior circulation patients with acute ischemic stroke with large vessel occlusion, presenting over a 4-year time period, who were transferred from a primary to a comprehensive stroke center for possible endovascular therapy, with magnetic resonance imaging that included perfusion-weighted imaging before transfer. Magnetic resonance imaging scans were processed using RAPID software to generate penumbral imaging variables. Perfusion-weighted images were processed to detect and quantify contrast leakage; cBBBD was calculated as the average of all leaky voxels in the ischemic core. Poor functional outcome was defined as a modified Rankin Scale score of >2 at 3 months. Linear regression was used except for the outcome, which used logistic regression, controlling for age, stroke severity, and baseline functional status. Out of 411 patients transferred for endovascular therapy, 291 were included in this analysis with a median age of 74 years; 49% were female patients. The median National Institutes of Health Stroke Scale score was 13, the mean core volume was 32.3 mL, and the mean cBBBD was 2.1%. 71% of patients underwent endovascular therapy. Admission National Institutes of Health Stroke Scale score ( In acute ischemic stroke with large vessel occlusion, disruption of the BBB in the core lesion is independently associated with clinical outcome. cBBBD represents a new imaging profile for acute stroke that may help guide treatments.33:Td9f, BACKGROUND: Multimodal imaging has expanded treatment for patients with acute ischemic stroke with large vessel occlusion. Blood-brain barrier (BBB) disruption measured in the ischemic core is associated with hemorrhagic transformation. However, the associations between core BBB disruption (cBBBD) and baseline clinical/imaging variables, as well as 3-month outcome, have not been explored. METHODS: This is a retrospective multicenter analysis of consecutive anterior circulation patients with acute ischemic stroke with large vessel occlusion, presenting over a 4-year time period, who were transferred from a primary to a comprehensive stroke center for possible endovascular therapy, with magnetic resonance imaging that included perfusion-weighted imaging before transfer. Magnetic resonance imaging scans were processed using RAPID software to generate penumbral imaging variables. Perfusion-weighted images were processed to detect and quantify contrast leakage; cBBBD was calculated as the average of all leaky voxels in the ischemic core. Poor functional outcome was defined as a modified Rankin Scale score of >2 at 3 months. Linear regression was used except for the outcome, which used logistic regression, controlling for age, stroke severity, and baseline functional status. RESULTS: Out of 411 patients transferred for endovascular therapy, 291 were included in this analysis with a median age of 74 years; 49% were female patients. The median National Institutes of Health Stroke Scale score was 13, the mean core volume was 32.3 mL, and the mean cBBBD was 2.1%. 71% of patients underwent endovascular therapy. Admission National Institutes of Health Stroke Scale score ( P <0.001) and glucose level ( P =0.033) were independently correlated with cBBBD. All imaging variables correlated strongly with cBBBD ( P <0.001). The strongest correlation was 0.50, observed between cBBBD and mismatch ratio ( r 2 =0.254). Increasing cBBBD was independently associated with poor functional outcome (adjusted odds ratio, 1.16 [CI, 1.03–1.32]; P =0.019; n=279), indicating that for every 1% increase in cBBBD, the odds of having a poor functional outcome increase by 16%. CONCLUSIONS: In acute ischemic stroke with large vessel occlusion, disruption of the BBB in the core lesion is independently associated with clinical outcome. cBBBD represents a new imaging profile for acute stroke that may help guide treatments. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Acute Ischemic Stroke: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Acute Ischemic Stroke (condition). Clinician-written summaries and actionable practice insights. 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LB catheters met the prespecified 10% noninferiority margin vs SLB for both FPE and recanalization.","limitations":"- SLB group was markedly smaller (n=107 vs n=1925 pre-match), limiting statistical power to detect modest differences.\n- Retrospective design introduces potential unmeasured confounding despite propensity matching.\n- SLB catheter technology is still emerging; specific device-level variation within each category was not analyzed.","practice_takeaway":"Standard large-bore aspiration catheters appear noninferior to superlarge-bore catheters for stroke thrombectomy — clinicians do not need to default to SLB devices to achieve comparable reperfusion and functional outcomes. Device selection can reasonably continue to be guided by operator familiarity, vessel anatomy, and availability."}},{"doi":"10.1136/jnis-2026-025573","pmid":"42660659","title":"Millipede Aspiration for Revascularization in Stroke (MARRS): prospective trial of a novel 0.088 inch corrugated catheter","journal_title":"Journal of NeuroInterventional Surgery","journal_issn":"1759-8478","published_at":"2026-08-27T00:00:00.000Z","url":"https://doi.org/10.1136/jnis-2026-025573","source_score":45,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-02T06:22:39.759Z","updated_at":"2026-09-02T06:22:39.759Z","tags":[{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"brand","value":"Millipede","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"condition","value":"Large Vessel Occlusion","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"modality","value":"Aspiration Catheter","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"modality","value":"Mechanical Thrombectomy","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"sample_size","value":"n=180","value_numeric":180},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"study_design","value":"Prospective Single-Arm Trial","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"warning","value":"Catheter assignment was based on vessel diameter rather than randomization, which may introduce selection bias between Millipede88 and Millipede70 subgroups.","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"warning","value":"No randomized control arm; comparisons to historical benchmarks should be made with caution.","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025573","tag_type":"warning","value":"Study includes both US and EU sites; regional differences in patient selection or practice patterns are not reported.","value_numeric":null}],"summaries":{"what_studied":"Prospective, multicenter, single-arm pivotal trial evaluating safety and efficacy of the corrugated Millipede aspiration catheter system (0.088 inch) in 180 adults aged 18–85 with acute ischemic stroke from large vessel occlusion (ICA, M1, M2, or basilar artery), treated within 8 hours.","key_result":"Primary efficacy endpoint (mTICI ≥2b in ≤3 passes without rescue) was met in 160/180 patients (88.9%; 95% CI lower bound 84.3%). First-pass mTICI ≥2c was 60% overall with Millipede88, rising to 75% in M1 occlusions. Symptomatic intracranial hemorrhage: 2.3%; intracranial dissection: 1.1%; no perforations; 90-day all-cause mortality: 13.9%.","limitations":"Single-arm design with no randomized comparator limits causal inference. Catheter selection was vessel-diameter based, introducing allocation variability. Generalizability may be limited as trial enrolled only ICA, M1, M2, and basilar occlusions.","practice_takeaway":"The Millipede 0.088-inch aspiration catheter achieved high rates of first-pass and final reperfusion (mTICI ≥2c) with low complication rates, particularly in M1 occlusions. Clinicians treating large vessel occlusion may find this system a viable front-line aspiration option, especially for larger-caliber target vessels."}},{"doi":"10.1007/s43678-026-01253-9","pmid":"42573948","title":"Treatment interventions and outcomes of stroke patients transported by helicopter emergency medical services to a comprehensive stroke center","journal_title":"Canadian Journal of Emergency Medicine","journal_issn":"1481-8035","published_at":"2026-08-10T00:00:00.000Z","url":"https://doi.org/10.1007/s43678-026-01253-9","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-14T13:24:51.373Z","updated_at":"2026-08-14T13:24:51.373Z","tags":[{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"modality","value":"Helicopter Emergency Medical Services","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"modality","value":"Thrombolysis","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"sample_size","value":"n=226","value_numeric":226},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"study_design","value":"Retrospective Population-Based Cohort Study","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"warning","value":"Sex breakdown is not reported in the abstract; the 'mixed' sex tag is inferred from the general adult population context.","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously—the study is observational and single-center; findings are strongly directional but require prospective validation.","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01253-9","tag_type":"warning","value":"The study is from a single Canadian province (Alberta) using one air transport service (STARS), which may limit applicability to other health systems or geographies.","value_numeric":null}],"summaries":{"what_studied":"This 4-year population study (2019–2022) examined 226 adults with confirmed or suspected acute ischemic stroke transported by helicopter EMS (STARS) to a comprehensive stroke center in Alberta, Canada, to determine what proportion received neuro-intervention (endovascular thrombectomy or neurosurgery) and which pre-transport factors predicted it.","key_result":"35% (n=80/226) received neuro-intervention; early (<6 h) and late (≥6 h) presenters had similar rates (36% vs. 31%, p=0.64). Pre-transport imaging (OR 5.3; 95% CI 1.8–10.7) and thrombolysis (OR 2.8; 95% CI 1.1–12.9) were the strongest independent predictors. A LAMS of 4–5 was associated with 92% neuro-intervention rate vs. 63% for lower scores. 23% (n=52) were 'low-yield' transports (died/palliated or discharged within 24 h without intervention).","limitations":"- Single comprehensive stroke center in one Canadian province limits generalizability.\n- Exploratory multivariable regression; study was not powered for definitive predictor identification.\n- 'Low-yield' transport classification does not fully account for patients who benefited from timely transfer even without neuro-intervention.","practice_takeaway":"Ensure pre-transport CT imaging and thrombolysis are completed at primary stroke centers before helicopter EMS transfer—these steps more than double to quintuple the odds of a patient receiving neuro-intervention. A LAMS of 4–5 can help identify the highest-yield candidates for urgent helicopter transport."}},{"doi":"10.1136/jnis-2026-025894","pmid":"42562636","title":"Thunderbolt System for acute ischemic stroke secondary to large vessel occlusion: primary results of the THUNDER study","journal_title":"Journal of NeuroInterventional Surgery","journal_issn":"1759-8478","published_at":"2026-08-06T00:00:00.000Z","url":"https://doi.org/10.1136/jnis-2026-025894","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-14T13:25:02.360Z","updated_at":"2026-08-14T13:25:02.360Z","tags":[{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"brand","value":"Thunderbolt","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"condition","value":"Large Vessel Occlusion","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"modality","value":"Computer-Assisted Vacuum Thrombectomy","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"modality","value":"Mechanical Thrombectomy","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"sample_size","value":"n=216","value_numeric":216},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"study_design","value":"Prospective Single-Arm Multicenter Study","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"warning","value":"Level of evidence assigned as 3 (prospective cohort); no randomized control arm was included.","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"warning","value":"Single-arm study design: no randomized comparator, so effectiveness claims vs. other devices rely on indirect historical comparisons only.","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025894","tag_type":"warning","value":"The 'Thunderbolt' brand name refers to aspiration tubing within the broader Penumbra System; clinicians should note this is a component-level innovation, not a fully standalone device.","value_numeric":null}],"summaries":{"what_studied":"The THUNDER study evaluated the safety and effectiveness of the Penumbra Thunderbolt computer-assisted vacuum thrombectomy (CAVT) system with modulated aspiration in 216 patients with emergent large vessel occlusion (ELVO) across 29 US centers, using a single-arm prospective multicenter design.","key_result":"The primary endpoint was met: post-Thunderbolt mTICI 2b-3 revascularization was achieved in 87.5% of patients (95% CI 82.3%–91.6%; p<0.001). First-pass mTICI 2b-3 was 64.8%, median time to revascularization was 20 min, sICH occurred in 0.9%, device/procedure-related SAEs in 2.8%, 90-day mRS 0–2 was 55.4%, and all-cause mortality at 90 days was 11.7%.","limitations":"Single-arm design without a concurrent control group limits causal inference. Comparison to prior large-bore catheter data is indirect and subject to patient selection differences. The study was conducted exclusively at US centers, which may limit generalizability.","practice_takeaway":"The Thunderbolt CAVT system achieved high revascularization rates (87.5% mTICI 2b-3) with a short median procedure time of 20 minutes and a low complication profile, making it a viable first-line aspiration option for ELVO. The first-pass effect rate (64.8%) numerically exceeded historical benchmarks for large-bore catheters and approached those of ultra-bore devices."}},{"doi":"10.1186/s12873-026-01711-8","pmid":null,"title":"Revalidation of the M-DIRECT scale in prehospital identification of acute stroke patients for endovascular treatment","journal_title":"BMC Emergency Medicine","journal_issn":"1471-227X","published_at":"2026-08-04T00:00:00.000Z","url":"https://doi.org/10.1186/s12873-026-01711-8","source_score":8,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-09-03T06:20:02.009Z","updated_at":"2026-09-03T06:20:02.009Z","tags":[{"paper_doi":"10.1186/s12873-026-01711-8","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01711-8","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01711-8","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01711-8","tag_type":"modality","value":"Endovascular Treatment","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01711-8","tag_type":"study_design","value":"Validation Study","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01711-8","tag_type":"warning","value":"Only bibliographic metadata was provided — no abstract, methods, results, or conclusions were included in the source text. Key result, sample size, and practice takeaway fields cannot be populated without speculation. The level of evidence and study design tags are estimated based on the study type implied by the title ('revalidation') and may not reflect the actual study design.","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01711-8","tag_type":"warning","value":"The DOI year (2026) is consistent with today's date, but the paper may be newly published and full text may not yet be widely indexed.","value_numeric":null}],"summaries":{"what_studied":"This study revalidated the M-DIRECT scale for prehospital identification of acute stroke patients likely to benefit from endovascular treatment (EVT), assessing its diagnostic accuracy in a prehospital setting.","limitations":"Only the abstract/metadata was provided; specific results, sample size, and methodology details are not available from the supplied text."}},{"doi":"10.1161/strokeaha.126.056478","pmid":"42535283","title":"Proposed Corrections to the 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-07-31T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.056478","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-07T13:23:11.203Z","updated_at":"2026-08-07T13:23:11.203Z","tags":[{"paper_doi":"10.1161/strokeaha.126.056478","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.056478","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.056478","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.056478","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.056478","tag_type":"study_design","value":"Guideline Correction / Erratum","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.056478","tag_type":"warning","value":"Only bibliographic metadata was provided — no abstract, methods, results, or correction details were available. All structured fields reflect this limitation. Clinicians should access the full text via the DOI for specific correction content.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.056478","tag_type":"warning","value":"Study design classified as 'Guideline Correction / Erratum' based on the title; this is not a primary research study and does not carry a meaningful evidence level beyond a reference/consensus document (level 7).","value_numeric":null}],"summaries":{"what_studied":"This document proposes corrections to the 2026 guideline for the early management of patients with acute ischemic stroke, as published in the journal *Stroke*.","limitations":"The source text provides only metadata (title, DOI, journal, date) with no abstract or body content, making it impossible to extract specific corrections, clinical recommendations, or supporting data.","practice_takeaway":"Clinicians using the 2026 acute ischemic stroke early management guideline should review the published corrections document to ensure they are applying the most up-to-date recommendations."}},{"doi":"10.1186/s12873-026-01706-5","pmid":null,"title":"Impact of prehospital scene-to-door time on functional outcomes after endovascular thrombectomy: insights from a regional stroke network","journal_title":"BMC Emergency Medicine","journal_issn":"1471-227X","published_at":"2026-07-27T00:00:00.000Z","url":"https://doi.org/10.1186/s12873-026-01706-5","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-08-05T13:23:02.124Z","updated_at":"2026-08-05T13:23:02.124Z","tags":[{"paper_doi":"10.1186/s12873-026-01706-5","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01706-5","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01706-5","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01706-5","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01706-5","tag_type":"study_design","value":"Observational Cohort Study","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01706-5","tag_type":"warning","value":"The full text of this paper was not provided — only the title, DOI, journal, and publication date were available. All structured fields requiring specific data (sample size, key results, limitations, practice takeaway) have been left null to avoid speculation. A full extraction requires the paper's abstract or body text.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated the impact of prehospital scene-to-door time (the interval from EMS arrival at the scene to hospital arrival) on functional outcomes in stroke patients treated with endovascular thrombectomy (EVT), using data from a regional stroke network."}},{"doi":"10.1161/str.0000000000000530","pmid":"42507797","title":"Correction to: 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-07-27T00:00:00.000Z","url":"https://doi.org/10.1161/str.0000000000000530","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-04T18:18:07.187Z","updated_at":"2026-08-04T18:18:07.187Z","tags":[{"paper_doi":"10.1161/str.0000000000000530","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000530","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000530","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000530","tag_type":"study_design","value":"Guideline Correction / Erratum","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000530","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the nature of the parent guideline (AHA/ASA national standard of care), not findings from this correction notice itself.","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000530","tag_type":"warning","value":"This document is a correction/erratum to a clinical practice guideline, not a primary research paper. No study design, sample size, or clinical outcome data are present. The specific content of the correction is not available in the provided source text, so no detail about what was corrected can be confirmed.","value_numeric":null}],"summaries":{"what_studied":"This is a published correction (erratum) to the 2026 AHA/ASA guideline for the early management of acute ischemic stroke, not a primary research study.","limitations":"As a correction notice, this document contains no primary data, outcomes, or clinical results to evaluate.","practice_takeaway":"Clinicians using the 2026 AHA/ASA Acute Ischemic Stroke guideline should review this correction to ensure they are applying the most up-to-date and accurate recommendations."}},{"doi":"10.1186/s12873-026-01654-0","pmid":"42380816","title":"Diagnostic accuracy of the ROSIER scale for detecting acute ischemic stroke: a comparison with FAST-ED, CPSS, and reference criteria","journal_title":"BMC Emergency Medicine","journal_issn":"1471-227X","published_at":"2026-06-30T00:00:00.000Z","url":"https://doi.org/10.1186/s12873-026-01654-0","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-06T13:36:20.105Z","updated_at":"2026-07-06T13:36:20.105Z","tags":[{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"modality","value":"Clinical Stroke Scale","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"sample_size","value":"n=655","value_numeric":655},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"study_design","value":"Prospective Cross-Sectional Study","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"warning","value":"AUROC differences between tools were not statistically significant, so rankings by sensitivity/specificity should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"warning","value":"NIHSS is included as a comparator despite being a severity scale rather than a purely diagnostic tool — its use as a diagnostic comparator may not reflect standard clinical workflows.","value_numeric":null},{"paper_doi":"10.1186/s12873-026-01654-0","tag_type":"warning","value":"The study was conducted at a single center in an ED setting; prehospital performance of these scales (especially NIHSS) may differ significantly in real-world field conditions.","value_numeric":null}],"summaries":{"what_studied":"This prospective cross-sectional study compared the diagnostic accuracy of four clinical stroke scales — ROSIER, CPSS, FAST-ED, and NIHSS — for detecting acute ischemic stroke (AIS) in 655 adult ED patients with suspected stroke, using brain MRI as the gold standard (June 2021–2023).","key_result":"All four tools showed good accuracy (AUROCs: CPSS 0.860, NIHSS 0.822, ROSIER 0.813, FAST-ED 0.811; no significant differences). CPSS was most sensitive (90.7% at ≥2), while NIHSS was most specific (81.5% at ≥8). 72.8% of patients (477/655) had confirmed AIS.","limitations":"- Single-center, ED-only design limits prehospital generalizability.\n- Cross-sectional study prevents assessment of inter-rater reliability across settings.\n- NIHSS requires trained examiners, which may not reflect real-world prehospital conditions.","practice_takeaway":"For prehospital or resource-limited settings, CPSS (≥2) offers the best sensitivity (90.7%) to rule out missed strokes. In the ED, NIHSS (≥8) provides better specificity (81.5%) to confirm AIS before imaging."}},{"doi":"10.18176/jiaci.1151","pmid":"41891507","title":"Acute Single Subcortical Infarction and Atypical Purpura in Eosinophilic Granulomatosis with Polyangiitis: A Case Report","journal_title":"Journal of Investigational Allergology and Clinical Immunology","journal_issn":"1018-9068","published_at":"2026-06-16T00:00:00.000Z","url":"https://doi.org/10.18176/jiaci.1151","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:16.722Z","updated_at":"2026-06-22T13:24:16.722Z","tags":[{"paper_doi":"10.18176/jiaci.1151","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"condition","value":"Eosinophilic Granulomatosis with Polyangiitis","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"condition","value":"Purpura","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"condition","value":"Vasculitis","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.18176/jiaci.1151","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"warning","value":"Age, sex, and treatment details of the patient are not available from the provided metadata alone; tags for age_group, sex, and modality/generic drug could not be populated.","value_numeric":null},{"paper_doi":"10.18176/jiaci.1151","tag_type":"warning","value":"The paper was published June 16, 2026, and is very recent — full text details (e.g., ANCA status, treatment used) were not supplied, so summary content is limited to what can be inferred from the title and journal entry.","value_numeric":null}],"summaries":{"what_studied":"A case report describing a patient with eosinophilic granulomatosis with polyangiitis (EGPA) who presented with two uncommon manifestations: acute single subcortical infarction (stroke) and atypical purpura.","key_result":"The case documents the co-occurrence of acute single subcortical cerebral infarction and atypical purpuric skin lesions as rare presenting features of EGPA, expanding the known clinical spectrum of this vasculitis.","limitations":"Single case report limits generalizability; causal mechanisms between EGPA and the neurological/cutaneous findings cannot be definitively established from one patient.","practice_takeaway":"Clinicians should consider EGPA in patients presenting with eosinophilia alongside atypical purpura or unexplained ischemic stroke, as neurological and atypical cutaneous manifestations may be underrecognized features of this vasculitis."}},{"doi":"10.1001/jamaneurol.2026.1706","pmid":"42258192","title":"Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke","journal_title":"JAMA Neurology","journal_issn":"2168-6149","published_at":"2026-06-08T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13247842/","source_score":59,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-14T13:34:43.534Z","updated_at":"2026-06-14T13:34:43.534Z","tags":[{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"condition","value":"Hemorrhagic Transformation","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"condition","value":"Large Vessel Occlusion","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"modality","value":"Antihypertensive Therapy","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"modality","value":"Vasopressor Therapy","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"sample_size","value":"n=440","value_numeric":440},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"warning","value":"Serious adverse events were numerically higher in the intervention group (15.8% vs. 12.0%), though not statistically significant; this asymmetry warrants monitoring in future studies.","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"warning","value":"The study enrolled only anterior circulation large-vessel occlusions with mTICI ≥2b; findings should not be extrapolated to incomplete reperfusion or posterior circulation strokes.","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.1706","tag_type":"warning","value":"The trial is open-label; clinicians and treating teams knew the assigned BP target, which could influence co-interventions beyond BP management.","value_numeric":null}],"summaries":{"what_studied":"This multicenter RCT (11 Spanish stroke centers, June 2021–October 2025) evaluated whether a reperfusion-guided systolic BP strategy (140–160 mmHg for mTICI 2b; 100–140 mmHg for mTICI 2c/3) improved 90-day functional outcomes vs. guideline-recommended management (systolic BP <180 mmHg) in 440 adults with acute ischemic stroke after successful endovascular therapy.","key_result":"At 90 days, 60.0% of the intervention group achieved mRS 0–2 vs. 47.1% in controls (ARD +13.3%; 95% CI 4.1%–22.6%; P = .005). Hemorrhagic transformation was lower in the intervention group (22.3% vs. 31.6%; OR 0.62, 95% CI 0.41–0.95). Symptomatic intracranial hemorrhage (3.5% vs. 3.9%) and 90-day mortality (15.4% vs. 15.6%) did not differ.","limitations":"- Open-label design (blinded endpoint assessment only) may introduce treatment bias.\n- Single-country trial (Spain) limits generalizability to other health systems and demographics.\n- Mean age of 75 years and anterior circulation occlusions only; results may not apply to younger patients or posterior circulation strokes.","practice_takeaway":"After successful thrombectomy, tailor post-procedure BP targets to reperfusion quality: aim for systolic 100–140 mmHg with complete reperfusion (mTICI 2c/3) and 140–160 mmHg with partial reperfusion (mTICI 2b) for 72 hours. This approach significantly improved good functional outcomes and cut hemorrhagic transformation rates without raising mortality or symptomatic hemorrhage risk."}},{"doi":"10.1161/strokeaha.126.055575","pmid":"42227105","title":"Diagnostic Yield of Cardiac CT to Detect Cardiac Thrombi in Patients With Acute Ischemic Stroke (AIS of HEARTS)","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-06-02T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.055575","source_score":15,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-01T13:22:03.374Z","updated_at":"2026-08-01T13:22:03.374Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"condition","value":"Cardiac Thrombus","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"condition","value":"Cardioembolic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"modality","value":"Cardiac Computed Tomography","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"modality","value":"Transthoracic Echocardiography","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"sample_size","value":"n=3919","value_numeric":3919},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"study_design","value":"Individual Patient Data Meta-Analysis","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"warning","value":"ECG-gated vs. non-ECG-gated protocols were used at different sites, introducing heterogeneity in both thrombus detection rates (7.6% vs. 5.4%) and scan time data.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"warning","value":"Median age of 74 years limits generalizability to younger stroke populations.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"warning","value":"TEE was performed in only 126 patients (too small for robust comparison), so cardiac CT vs. TEE yield data should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"warning","value":"The study is observational; despite multivariable adjustment, causal conclusions about thrombus detection and outcomes should be made cautiously.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055575","tag_type":"warning","value":"TIA patients were excluded, so results may not generalize to milder cerebrovascular events.","value_numeric":null}],"summaries":{"what_studied":"This 1-stage individual patient data meta-analysis of 4 prospective observational cohorts evaluated the diagnostic yield of cardiac CT (ECG-gated and non-ECG-gated) added to the acute stroke imaging protocol in 3,919 patients with AIS between May 2018 and June 2024. Primary outcome was proportion with cardiac thrombus detected; secondary outcomes included comparison with TTE, additional scan time, radiation dose, and 90-day functional outcomes.","key_result":"Cardiac CT detected a thrombus in 243/3,919 (6.2%) patients, with 7.4× higher yield than TTE (OR 7.4, 95% CI 4.0–15.1, P<0.001) among 1,323 patients who had both. Patients with thrombi had higher 90-day mortality (33% vs 15%, aOR 1.6, 95% CI 1.1–2.3) and worse mRS scores (median 3 vs 2, aOR 1.6, 95% CI 1.2–2.0), but similar recurrent stroke rates (5% vs 4%, aOR 1.4, 95% CI 0.7–2.5). Non-ECG-gated CT added only 13 seconds; ECG-gated added 6 minutes; median extra radiation was 2.9 mSv.","limitations":"- Scan protocol and thrombus definitions varied across the 4 hospitals; the LV was not visualized in 31% of patients, likely missing some thrombi.\n- Echocardiography was performed in only ~one-third of patients, with a median 9-day delay after cardiac CT, raising the possibility of thrombus dissolution before TTE.\n- Observational design means residual confounding cannot be excluded, and reliance on medical records may have underestimated recurrent stroke and other events.","practice_takeaway":"Adding cardiac CT to the acute stroke scan protocol is feasible and finds a cardiac thrombus in ~1 in 16 AIS patients, with far better yield than TTE—especially for left atrial appendage thrombi. Clinicians should consider integrating cardiac CT (particularly non-ECG-gated, which adds only seconds) into routine acute stroke imaging, as early thrombus detection can guide timely anticoagulation decisions."}},{"doi":"10.1161/strokeaha.126.055632","pmid":"42212393","title":"Intensive Versus Conventional Blood Pressure Lowering After Successful Endovascular Thrombectomy: OPTIMAL-BP 1-Year Outcomes","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-05-29T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.055632","source_score":19,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-31T13:37:12.563Z","updated_at":"2026-07-31T13:37:12.563Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"condition","value":"Large Vessel Occlusion","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"modality","value":"Antihypertensive Therapy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"sample_size","value":"n=306","value_numeric":306},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"warning","value":"The ITT primary endpoint (functional independence at 1 year) narrowly missed conventional statistical significance (P=0.051); the practice-changing flag is based on the convergent per-protocol result and consistency with prior short-term harm signals — clinicians should weigh this context.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"warning","value":"The level of evidence is set to 2 (phase 3 RCT) rather than 1 because this is a 1-year follow-up extension of the original trial, not a pre-specified primary trial analysis.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055632","tag_type":"warning","value":"The trial was conducted exclusively in South Korea; applicability to other ethnic or healthcare populations is uncertain.","value_numeric":null}],"summaries":{"what_studied":"This phase 3 RCT (OPTIMAL-BP, 19 centers in South Korea) compared intensive BP lowering (systolic BP target <140 mmHg) vs. conventional management (140–180 mmHg) for 24 hours after successful endovascular thrombectomy in acute ischemic stroke patients with large vessel occlusion and post-recanalization hypertension; 1-year outcomes were assessed in 294 of 306 randomized patients.","key_result":"Functional independence (mRS 0–2) at 1 year was lower in the intensive group vs. conventional group (40.5% vs. 52.7%; aOR 0.59 [95% CI 0.34–1.00]; P=0.051 by ITT; per-protocol: 41.1% vs. 54.7%, aOR 0.56, P=0.040); 1-year mortality and mRS shift from 3 months to 1 year did not differ between groups.","limitations":"- Open-label design (blinded endpoints only) may introduce management bias.\n- Single-country study (South Korea) limits generalizability.\n- ITT primary endpoint narrowly missed statistical significance (P=0.051), reaching significance only in per-protocol analysis.","practice_takeaway":"Avoid targeting systolic BP <140 mmHg in the first 24 hours after successful thrombectomy — the harm seen at 90 days persists at 1 year. Maintain systolic BP in the 140–180 mmHg range per current guidelines in this setting."}},{"doi":"10.1161/strokeaha.125.051476","pmid":"42200274","title":"Thromboinflammation in Acute Stroke: From Pathophysiological Challenges to Emerging Therapeutic Opportunities","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-05-27T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.125.051476","source_score":20,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-01T13:39:38.822Z","updated_at":"2026-06-01T13:39:38.822Z","tags":[{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"condition","value":"Ischemia-Reperfusion Injury","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"modality","value":"Anti-Inflammatory Agent","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"modality","value":"Complement Inhibitor","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"modality","value":"Thrombolysis","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the paradigm-shift framing of the review; actual clinical practice change awaits prospective trial validation of the described therapies.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"warning","value":"The 'nearly half of patients' failure-to-recover statistic is cited without a specific primary source in the abstract — clinicians should verify this figure in the full text.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.051476","tag_type":"warning","value":"This is a narrative review published in 2026; therapeutic strategies discussed are framed as 'emerging' and may not yet have Phase III trial evidence.","value_numeric":null}],"summaries":{"what_studied":"This review examines thromboinflammation in acute ischemic stroke — specifically the interplay of coagulation and innate immunity (NETs, platelet-leukocyte aggregates, complement activation) — and how it drives the recanalization-reperfusion gap, no-reflow, and ischemia-reperfusion injury despite successful vessel reopening.","key_result":"The authors identify thromboinflammation as a core reason nearly half of patients fail functional recovery after technically successful recanalization, and outline emerging strategies: enzymatic NET-targeting, adjunctive anti-inflammatory agents, biomarker-guided precision approaches, and novel device technologies.","limitations":"As a narrative review, no original patient data or meta-analytic pooling is provided; therapeutic strategies discussed are largely pre-clinical or early-phase, limiting direct clinical translation.","practice_takeaway":"Successful vessel reopening alone does not guarantee tissue recovery — clinicians should recognize the thromboinflammatory biology driving no-reflow and reperfusion injury as active therapeutic targets. Emerging adjunctive anti-inflammatory strategies may eventually complement standard thrombolysis and thrombectomy to close the recanalization-reperfusion gap."}},{"doi":"10.1161/jaha.125.046038","pmid":"42179273","title":"Association of 24‐Hour Computed Tomography Infarct Density on Functional Outcomes in Stroke: Secondary Analysis From the AcT Trial","journal_title":"Journal of the American Heart Association","journal_issn":"2047-9980","published_at":"2026-05-25T00:00:00.000Z","url":"https://doi.org/10.1161/jaha.125.046038","source_score":15,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-03T13:38:57.310Z","updated_at":"2026-07-03T13:38:57.310Z","tags":[{"paper_doi":"10.1161/jaha.125.046038","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"brand","value":"Activase","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"generic","value":"alteplase","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"generic","value":"tenecteplase","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"modality","value":"Thrombolytic Therapy","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"sample_size","value":"n=839","value_numeric":839},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"study_design","value":"Secondary Analysis of Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"warning","value":"Median infarct volume was small (7.5 mL), which may limit applicability to large-core stroke populations.","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"warning","value":"The female sex percentage in the abstract (9.3%) appears to be a typographical error in the source text; the results section and Table 1 correctly state 414/839 (49.3%) female.","value_numeric":null},{"paper_doi":"10.1161/jaha.125.046038","tag_type":"warning","value":"The study is a secondary/post-hoc analysis of the AcT trial, so results are exploratory and no correction for multiple comparisons was applied — interpret effect sizes cautiously.","value_numeric":null}],"summaries":{"what_studied":"This secondary analysis of the AcT RCT evaluated whether 24-hour CT standardized infarct density (mean HU ÷ SD within the infarct) modifies the relationship between 24-hour CT infarct volume and 90-day functional outcomes in 839 acute ischemic stroke patients treated with IV thrombolysis within 4.5 hours.","key_result":"Higher standardized infarct density (less severe infarction) was independently associated with better 90-day mRS score (acOR 0.87 per 1-sHU increase; 95% CI 0.80–0.96), while infarct volume alone was not (acOR 0.96 per 5-mL increase; 95% CI 0.90–1.01). Density significantly modified the effect of volume on mRS (P-interaction=0.001) and mortality (P-interaction=0.014).","limitations":"- Blood products and contrast leakage in hemorrhagic infarction may artificially elevate CT density, especially in larger infarcts.\n- Heterogeneous CT scanner models and acquisition protocols across centers could affect HU measurements.\n- Excludes ~one-third of the AcT cohort (no visible infarct or parenchymal hematoma) and patients treated beyond 4.5 hours, limiting generalizability to mild strokes and late-window cases.","practice_takeaway":"When reviewing 24-hour CT after thrombolysis, consider assessing infarct density (degree of hypodensity), not just volume — a more hypodense lesion signals worse infarct severity and worse prognosis independent of size. These findings need external validation before changing routine practice."}},{"doi":"10.1161/strokeaha.126.055331","pmid":"42100815","title":"Redefining the Cerebral Ischemic Core-Penumbra-Oligemia Continuum","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-05-08T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.055331","source_score":51,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-12","doi":"10.1161/strokeaha.126.055331","days":"14","issn":"0039-2499","rank":"6","field":"Clinical Medicine","score":"51","category":"Clinical Neurology","categories":["Clinical Neurology"],"_categories":["Clinical Neurology"]},"pubmed":{"doi":"10.1161/STROKEAHA.126.055331","title":"Redefining the Cerebral Ischemic Core-Penumbra-Oligemia Continuum.","journal":"Stroke","methods":"","results":"","abstract":"$30","keywords":["infarction","perfusion","reperfusion","stroke","thrombectomy"],"pubmed_id":"42100815","conclusions":"","publication_date":"2026-05-08T00:00:00"},"crossref":{"DOI":"10.1161/strokeaha.126.055331","URL":"https://doi.org/10.1161/strokeaha.126.055331","ISSN":["0039-2499","1524-4628"],"link":[{"URL":"https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.126.055331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Redefining the Cerebral Ischemic Core-Penumbra-Oligemia Continuum"],"author":[{"given":"Umberto","family":"Pensato","sequence":"first","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Milan, Italy (U.P.)."},{"name":"Department of Biomedical Sciences, Humanitas University, Milan, Italy (U.P.)."}]},{"given":"Johanna M.","family":"Ospel","sequence":"additional","affiliation":[{"name":"Department of Radiology (J.M.O.), University of Calgary, Alberta, Canada."}]},{"given":"Aravind","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}]},{"given":"Nishita","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Canada (N.S.)."}]},{"given":"Mohammed","family":"Almekhlafi","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}]},{"given":"Gabriel","family":"Broocks","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (G. Broocks)."},{"name":"Department of Neuroradiology, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany (G. Broocks)."}]},{"given":"Giorgio","family":"Busto","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy (G. Busto, E.F.)."}]},{"given":"Enrico","family":"Fainardi","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy (G. Busto, E.F.)."},{"name":"Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (E.F.)."}]},{"given":"Diego","family":"Gutierrez Vasquez","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, Pontifical Catholic University of Chile, Santiago (D.G.V.)."}]},{"given":"Tyler","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dalhousie University, Halifax, Nova Scotia, Canada (T.H.)."}]},{"given":"Maarten G.","family":"Lansberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stanford University School of Medicine, CA (M.G.L., G.W.A.)."}]},{"given":"Felix","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (F.N., B.C.V.C.)."}]},{"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.)."}]},{"given":"Jean-Marc","family":"Olivot","sequence":"additional","affiliation":[{"name":"Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulousepital Pierre-Paul Riquet, CHU Toulouse, France (J.-M.O.)."}]},{"given":"Mark W.","family":"Parsons","sequence":"additional","affiliation":[{"name":"Neurology Department, John Hunter and Liverpool Hospitals, Ingham Institute of Applied Medical Science, University of New South Wales, Sydney, Australia (M.W.P.)."}]},{"given":"Vignan","family":"Yogendrakumar","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (V. Yogendrakumar)."}]},{"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Italy (A.Z.)."}]},{"given":"Beom Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cerebrovascular Disease Center Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K.)."}]},{"given":"Vivek","family":"Yedavalli","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD (V. Yedavalli)."}]},{"given":"Gregory W.","family":"Albers","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stanford University School of Medicine, CA (M.G.L., G.W.A.)."}]},{"given":"Bruce C.V.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (F.N., B.C.V.C.)."}]},{"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}]},{"given":"Bijoy K.","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}]},{"given":"Andrew M.","family":"Demchuk","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., 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It summarizes evidence challenging the binary view and proposes a 6-level continuum: benign oligemia, vulnerable oligemia, durable penumbra, critical penumbra, nonleaky core, and leaky core, with clinical implications.","key_result":"Clinical benefits and hemorrhagic transformation with reperfusion therapies are observed across a spectrum of core volumes, challenging deterministic assumptions of the core–penumbra hypothesis; the authors propose a 6-tier tissue vulnerability framework in response.","limitations":"Conceptual review without new empirical data or quantitative validation of the proposed 6-level classification; no numerical outcomes or thresholds are provided.","practice_takeaway":"Do not treat automated core–penumbra thresholds as deterministic; infarct evolution is a continuum. 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Neuroradiol","doi-asserted-by":null},{"DOI":"10.1161/STROKEAHA.114.005249","key":"e_1_3_3_14_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1212/WNL.0000000000002862","key":"e_1_3_3_15_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1002/acn3.52236","key":"e_1_3_3_16_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1161/STROKEAHA.116.013805","key":"e_1_3_3_17_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1161/STROKEAHA.121.036104","key":"e_1_3_3_18_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1016/j.ijsu.2014.07.013","key":"e_1_3_3_19_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1002/9781118548387","key":"e_1_3_3_20_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1161/STROKEAHA.124.050171","key":"e_1_3_3_21_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1136/neurintsurg-2021-017946","key":"e_1_3_3_22_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1161/STROKEAHA.121.036670","key":"e_1_3_3_23_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1080/07853890.2025.2453635","key":"e_1_3_3_24_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1177/23969873251357151","key":"e_1_3_3_25_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1002/ana.26478","key":"e_1_3_3_26_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1161/STROKEAHA.117.017080","key":"e_1_3_3_27_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1007/s00281-023-00984-6","key":"e_1_3_3_28_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1002/ana.25785","key":"e_1_3_3_29_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1155/2021/9933015","key":"e_1_3_3_30_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1111/jon.13172","key":"e_1_3_3_31_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1161/01.STR.0000144051.32131.09","key":"e_1_3_3_32_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1161/STROKEAHA.122.039090","key":"e_1_3_3_33_2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"}],"short-title":[],"update-policy":"https://doi.org/10.1161/crossmarkpolicy","alternative-id":["10.1161/STROKEAHA.126.055955"],"article-number":"STROKEAHA.126.055955","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"original-title":[],"container-title":["Stroke"],"reference-count":32,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,6]]},"references-count":32,"short-container-title":["Stroke"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1161/strokeaha.126.055955","is_oa":true,"title":"Core Blood-Brain Barrier Disruption in Patients With Large Vessel Occlusion","updated":"2026-05-12T08:54:10+00:00","published_date":"2026-05-06","best_oa_location":{"url":"https://doi.org/10.1161/strokeaha.126.055955","pmh_id":null,"url_for_pdf":null,"url_for_landing_page":"https://doi.org/10.1161/strokeaha.126.055955"}}},"created_at":"2026-05-10T13:20:48.394Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"condition","value":"Blood-Brain Barrier Disruption","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"condition","value":"Large Vessel Occlusion","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"modality","value":"Endovascular Therapy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"modality","value":"MRI Perfusion-Weighted Imaging","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"sample_size","value":"n=291","value_numeric":291},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"study_design","value":"Retrospective Multicenter Cohort Study","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"warning","value":"Median patient age of 74 years suggests an older cohort; findings may not generalize to younger stroke populations.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — while results are compelling, this is a retrospective study and cBBBD is not yet a validated clinical tool; prospective studies are needed.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"warning","value":"The study population was limited to patients transferred between stroke centers with pre-transfer MRI, which is not standard at all centers and may introduce selection bias.","value_numeric":null}],"summaries":{"what_studied":"This retrospective multicenter study evaluated core blood-brain barrier disruption (cBBBD) measured via MRI perfusion-weighted imaging in 291 anterior circulation large vessel occlusion (LVO) stroke patients transferred from primary to comprehensive stroke centers over 4 years, examining associations with baseline clinical/imaging variables and 3-month functional outcome.","key_result":"Each 1% increase in cBBBD was independently associated with a 16% higher odds of poor functional outcome (mRS >2 at 3 months; aOR 1.16 [95% CI, 1.03–1.32]; P=0.019). Admission NIHSS (P<0.001) and glucose (P=0.033) were independently correlated with cBBBD; mismatch ratio showed the strongest imaging correlation (r=0.50, r²=0.254).","limitations":"- Retrospective design with potential selection bias; only patients transferred from primary to comprehensive stroke centers are included, limiting generalizability.\n- Significant reduction from 411 eligible to 291 included patients (and 279 for outcome analysis) raises concern for incomplete data.\n- cBBBD measurement relies on RAPID software contrast leakage detection, and thresholds/methodology are not independently validated in this cohort.","practice_takeaway":"In LVO stroke, higher core BBB disruption on admission MRI independently predicts worse 3-month outcomes — consider cBBBD as an additional imaging biomarker alongside core volume and mismatch ratio when counseling patients and families. This metric may eventually help refine patient selection for endovascular therapy, though prospective validation is needed."}},{"doi":"10.1161/strokeaha.126.055656","pmid":"42089412","title":"Time-Dependent Efficacy of Thrombolysis Before Thrombectomy: RES-Q","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-05-06T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.055656","source_score":18,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-01T13:22:03.759Z","updated_at":"2026-08-01T13:22:03.759Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"condition","value":"Large Vessel Occlusion","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"generic","value":"alteplase","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"modality","value":"Thrombolysis","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"sample_size","value":"n=3009","value_numeric":3009},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"study_design","value":"Observational Registry Cohort Study","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"warning","value":"Mean age of 69.2 years with 45.6% female places the cohort primarily in the older adult range but includes a broad adult age spectrum.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"warning","value":"The generic tag 'alteplase' is inferred as the most common IVT agent; the paper does not explicitly name the thrombolytic used.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied with caution — this is observational data and the authors themselves note randomized confirmation is needed.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055656","tag_type":"warning","value":"The study population is described as 'anterior-circulation LVO'; posterior-circulation strokes were excluded, limiting generalizability.","value_numeric":null}],"summaries":{"what_studied":"This multinational observational cohort study (RES-Q registry, 2022–2024, 38 countries) evaluated whether treatment timing modifies the benefit of combined IVT+EVT versus EVT alone in 3,009 anterior-circulation large-vessel occlusion patients, using ordinal mRS at discharge as the primary outcome across four onset-to-needle time strata (≤100, >100–150, >150–255, and >255 minutes).","key_result":"IVT+EVT showed the strongest benefit in the earliest windows: at ≤100 min, ordinal mRS OR 1.99 (95% CI 1.49–2.63), mRS 0–2 OR 1.76 (95% CI 1.24–2.51), and in-hospital survival OR 1.81 (95% CI 1.13–2.92); at >100–150 min, ordinal mRS OR 1.58 and mRS 0–2 OR 1.64; benefit was attenuated beyond 150 minutes (treatment-by-time interaction P=0.002 for ordinal mRS, P=0.02 for mRS 0–2).","limitations":"- Observational design limits causal inference despite inverse probability weighting; unmeasured confounders (e.g., clot burden, collateral status) may persist.\n- Onset-to-needle time for EVT-only patients was predicted (not measured), introducing classification uncertainty in time strata.\n- Outcomes are discharge mRS only — no 90-day follow-up data available.","practice_takeaway":"Prioritize combining IVT with EVT when thrombolysis can be delivered within 150 minutes of onset — the benefit is strongest under 100 minutes and diminishes beyond 150 minutes. Beyond 150 minutes, EVT alone may be sufficient, though this registry finding should be confirmed in randomized trials."}},{"doi":"10.1016/j.jemermed.2026.04.021","pmid":"42275899","title":"Repeat Intravenous Tenecteplase for Posterior Circulation Stroke Without Completed Infarction","journal_title":"The Journal of Emergency Medicine","journal_issn":"0736-4679","published_at":"2026-04-30T00:00:00.000Z","url":"https://doi.org/10.1016/j.jemermed.2026.04.021","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-19T13:23:26.673Z","updated_at":"2026-06-19T13:23:26.673Z","tags":[{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"condition","value":"Basilar Artery Occlusion","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"condition","value":"Posterior Circulation Stroke","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"condition","value":"Vertebral Artery Dissection","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"generic","value":"tenecteplase","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"modality","value":"Thrombolytic","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"warning","value":"Study design classification as 'Case Report' is unambiguous, but the level of evidence (5) reflects this limitation explicitly.","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"warning","value":"The interval between doses (~140 hours) is unusually long — the relevance of this timing to repeat-dosing safety is unclear and not generalizable.","value_numeric":null},{"paper_doi":"10.1016/j.jemermed.2026.04.021","tag_type":"warning","value":"This is a single case report (n=1); no safety or efficacy conclusions can be drawn beyond the individual patient described.","value_numeric":null}],"summaries":{"what_studied":"A single case of repeat IV tenecteplase administration in a 39-year-old woman with early recurrent posterior circulation stroke (right vertebral artery dissection with subsequent basilar artery occlusion), with the second dose given ~140 hours after the first.","key_result":"Repeat IV tenecteplase resulted in rapid neurologic recovery and restoration of posterior circulation flow, with no thrombolysis-related complications and neurologically intact discharge.","limitations":"Single case report — no generalizability or safety data beyond this one patient. Nearly all prior repeat thrombolysis literature involves alteplase, not tenecteplase. Selection bias is inherent: only patients with disabling symptoms and no completed infarction were considered.","practice_takeaway":"In highly selected patients with disabling recurrent posterior circulation stroke symptoms and no completed infarction, repeat IV tenecteplase may be a viable rescue option. Timely vascular imaging and multidisciplinary input are essential before this decision."}},{"doi":"10.5853/jos.2025.05211","pmid":"42019946","title":"Early Anticoagulation in Acute Ischemic Stroke With Atrial Fibrillation","journal_title":"Journal of Stroke","journal_issn":"2287-6391","published_at":"2026-04-23T00:00:00.000Z","url":"https://doi.org/10.5853/jos.2025.05211","source_score":37,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-13T15:34:56.829Z","updated_at":"2026-06-13T15:34:56.829Z","tags":[{"paper_doi":"10.5853/jos.2025.05211","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"brand","value":"Xarelto","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"condition","value":"Acute Ischemic Stroke","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"generic","value":"apixaban","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"generic","value":"dabigatran","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"generic","value":"edoxaban","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"generic","value":"rivaroxaban","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"generic","value":"warfarin","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"modality","value":"Direct Oral Anticoagulant","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"modality","value":"Vitamin K Antagonist","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"sample_size","value":"n=5441","value_numeric":5441},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"warning","value":"Mean age of 77.7 years and 45.4% female in the CATALYST IPDMA may not fully represent all AIS-AF populations, especially younger patients or those with valvular AF (who were excluded from trials).","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"warning","value":"The CATALYST IPDMA sample size of 5,441 reflects the pooled RCT population cited in this review; individual trial sizes differ. The review's own sample size tag reflects this pooled figure.","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"warning","value":"The level of evidence (2) reflects the IPDMA of RCTs underpinning the review's primary conclusions; the review itself is narrative and does not conduct original analysis.","value_numeric":null},{"paper_doi":"10.5853/jos.2025.05211","tag_type":"warning","value":"The paper is authored by clinicians affiliated with institutions in Korea and Japan, which may reflect a perspective particularly attentive to Asian patient considerations.","value_numeric":null}],"summaries":{"what_studied":"This narrative review synthesizes evidence on the optimal timing of NOAC initiation after acute ischemic stroke (AIS) in patients with atrial fibrillation (AF), integrating data from four RCTs (TIMING, ELAN, OPTIMAS, START) and the CATALYST individual patient data meta-analysis (IPDMA) of 5,441 patients.","key_result":"The CATALYST IPDMA found early NOAC initiation (≤4 days) significantly reduced the composite of recurrent ischemic stroke, symptomatic ICH, or unclassified stroke at 30 days vs. late initiation (2.12% vs. 3.02%; OR 0.70; 95% CI 0.50–0.98; NNT=108), with no increase in symptomatic ICH (0.37% vs. 0.36%). Individual RCTs confirmed non-inferiority of early initiation across stroke severities.","limitations":"- Patients with very severe stroke (NIHSS >15) were underrepresented across all RCTs (8.9–12.6%), limiting generalizability to this group.\n- Asian patients comprised only 5.3% of the four RCT populations (355/6,722), leaving uncertainty about applicability to higher-bleeding-risk Asian populations.\n- Data on early NOAC use in patients with hemorrhagic transformation remain sparse (only 247 patients with HT in the ELAN subanalysis).","practice_takeaway":"For most patients with AF-related AIS of mild-to-moderate severity, starting a NOAC within 4 days appears safe and reduces early recurrent ischemic stroke without increasing bleeding risk. Decisions should still be individualized for severe stroke, hemorrhagic transformation, and Asian patients, where evidence remains limited."}}],"initialOffset":24,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Acute Ischemic Stroke"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Acute Ischemic Stroke"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Acute Ischemic Stroke"}}}]]

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