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:T6e1,Novel stroke risk factors have received widespread attention. This study examined the association between sarcopenia status, grip strength, and walking pace with incident stroke (any stroke, ischemic stroke, and hemorrhagic stroke) and poststroke mortality. This prospective study included 482 699 participants from the UK Biobank, a large-scale, population-based cohort. Sarcopenia status was assessed according to the EWGSOP2 criteria (European Working Group on Sarcopenia in Older People 2). Incident strokes were ascertained based on health records. Stroke risk was assessed using multivariable-adjusted Cox proportional hazards models, whereas poststroke mortality was compared using the Kaplan-Meier analysis with log-rank tests. A 2-sample Mendelian randomization analysis, utilizing genetic instruments from public genome-wide association studies, was conducted to infer causal associations. The cohort (mean age±SD: 56.4±8.1 years; 45.37% were men; n=219 015) had a probable sarcopenia prevalence of 4.7% and a confirmed sarcopenia prevalence of 0.4%. Participants with probable sarcopenia had a higher risk of any stroke (adjusted hazard ratio [aHR], 1.30 [95% CI, 1.21-1.39]), ischemic stroke (aHR, 1.31 [95% CI, 1.22-1.42]), and hemorrhagic stroke (aHR, 1.41 [95% CI, 1.20-1.67]) than those without. Among those who had a stroke, probable or confirmed sarcopenia was associated with increased all-cause mortality. Higher risk of any stroke was associated with lower grip strength (absolute: aHR, 1.07 [95% CI, 1.06-1.09] per 5 kg; relative: aHR, 1.36 [95% CI, 1.28-1.44] per 1 kg/[kg/m Sarcopenia status, lower grip strength, and slower walking pace were associated with an increased risk of incident stroke and all-cause poststroke mortality.31:Tafe, BACKGROUND: Novel stroke risk factors have received widespread attention. This study examined the association between sarcopenia status, grip strength, and walking pace with incident stroke (any stroke, ischemic stroke, and hemorrhagic stroke) and poststroke mortality. METHODS: This prospective study included 482 699 participants from the UK Biobank, a large-scale, population-based cohort. Sarcopenia status was assessed according to the EWGSOP2 criteria (European Working Group on Sarcopenia in Older People 2). Incident strokes were ascertained based on health records. Stroke risk was assessed using multivariable-adjusted Cox proportional hazards models, whereas poststroke mortality was compared using the Kaplan-Meier analysis with log-rank tests. A 2-sample Mendelian randomization analysis, utilizing genetic instruments from public genome-wide association studies, was conducted to infer causal associations. RESULTS: The cohort (mean age±SD: 56.4±8.1 years; 45.37% were men; n=219 015) had a probable sarcopenia prevalence of 4.7% and a confirmed sarcopenia prevalence of 0.4%. Participants with probable sarcopenia had a higher risk of any stroke (adjusted hazard ratio [aHR], 1.30 [95% CI, 1.21−1.39]), ischemic stroke (aHR, 1.31 [95% CI, 1.22−1.42]), and hemorrhagic stroke (aHR, 1.41 [95% CI, 1.20−1.67]) than those without. Among those who had a stroke, probable or confirmed sarcopenia was associated with increased all-cause mortality. Higher risk of any stroke was associated with lower grip strength (absolute: aHR, 1.07 [95% CI, 1.06−1.09] per 5 kg; relative: aHR, 1.36 [95% CI, 1.28−1.44] per 1 kg/[kg/m 2 ]) and a slow walking pace (aHR, 1.64 [95% CI, 1.54−1.75]; compared with brisk pace). Mendelian randomization analysis demonstrated that a faster walking pace was associated with a lower risk of any stroke (odds ratio, 0.94 [95% CI, 0.90−0.97] per-SD increase) and ischemic stroke (odds ratio, 0.95 [95% CI, 0.91−0.98] per-SD increase). CONCLUSIONS: Sarcopenia status, lower grip strength, and slower walking pace were associated with an increased risk of incident stroke and all-cause poststroke mortality. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Ischemic Stroke: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Ischemic Stroke (condition). Clinician-written summaries and actionable practice insights. 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Pancreatic cancer carried the highest risk (SIR 5.9; 95% CI 4.8–7.3), followed by lung cancer (SIR 3.9; 95% CI 3.4–4.4). Younger patients (40–54 yrs) had SIR 3.6 vs. 1.4 in those ≥75 yrs. Metastatic disease SIR was 2.8 vs. 1.2 for localized disease. One-year cumulative IS incidence was 0.62% overall (range: 0.30% breast to 1.62% pancreatic); breast and prostate cancers showed no significant excess risk.","limitations":"- Cancer stage was unknown in ~48% of cases, limiting stage-specific interpretation.\n- No data on comorbidities, anticancer treatments, or antithrombotic medications, precluding adjustment for these confounders.\n- Only hospitalized strokes were captured; pre-admission fatal strokes were missed, likely causing modest underestimation.","practice_takeaway":"Clinicians should treat the first 3 months after cancer diagnosis—especially for pancreatic, lung, esophageal, and gallbladder cancers—as a high-risk window for ischemic stroke, and consider integrating cerebrovascular risk assessment into early oncologic care. Younger patients and those with metastatic disease carry disproportionately elevated relative risk and may benefit most from targeted vascular surveillance."}},{"doi":"10.1212/wnl.0000000000218543","pmid":"42685298","title":"Association Between Immigration Status and the Intensity of Acute Stroke Care in Ontario, Canada","journal_title":"Neurology","journal_issn":"0028-3878","published_at":"2026-09-02T00:00:00.000Z","url":"https://doi.org/10.1212/wnl.0000000000218543","source_score":25,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-08T06:32:12.260Z","updated_at":"2026-09-08T06:32:12.260Z","tags":[{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"sample_size","value":"n=85507","value_numeric":85507},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"warning","value":"Immigration status was operationalized using administrative records (arrival after 1985, born outside Canada); refugee vs. other immigrant sub-groups were analyzed but granular visa/legal status data were limited.","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"warning","value":"No modality, brand, or generic drug tags applied — the study focuses on care intensity patterns (ICU admission, ventilation, feeding tubes, reperfusion) rather than a specific therapeutic intervention.","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218543","tag_type":"warning","value":"The 'safety_signal' impact flag is applied cautiously — longer ICU stays with higher life-sustaining treatment rates may reflect unmet communication or cultural needs rather than a direct patient safety event.","value_numeric":null}],"summaries":{"what_studied":"This population-based retrospective cohort study examined whether immigration status was associated with ICU admission rates and length of stay among 85,507 adults hospitalized for ischemic stroke in Ontario, Canada, from April 2014 to March 2023, comparing immigrants (arrived after 1985, born outside Canada) to long-term residents.","key_result":"Immigrants had similar ICU admission rates as long-term residents (18.2% vs 19.7%; aOR 0.97, 95% CI 0.91–1.04), but significantly longer ICU stays (mean 5.6 vs 3.8 days; aRR 1.30, 95% CI 1.13–1.48), even among those who did not receive reperfusion treatments (aRR 1.27, 95% CI 1.09–1.49); refugees and those from Africa, East Asia, and the Middle East had the longest stays.","limitations":"- Retrospective design limits causal inference; unmeasured confounders (e.g., language barriers, advance care preferences, social support) may explain longer ICU stays.\n- Long-term functional outcomes were not assessed, so clinical significance of longer stays is unclear.\n- Immigration status was defined by administrative data (arrived after 1985), which may not capture all nuances of immigrant experience or legal status.","practice_takeaway":"Clinicians caring for immigrant ischemic stroke patients should be aware that this group is more likely to receive life-sustaining treatments and to have longer ICU stays, even with lower stroke severity — suggesting potential gaps in goals-of-care communication. Targeted language and cultural support during acute hospitalization may help align care with patient and family preferences."}},{"doi":"10.1161/strokeaha.126.055247","pmid":"42663055","title":"Prevalence and Clinical Relevance of Antiphospholipid Antibodies in Ischemic Stroke: A Systematic Review and Meta-Analysis","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-08-28T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13528693/","source_score":11,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-05T06:20:15.670Z","updated_at":"2026-09-05T06:20:15.670Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"condition","value":"Antiphospholipid Syndrome","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"generic","value":"anti-beta-2 glycoprotein I antibody","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"generic","value":"anticardiolipin antibody","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"generic","value":"lupus anticoagulant","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"modality","value":"Autoantibody Testing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"sample_size","value":"n=19097","value_numeric":19097},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"warning","value":"Age and sex breakdowns were not reported in the abstract; age_group and sex tags reflect the expected mixed nature of stroke study populations rather than explicitly stated demographics.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"warning","value":"Extreme heterogeneity (I²up to 95.8%) across pooled estimates suggests substantial variation in study populations, aPL assay methods, and positivity thresholds, which may limit generalizability.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055247","tag_type":"warning","value":"The largest sample size (n=19,097) reflects the first-stroke association analysis; the recurrent stroke analysis used a much smaller subset (n=2,873 across 9 studies), and the null result there should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis (52 studies; 40 case-control, 12 cohort) examined the prevalence of antiphospholipid antibody (aPL) seropositivity in ischemic stroke patients and its association with first and recurrent ischemic stroke events, searching PubMed and Embase through May 2025.","key_result":"aPL seropositivity was found in ~1-in-5 ischemic stroke patients (pooled prevalence 19.1%; 95% CI 15.4–23.0%; n=9,438). It was significantly associated with first ischemic stroke (OR 2.93; 95% CI 2.31–3.73; n=19,097), with the strongest effect for lupus anticoagulant (OR 6.69; 95% CI 2.94–15.2) and IgG anticardiolipin antibody (OR 2.56; 95% CI 1.96–3.35). No significant association was found for recurrent stroke (OR 1.20; 95% CI 0.87–1.67; n=2,873).","limitations":"- Very high heterogeneity for most pooled estimates (I²=68.7%–95.8%), limiting precision of effect sizes.\n- The null finding for recurrent stroke was based on only 9 studies (n=2,873), leaving this question underpowered.\n- Risk of bias was assessed with ROBINS-I, suggesting primarily observational evidence with inherent confounding potential.","practice_takeaway":"Screen ischemic stroke patients for aPL antibodies — nearly 1 in 5 will test positive, and lupus anticoagulant in particular carries a markedly elevated stroke risk (OR ~6.7). Current evidence does not confirm that aPL seropositivity predicts stroke recurrence, so anticoagulation decisions for secondary prevention should not rely on aPL status alone."}},{"doi":"10.1183/23120541.00462-2026","pmid":null,"title":"Cardiovascular effects and mortality of short-acting bronchodilators in asthma and COPD","journal_title":"ERJ Open Research","journal_issn":"2312-0541","published_at":"2026-08-26T00:00:00.000Z","url":"https://doi.org/10.1183/23120541.00462-2026","source_score":110,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-09-03T06:20:01.379Z","updated_at":"2026-09-03T06:20:01.379Z","tags":[{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"condition","value":"Arrhythmia","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"condition","value":"Asthma","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"condition","value":"Chronic Obstructive Pulmonary Disease","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"condition","value":"Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"modality","value":"Short-Acting Beta2-Agonist","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"modality","value":"Short-Acting Muscarinic Antagonist","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"sample_size","value":"n=283760","value_numeric":283760},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"warning","value":"No specific brand names for SABA or SAMA are identified in the abstract; generic tags reflect drug classes only.","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"warning","value":"The dose-response associations observed are consistent with confounding by indication (sicker patients use more inhalers); the adjusted Cox model may not fully account for disease severity.","value_numeric":null},{"paper_doi":"10.1183/23120541.00462-2026","tag_type":"warning","value":"Total sample size (283,760) is the sum of the asthma and COPD cohorts; some patients may overlap if they carry both diagnoses — the paper does not explicitly clarify mutual exclusivity.","value_numeric":null}],"summaries":{"what_studied":"This Belgian nationwide cohort study (2017–2022) examined whether use of short-acting bronchodilators — SABA, SAMA, or SABA+SAMA — was associated with cardiovascular events (heart failure, arrhythmia, MI, ischemic stroke) and all-cause mortality in 226,314 adults with asthma and 57,446 adults with COPD, using Cox models adjusted for age, sex, smoking, socioeconomic status, comorbidities, and medication use.","key_result":"SAMA and SABA+SAMA use (1–2 and ≥3 canisters/year) were associated with 1.1–1.4-fold increased heart failure, arrhythmia, and mortality risk in both asthma and COPD patients; ≥3 SABA canisters/year was linked to a 1.1-fold increased heart failure and mortality risk; 1–2 SABA canisters showed no increased risk.","limitations":"Observational design limits causal inference; residual confounding by disease severity (e.g., patients using more canisters may have more severe disease) cannot be excluded; canister count is a proxy for use and may not reflect actual drug exposure.","practice_takeaway":"Clinicians should view high SAMA or SABA+SAMA use (≥1–2 canisters/year) as a red flag for elevated cardiovascular risk and mortality in both asthma and COPD patients. Escalating to controller therapy and reviewing cardiac comorbidities is warranted before or alongside increased short-acting bronchodilator prescribing."}},{"doi":"10.1002/cns.71035","pmid":"42605248","title":"Exercise and Circadian Rhythm Regulation: Mechanisms, Resilience, and Therapeutic Potential for Neurological Diseases","journal_title":"CNS Neuroscience & Therapeutics","journal_issn":"1755-5930","published_at":"2026-08-17T00:00:00.000Z","url":"https://doi.org/10.1002/cns.71035","source_score":21,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-22T06:53:22.093Z","updated_at":"2026-08-22T06:53:22.093Z","tags":[{"paper_doi":"10.1002/cns.71035","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"category","value":"Neurosciences","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Alzheimer's Disease","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Circadian Rhythm Disruption","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Intracerebral Hemorrhage","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Stroke","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Subarachnoid Hemorrhage","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"modality","value":"Behavioral Chronotherapy","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"warning","value":"Most mechanistic evidence is from rodent models; direct translation to human clinical practice should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"warning","value":"No sample size tag applied — this is a review with no original patient cohort. The ICH mortality statistic (3.6× odds, 70% mortality reduction) is cited from a single prospective observational study, not from a trial conducted by these authors.","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"warning","value":"The study design is a narrative (not systematic) review; risk of selection bias in included studies cannot be excluded.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examines the molecular and systemic mechanisms by which exercise — acting as a non-photic zeitgeber — modulates circadian rhythms, and evaluates the therapeutic implications for two neurological diseases: stroke (ischemic, ICH, SAH) and Alzheimer's disease (AD).","key_result":"Exercise enhances circadian amplitude, stability, and phase alignment via AMPK-SIRT1-BMAL1 signaling, PGC-1α-dependent mitochondrial regulation, and immune-clock coupling. In stroke, pre-stroke physical activity was associated with ~3.6× higher odds of mild neurological deficits at ICH onset and ~70% lower 30-day mortality. In AD, regular exercise reduces Aβ burden, shifts microglia toward anti-inflammatory states, and normalizes sleep-wake cycles in preclinical and observational data.","limitations":"- Almost entirely based on preclinical (rodent) models and observational data; randomized controlled trials on circadian-targeted exercise in stroke or AD are lacking.\n- Optimal exercise timing, intensity, and duration for circadian benefit in neurological disease have not been established.\n- Individual variation by age, sex, chronotype, and disease stage is acknowledged but uncharacterized.","practice_takeaway":"Appropriately timed, regular moderate exercise may improve circadian alignment and support neurological recovery in stroke and AD — consider it a behavioral chronotherapy adjunct, not just a fitness tool. Until optimal timing protocols are defined, encouraging habitual physical activity remains a low-risk, evidence-supported recommendation for patients with or at risk for these conditions."}},{"doi":"10.1093/europace/euag159","pmid":"42486484","title":"Long-term efficacy and safety of left atrial appendage closure vs. oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials","journal_title":"Europace","journal_issn":"1099-5129","published_at":"2026-07-23T00:00:00.000Z","url":"https://doi.org/10.1093/europace/euag159","source_score":23,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-28T14:02:29.059Z","updated_at":"2026-07-28T14:02:29.059Z","tags":[{"paper_doi":"10.1093/europace/euag159","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"brand","value":"Watchman","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"condition","value":"Systemic Embolism","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"modality","value":"Direct Oral Anticoagulant","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"modality","value":"Left Atrial Appendage Closure","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"modality","value":"Oral Anticoagulation","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"modality","value":"Vitamin K Antagonist","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"sample_size","value":"n=7004","value_numeric":7004},{"paper_doi":"10.1093/europace/euag159","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"study_design","value":"Systematic Review and Meta-Analysis of Randomized Controlled Trials","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"warning","value":"All six included trials were rated 'some concern' for overall risk of bias per RoB 2, driven largely by open-label design (inherent to device trials); this limits confidence in subjectively measured outcomes.","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"warning","value":"Mean patient age ranged from 69.4 to 78.5 years across trials, so findings may not generalize to younger AF populations.","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"warning","value":"The haemorrhagic stroke subgroup interaction (VKA vs. DOAC comparator, P=0.02) suggests LAAC's bleeding benefit may be comparator-dependent and should be interpreted cautiously in DOAC-eligible patients.","value_numeric":null},{"paper_doi":"10.1093/europace/euag159","tag_type":"warning","value":"The impact_flag 'practice_changing' was applied because this is the largest RCT-only meta-analysis to date, overturning prior signals of mortality and haemorrhagic stroke benefit and establishing a significant ischaemic stroke harm signal with LAAC vs. OAC.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis of 6 RCTs (n=7,004; 3,681 LAAC vs. 3,323 OAC) compared percutaneous left atrial appendage closure (LAAC) with oral anticoagulation (OAC) for long-term stroke prevention in AF, using the longest available follow-up (36–49.6 months) and including the most recent CHAMPION-AF and CLOSURE-AF trials.","key_result":"LAAC significantly raised the risk of ischaemic stroke or systemic embolism vs. OAC (134 vs. 80 events; RR 1.41, 95% CI 1.07–1.86; ~10 extra events per 1,000 patients; moderate certainty). No significant differences were seen for overall stroke, all-cause mortality, major bleeding, or haemorrhagic stroke. LAAC halved nonprocedural clinically relevant bleeding (RR 0.50, 95% CI 0.43–0.59; NNT ~14 per 1,000; high certainty).","limitations":"- Trial-level (aggregate) data only—could not assess patient-level effect modifiers such as age, renal function, or bleeding history.\n- Substantial heterogeneity across trials in device generation, comparator (VKA vs. DOAC vs. physician-directed care), and enrolled populations spanning nearly two decades.\n- CLOSURE-AF's control arm included ~12% non-anticoagulated patients, potentially attenuating the observed OAC benefit.","practice_takeaway":"LAAC should not replace OAC in unselected AF patients, as it carries a 41% higher relative risk of ischaemic stroke or systemic embolism. Reserve LAAC for patients with a genuine contraindication or intolerance to long-term anticoagulation, where its consistent reduction in nonprocedural bleeding may provide meaningful benefit."}},{"doi":"10.1212/wnl.0000000000218298","pmid":"42447422","title":"Two-Year Retention of Benefits After Paired Vagus Nerve Stimulation in Stroke","journal_title":"Neurology","journal_issn":"0028-3878","published_at":"2026-07-14T00:00:00.000Z","url":"https://doi.org/10.1212/wnl.0000000000218298","source_score":26,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-23T07:33:14.879Z","updated_at":"2026-08-23T07:33:14.879Z","tags":[{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"brand","value":"Vivistim","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"condition","value":"Upper Extremity Motor Deficit","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"modality","value":"Neuromodulation","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"modality","value":"Vagus Nerve Stimulation","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"sample_size","value":"n=49","value_numeric":49},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"study_design","value":"Post Hoc Analysis of Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"warning","value":"Several authors disclose consulting relationships with MicroTransponder (the device manufacturer and trial funder), which may introduce industry bias.","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"warning","value":"Study design tag reflects a post hoc analysis of RCT data rather than a prospective RCT; level of evidence reflects the original trial design but the long-term uncontrolled follow-up is effectively Level 3.","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"warning","value":"The 3-year data come from only 16 participants, limiting generalizability of that subgroup finding.","value_numeric":null},{"paper_doi":"10.1212/wnl.0000000000218298","tag_type":"warning","value":"This is a post hoc, uncontrolled analysis of a subset (49/108) of the original RCT cohort — attrition was substantial, partly due to COVID-19, and no formal comparison to a concurrent control arm was made in the long-term phase. Causal attribution should be interpreted with caution.","value_numeric":null}],"summaries":{"what_studied":"This post hoc analysis of the triple-blind, sham-controlled VNS-REHAB pivotal RCT examined long-term (2- and 3-year) outcomes of implanted paired vagus nerve stimulation (VNS) plus rehabilitation in adults with moderate-to-severe chronic ischemic stroke and upper extremity (UE) deficits (n=49 at 2 years; n=16 at 3 years).","key_result":"At 2 years, FMA-UE scores improved by **7.51 points** (95% CI 5.80–9.22; p<0.001) and WMFT-FAS scores improved by **0.63 points** (95% CI 0.50–0.75; p<0.001) from baseline; **76% of participants (37/49)** achieved a clinically meaningful improvement in FMA-UE and/or WMFT. Significant gains were seen in 5 of 7 participation and quality-of-life measures (SIS-ADL, SIS-Hand, MAL-AOU, MAL-QOM, SS-QOL), and improvements were retained at 3 years in the 16-person subset.","limitations":"- **No control comparator** in the long-term phase — all participants received active VNS, so natural recovery cannot be separated from treatment effect.\n- **Unblinded assessments** during the long-term follow-up introduce potential bias.\n- Only **49 of 108** original participants had 2-year data (largely due to COVID-19 pandemic disruptions), raising concerns about attrition bias; self-activated therapy frequency was poorly documented.","practice_takeaway":"Paired VNS (Vivistim) delivers durable UE motor gains lasting at least 2 years in selected chronic ischemic stroke patients — clinicians should consider it for those with moderate-to-severe arm/hand deficits who remain motivated to engage in ongoing self-activated home therapy. Nearly 3 in 4 users reached a clinically meaningful threshold at 2 years, and some continued to improve beyond year 1."}},{"doi":"10.1161/strokeaha.126.055949","pmid":"42422957","title":"Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-07-09T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.055949","source_score":55,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-30T06:19:58.843Z","updated_at":"2026-08-30T06:19:58.843Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"condition","value":"Posterior Cerebral Artery Occlusion","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"condition","value":"Symptomatic Intracranial Hemorrhage","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"modality","value":"CT Perfusion Imaging","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"modality","value":"Intravenous Thrombolysis","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"modality","value":"MR Perfusion Imaging","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"sample_size","value":"n=443","value_numeric":443},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"study_design","value":"Multicenter Observational Registry Study (Prespecified Secondary Analysis)","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"warning","value":"Median age of 74 years and 41.8% female; results may not apply equally across all demographic subgroups.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"warning","value":"Only 443 of 1,811 registry patients had perfusion imaging and met inclusion criteria, which may introduce selection bias and limit generalizability to routine practice.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"warning","value":"The study is observational; EVT assignment was not randomized, so residual confounding likely persists despite IPTW adjustment.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055949","tag_type":"warning","value":"The symptomatic intracranial hemorrhage interaction estimate (ratio of OR 10.15) has extremely wide confidence intervals (1.06–96.93), indicating high imprecision — this finding should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"This prespecified secondary analysis of the PLATO registry evaluated whether baseline perfusion imaging parameters (hypoperfusion volume, infarct core volume, mismatch ratio) are associated with outcomes and whether they modify the benefit of endovascular therapy (EVT) vs. medical management in 443 adults with isolated posterior cerebral artery occlusion (iPCAO) across 35 centers in 10 countries (2015–2025).","key_result":"Larger hypoperfusion volume independently reduced odds of excellent 90-day outcome (mRS 0–1; adjusted OR 0.72 per log-unit increase). Perfusion parameters did not identify EVT responders, but larger infarct core was linked to worse mRS shift (ratio of OR 0.66; p=0.009) and higher mortality (ratio of OR 1.82; p=0.021) with EVT, and larger hypoperfusion volume was linked to higher symptomatic intracranial hemorrhage risk with EVT (ratio of OR 10.15; p=0.044).","limitations":"Observational design with inherent selection bias in who received EVT vs. medical management; inverse probability of treatment weighting adjusts but cannot fully eliminate confounding. Inclusion criteria (perfusion imaging availability) limited the sample to 443 of 1,811 registry patients, reducing generalizability. The symptomatic intracranial hemorrhage interaction had very wide confidence intervals (95% CI 1.06–96.93), suggesting imprecision.","practice_takeaway":"In isolated posterior cerebral artery occlusion, perfusion imaging adds prognostic value but should not be used to select patients for EVT — larger core and hypoperfusion volumes may instead flag higher procedural risk, including worse functional outcomes and bleeding. Clinicians should exercise caution before pursuing EVT in iPCAO patients with large perfusion deficits."}},{"doi":"10.1161/strokeaha.126.055374","pmid":"42403349","title":"Defining the Therapeutic Ceiling of Endovascular Thrombectomy in Large-Core Stroke: Beyond the Limits of ASPECTS","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-07-06T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.055374","source_score":20,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-29T06:19:21.049Z","updated_at":"2026-08-29T06:19:21.049Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"condition","value":"Large Core Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"modality","value":"Endovascular Thrombectomy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"sample_size","value":"n=552","value_numeric":552},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"study_design","value":"Registry-Based Cohort Study with Target Trial Emulation","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"warning","value":"The 110 mL therapeutic ceiling is derived from DWI volumetry and is not directly interchangeable with CTP-based thresholds (CTP tends to overestimate core volume relative to DWI).","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"warning","value":"The cohort is exclusively Korean (18 centers in Korea), which may limit generalizability to non-Asian populations with different collateral profiles.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"warning","value":"The study design is labeled 'Registry-Based Cohort Study with Target Trial Emulation' — the emulation component strengthens causal inference but does not replace an RCT; the level of evidence is assigned 3 accordingly.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055374","tag_type":"warning","value":"Two co-corresponding authors (Ryu, Sunwoo) are employees of JLK Inc., the company whose automated imaging software was used throughout; this is a potential conflict of interest.","value_numeric":null}],"summaries":{"what_studied":"Among 552 thrombectomy-treated patients with anterior circulation large vessel occlusion in a Korean nationwide multicenter registry (2022–2024), this study compared the prognostic value of quantitative infarct volumetry (DWI, CTP, NCCT) versus ASPECTS, and used target trial emulations to estimate EVT benefit across volumetric strata, with 90-day mRS score as the primary outcome.","key_result":"Quantitative volumetry outperformed ASPECTS for prognosis (DWI AUC 0.75 vs. ASPECTS 0.61, P<0.001). ASPECTS-only large-core patients had poor outcomes similar to small-core patients (11.8% vs. 11.7%). EVT benefit was significant in the 50–110 mL DWI core range (cOR 0.38 [95% CI, 0.15–0.97]) but disappeared above 110 mL, identifying a therapeutic ceiling.","limitations":"- Observational design limits causal inference; residual confounding from unmeasured factors (e.g., collateral status, clinical gestalt, goals-of-care) cannot be excluded.\n- Cohort is exclusively Asian, limiting generalizability of specific volumetric cutoffs.\n- The 110 mL threshold is sensitive to DWI acquisition parameters and segmentation software, requiring cross-platform validation before broad adoption.","practice_takeaway":"For large-core stroke patients, DWI core volume ≥110 mL may mark a therapeutic ceiling beyond which EVT offers negligible benefit — consider volumetric assessment alongside ASPECTS, especially in borderline cases, to avoid futile reperfusion. ASPECTS alone frequently mislabels patients as large-core when their true infarct burden is modest."}},{"doi":"10.1161/str.0000000000000528","pmid":"42389837","title":"Management of Patients at Risk of Ischemic Stroke With Left Ventricular Systolic Dysfunction in the Absence of Intracardiac Thrombus: A Scientific Statement From the American Heart Association","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-07-02T00:00:00.000Z","url":"https://doi.org/10.1161/str.0000000000000528","source_score":29,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-10T13:25:37.255Z","updated_at":"2026-07-10T13:25:37.255Z","tags":[{"paper_doi":"10.1161/str.0000000000000528","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"condition","value":"Heart Failure with Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"condition","value":"Left Ventricular Systolic Dysfunction","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"modality","value":"Antiplatelet","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"study_design","value":"Scientific Statement / Systematic Review with Meta-Analysis","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"No specific sample size (total N) was reported in the abstract; the tag has been omitted accordingly.","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"Study design label reflects a hybrid AHA Scientific Statement combining narrative review and meta-analysis; it is not a standard RCT or purely observational study.","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"The meta-analysis is based on secondary analyses of RCTs not originally designed to address this specific question, limiting causal inference and precision of effect estimates.","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — while this statement shifts guidance toward individualized anticoagulation for secondary prevention, it stops short of a blanket recommendation and emphasizes shared decision-making.","value_numeric":null}],"summaries":{"what_studied":"This AHA scientific statement evaluated the risk of incident and recurrent ischemic stroke in patients with LV systolic dysfunction (LVEF ≤40% or wall motion abnormality) without intracardiac thrombus, and compared anticoagulation vs. non-anticoagulation strategies for primary and secondary stroke prevention via narrative review and meta-analysis of secondary RCT analyses.","key_result":"Anticoagulation was associated with lower incident stroke risk in LV dysfunction without thrombus, but showed **no net benefit over non-anticoagulant strategies for primary prevention**. For secondary prevention (post-stroke), anticoagulation may reduce recurrent stroke risk with a net benefit compared to antiplatelet therapy.","limitations":"- Evidence is based on secondary analyses of RCTs, not trials designed primarily for this question.\n- No direct head-to-head RCT data specifically for stroke patients with LV dysfunction without thrombus.\n- Individualized risk-benefit balance is difficult to quantify given heterogeneity across included studies.","practice_takeaway":"For stroke patients with LV systolic dysfunction but no detected thrombus, anticoagulation may offer net benefit over antiplatelets for recurrent stroke prevention — consider shared decision-making with cardiology and neurology. Anticoagulation is **not** recommended for routine primary stroke prevention in this group based on current evidence."}},{"doi":"10.1136/jnis-2026-025448","pmid":"42336644","title":"Clinical evidence standards for high-risk endovascular devices in ischemic stroke: a European multisociety consensus","journal_title":"Journal of NeuroInterventional Surgery","journal_issn":"1759-8478","published_at":"2026-06-23T00:00:00.000Z","url":"https://doi.org/10.1136/jnis-2026-025448","source_score":6,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-27T13:27:51.468Z","updated_at":"2026-06-27T13:27:51.468Z","tags":[{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"modality","value":"Endovascular Thrombectomy Device","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"sample_size","value":"n=18","value_numeric":18},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"study_design","value":"Expert Consensus / Delphi Study with Systematic Review","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"warning","value":"No patient-level data or clinical outcome statistics are reported; all recommendations are consensus-based.","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"warning","value":"The full text retrieved appears to be the MDCG 2020-6 guidance document on legacy device clinical evidence, not the actual paper described in the abstract (JNIS 2026 multisociety consensus). The summary, tags, and takeaways are based on the abstract, as the full text does not match the cited paper.","value_numeric":null},{"paper_doi":"10.1136/jnis-2026-025448","tag_type":"warning","value":"The sample size of n=18 refers to Delphi expert panelists, not a patient population — clinical applicability should be interpreted accordingly.","value_numeric":null}],"summaries":{"what_studied":"This European multisociety consensus used a modified Delphi process with 18 experts from ESMINT, ESO, and ESNR to develop methodological recommendations for regulatory clinical investigations of high-risk endovascular stroke devices under the EU Medical Device Regulation (MDR).","key_result":"Consensus was reached that prospective observational studies — including externally controlled designs and single-arm studies with performance benchmarks — are appropriate for most regulatory scenarios. Core outcome domains identified were: functional independence at 90 days, successful reperfusion, and symptomatic intracranial hemorrhage. No consensus was reached on optimal study design for conceptually novel devices.","limitations":"- Consensus was not achieved on study design for novel devices, leaving a key gap.\n- The Delphi process reflects expert opinion, which may not capture all stakeholder perspectives (e.g., regulators, patients, industry).\n- Recommendations are specific to the European MDR context and may not translate directly to other regulatory frameworks.","practice_takeaway":"For regulatory studies of endovascular stroke devices in Europe, prospective observational designs with external controls or performance benchmarks are now considered acceptable — RCTs are not required for most scenarios.\n\nClinicians designing or reviewing such trials should ensure multicenter structure, imaging core-lab adjudication, independent monitoring, and use of the three core endpoints: 90-day functional independence, reperfusion success, and symptomatic intracranial hemorrhage."}},{"doi":"10.1161/strokeaha.126.055194","pmid":"42267424","title":"Gout and Risk of Ischemic Stroke in Patients With Atrial Fibrillation: A Nationwide Cohort Study","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-06-10T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.126.055194","source_score":19,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-31T13:37:12.193Z","updated_at":"2026-07-31T13:37:12.193Z","tags":[{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"condition","value":"Gout","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"generic","value":"allopurinol","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"generic","value":"febuxostat","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"modality","value":"Oral Anticoagulant","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"modality","value":"Urate-Lowering Therapy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"sample_size","value":"n=229565","value_numeric":229565},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"warning","value":"Impact flag 'practice_changing' assigned because findings challenge current AF guidelines that do not recognize gout as a stroke risk factor, though RCT confirmation is still needed.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"warning","value":"Study population is Finnish (2007–2018); generalizability to other ethnic groups or healthcare systems may be limited.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"warning","value":"The ~30% stroke rate reduction with urate-lowering therapy is from observational data with time-dependent exposure; causality is not established and confounding by indication cannot be ruled out.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055194","tag_type":"warning","value":"The subgroups of gout patients with CHA2DS2-VA scores of 0 or 1 were small (n=103 and n=443, respectively); stroke rate estimates in these groups should be interpreted as hypothesis-generating.","value_numeric":null}],"summaries":{"what_studied":"This nationwide Finnish retrospective cohort study (FinACAF, 2007–2018) assessed whether gout is independently associated with ischemic stroke risk in 229,565 patients with new-onset AF (mean age 72.7 years, 50% female, mean follow-up 4.0 years), and whether urate-lowering therapy (allopurinol or febuxostat) modifies that risk.","key_result":"Gout (present in 3.0% of patients) was associated with a 12% higher adjusted stroke risk overall (IRR 1.12 [95% CI, 1.02–1.24]) and 26% higher during anticoagulation-free follow-up (IRR 1.26 [95% CI, 1.09–1.46]). Time-dependent urate-lowering therapy use was associated with ~30% lower stroke rate in patients with gout and AF (adjusted IRR ~0.70). Nonanticoagulated stroke rates in gout patients reached ≥1% per year even at CHA2DS2-VA scores of 0–1.","limitations":"- Registry-based design: residual confounding from unmeasured variables (urate levels, eGFR, smoking, blood pressure, gout severity/flare count) cannot be excluded.\n- Pharmacy claims confirm dispensing but not actual medication adherence.\n- No colchicine use in the cohort, preventing analysis of its effect on stroke risk.","practice_takeaway":"Clinicians managing AF patients with gout should consider it a stroke risk factor that may justify anticoagulation even when conventional CHA2DS2-VA scores are low (0–1). Treating gout to target with urate-lowering therapy may independently reduce stroke risk in this population."}},{"doi":"10.1016/j.afjem.2026.100988","pmid":null,"title":"Value of CT perfusion imaging in wake-up strokes – a comparative study of patients qualifying for thrombolysis vs those not suitable for thrombolysis","journal_title":"African Journal of Emergency Medicine","journal_issn":"2211-419X","published_at":"2026-06-05T00:00:00.000Z","url":"https://doi.org/10.1016/j.afjem.2026.100988","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:06.282Z","updated_at":"2026-06-10T14:24:06.282Z","tags":[{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"condition","value":"Wake-Up Stroke","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"modality","value":"CT Perfusion Imaging","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"modality","value":"Thrombolysis","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"study_design","value":"Comparative Study","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"warning","value":"Only bibliographic metadata was provided; no abstract, methods, results, or conclusions were available. Summary content is derived solely from the paper title and cannot be verified against actual study data. Key result and limitations fields reflect this constraint.","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"warning","value":"Publication date (2026-06-05) is in the near future relative to today; this may be an ahead-of-print or early access article — findings should be interpreted with caution until fully indexed.","value_numeric":null},{"paper_doi":"10.1016/j.afjem.2026.100988","tag_type":"warning","value":"Sample size could not be determined from the available information.","value_numeric":null}],"summaries":{"what_studied":"This comparative study evaluated the value of CT perfusion (CTP) imaging in wake-up stroke patients, comparing those who qualified for thrombolysis versus those who did not, to assess CTP's role in guiding treatment decisions.","key_result":"The paper's specific quantitative outcomes (e.g., sample sizes, mismatch ratios, or clinical endpoints) are not provided in the available abstract; full numerical results cannot be confirmed from the source text alone.","limitations":"Full text details on methodology, sample size, and outcome measures are not available from the provided source, limiting assessment of internal validity and generalizability.","practice_takeaway":"CTP imaging may help identify wake-up stroke patients eligible for thrombolysis by distinguishing salvageable penumbra from irreversible infarct core; clinicians should consider CTP as part of the imaging workup when standard eligibility criteria are unclear."}},{"doi":"10.1002/cns.70955","pmid":"42231817","title":"Neuroplastic Mechanisms of Acupuncture in Post‐Stroke Motor Recovery: A Randomized Multimodal\n MRI\n Trial","journal_title":"CNS Neuroscience & Therapeutics","journal_issn":"1755-5930","published_at":"2026-06-03T00:00:00.000Z","url":"https://doi.org/10.1002/cns.70955","source_score":55,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:23:54.616Z","updated_at":"2026-06-10T14:23:54.616Z","tags":[{"paper_doi":"10.1002/cns.70955","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"category","value":"Neurosciences","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"condition","value":"Post-Stroke Hemiplegia","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"modality","value":"Acupuncture","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"sample_size","value":"n=46","value_numeric":46},{"paper_doi":"10.1002/cns.70955","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"warning","value":"Age range of 35–80 years spans adult and older-adult groups; subgroup analysis by age was not performed.","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"warning","value":"Both groups received concurrent standard pharmacotherapy, making it difficult to isolate acupuncture-specific effects.","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"warning","value":"No statistically significant group × time interaction was reported; within-group findings drive the main conclusions, which limits causal inference.","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"warning","value":"The analyzable sample (n=46) is smaller than the originally planned 60 per arm, which may reduce statistical power for between-group comparisons.","value_numeric":null},{"paper_doi":"10.1002/cns.70955","tag_type":"warning","value":"The trial was single-blind (only acupuncturists unblinded); patient blinding to true vs. sham acupoints may be imperfect, introducing performance/expectation bias.","value_numeric":null}],"summaries":{"what_studied":"This 2-week RCT (n=46 analyzable; TA=30, SA=16; 2:1 allocation) evaluated acupuncture at true acupoints (TA) vs. sham acupoints (SA) in adults with unilateral hemiplegia within 6 weeks of ischemic stroke, using multimodal MRI (resting-state fMRI + structural T1) to assess neuroplastic changes alongside clinical motor scales (FMA, Brunnstrom, NIHSS).","key_result":"TA—but not SA—produced significant Brunnstrom score gains (upper and lower limbs, both p<0.001), reduced DMN disjointedness (FDR-corrected p=0.041), and increased GMV in 14+ brain regions (frontal, parietal, temporal, occipital, cerebellar); GMV increases in right opercular inferior frontal gyrus, postcentral gyrus, and cerebellar region 10 correlated positively with FMA improvement. Both groups improved on FMA.","limitations":"- No statistically significant group × time interaction was demonstrated, limiting causal inference about TA superiority over SA.\n- Small sample (n=46 analyzable), single-center, with only a 2-week follow-up and no long-term data on durability of neuroplastic changes.\n- MRI-derived GMV changes are surrogate markers; they do not confirm cellular or microstructural plasticity.","practice_takeaway":"For post-stroke hemiplegia within 6 weeks of ischemic stroke, true-acupoint acupuncture at standard motor-rehabilitation points (LI11, ST36, SP6, GB34, etc.) over 2 weeks may add measurable benefit in limb spasticity/motor control (Brunnstrom scores) beyond standard pharmacotherapy alone. Clinicians integrating acupuncture into stroke rehabilitation can point to specific neuroimaging correlates—DMN stabilization and GMV increases in sensorimotor regions—as plausible central mechanisms, though larger confirmatory trials are needed."}},{"doi":"10.1007/s12975-026-01451-8","pmid":"42228231","title":"Lysophosphatidic Acid Reduces Ischemic Brain Injury by Attenuating Vascular Permeability Through LPA4 Receptor Signaling","journal_title":"Translational Stroke Research","journal_issn":"1868-4483","published_at":"2026-06-02T00:00:00.000Z","url":"https://doi.org/10.1007/s12975-026-01451-8","source_score":80,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:04.142Z","updated_at":"2026-06-10T14:24:04.142Z","tags":[{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"category","value":"Neurosciences","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"condition","value":"Blood-Brain Barrier Disruption","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"condition","value":"Cerebral Edema","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"generic","value":"lysophosphatidic acid","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"modality","value":"Lysophospholipid Receptor Agonist","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"sample_size","value":"n=124","value_numeric":124},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"study_design","value":"Preclinical Animal Study","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"warning","value":"All experiments used female mice only; results may not apply to male patients or those with different hormonal profiles.","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"warning","value":"BBB permeability outcomes were not normalized to infarct volume, making it difficult to fully separate direct BBB stabilization from secondary effects of smaller infarcts.","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"warning","value":"LPA is a non-selective multi-receptor agonist; contributions from LPA receptors other than LPA4 in wild-type animals cannot be excluded at the dose used (10 mg/kg).","value_numeric":null},{"paper_doi":"10.1007/s12975-026-01451-8","tag_type":"warning","value":"The permanent dMCAO model does not include reperfusion, which is central to clinical stroke care — LPA effects during reperfusion are untested.","value_numeric":null}],"summaries":{"what_studied":"This mouse study tested whether intraperitoneal lysophosphatidic acid (LPA, 10 mg/kg, five doses over 48 h) reduces ischemic injury and blood-brain barrier (BBB) disruption after permanent distal middle cerebral artery occlusion (dMCAO) in adult female C57BL/6 mice (n=124 final), and whether the LPA4 receptor mediates these effects using LPA4 knockout (KO) mice.","key_result":"LPA treatment reduced infarct volume by ~60% and significantly attenuated brain edema and BBB permeability (Evans blue and FITC-dextran leakage) at 48 h post-dMCAO, with preserved endothelial claudin-5 expression; these protective effects were completely abolished in LPA4 KO mice. Single-cell RNA-seq confirmed selective, sustained LPA4 receptor expression in vascular endothelial cells after ischemia.","limitations":"- Only adult female mice were used and estrous cycle was not controlled, limiting generalizability to males or varying hormonal states.\n- Permanent dMCAO model excludes reperfusion injury, which is the dominant clinical scenario with thrombolysis/thrombectomy.\n- All outcomes assessed only at 48 h; therapeutic time window, long-term effects, and full dose-response were not evaluated.","practice_takeaway":"LPA–LPA4 signaling is a candidate BBB-protective target in acute ischemic stroke, but findings are preclinical (mouse only) and selective LPA4 agonists do not yet exist for clinical use. Clinicians should watch for translational studies testing LPA4-selective agents alongside reperfusion therapy."}},{"doi":"10.1016/j.clineuro.2026.109513","pmid":"42190493","title":"Uninterrupted oral anticoagulation plus short-term single antiplatelet therapy in anticoagulated patients undergoing carotid artery stenting","journal_title":"Clinical Neurology and Neurosurgery","journal_issn":"0303-8467","published_at":"2026-05-25T00:00:00.000Z","url":"https://doi.org/10.1016/j.clineuro.2026.109513","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-06T13:22:46.572Z","updated_at":"2026-06-06T13:22:46.572Z","tags":[{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"condition","value":"Carotid Artery Stenosis","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"generic","value":"direct oral anticoagulant","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"modality","value":"Anticoagulation","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"modality","value":"Antiplatelet Therapy","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"modality","value":"Carotid Artery Stenting","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"sample_size","value":"n=30","value_numeric":30},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"warning","value":"Brand names of specific DOACs or antiplatelets used were not reported in the abstract; generic drug-level granularity beyond 'DOAC' is unavailable.","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"warning","value":"No comparator group (e.g., DAPT or interrupted OAT) was included, so relative efficacy or safety versus standard approaches cannot be determined.","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"warning","value":"The cohort is very small (n=30) and single-center; results should be interpreted with caution and not generalized without larger validation.","value_numeric":null},{"paper_doi":"10.1016/j.clineuro.2026.109513","tag_type":"warning","value":"The study is retrospective and analyses are primarily descriptive — no adjusted or comparative statistics were reported.","value_numeric":null}],"summaries":{"what_studied":"Single-center retrospective study evaluating uninterrupted oral anticoagulation therapy (OAT) plus short-term single antiplatelet therapy (SAPT) — added ≥5 days pre-procedure and continued ≥30 days — in 30 consecutive anticoagulated adults undergoing elective carotid artery stenting (CAS) between August 2020 and October 2025. Primary outcome was 30-day net adverse clinical events (NACE).","key_result":"30-day NACE occurred in 2/30 patients (6.7%): one ischemic stroke from subacute in-stent thrombosis and one major gastrointestinal bleed. Stent patency at 30 days was confirmed in all event-free patients. Favorable functional outcome (mRS ≤2) was achieved in 86.7% at 1 month and 83.3% at 3 months.","limitations":"- Very small single-center cohort (n=30) with no control group, limiting generalizability.\n- Retrospective design with primarily descriptive analyses; no statistical comparisons possible.\n- Available literature is sparse, heterogeneous, and incompletely reported, making contextualization difficult.","practice_takeaway":"In anticoagulated patients (mostly DOAC for AF) undergoing elective CAS, continuing OAT and adding SAPT for at least 30 days peri-procedurally appears feasible with a 6.7% NACE rate. This approach warrants consideration as a pragmatic bleeding-sparing alternative to DAPT, but must be validated in larger prospective studies before broad adoption."}},{"doi":"10.1177/0271678x261449017","pmid":"42157525","title":"Stroke-induced gut microbiome dysbiosis accelerates Alzheimer’s disease progression","journal_title":"Journal of Cerebral Blood Flow & Metabolism","journal_issn":"0271-678X","published_at":"2026-05-19T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13190380/","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-27T15:43:14.863Z","updated_at":"2026-05-27T15:43:14.863Z","tags":[{"paper_doi":"10.1177/0271678x261449017","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"condition","value":"Alzheimer's Disease","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"condition","value":"Gut Microbiome Dysbiosis","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"condition","value":"Post-Stroke Dementia","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"modality","value":"Fecal Microbiota Transplantation","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"sample_size","value":"n=83","value_numeric":83},{"paper_doi":"10.1177/0271678x261449017","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"study_design","value":"Preclinical Animal Study with Human Donor Cohort (FMT Model)","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"warning","value":"Behavioral differences between stroke-FMT and healthy-FMT groups did not reach statistical significance; molecular findings are not yet mirrored by robust functional outcomes at the timepoint studied.","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"warning","value":"Sample sizes for some sub-analyses (e.g., spatial transcriptomics: n=3/group; human donors: n=5–6) are small, limiting generalizability.","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"warning","value":"The healthy donor group was entirely female while the stroke donor group was mixed-sex (3M:2F), introducing a potential sex confound in microbiome comparisons.","value_numeric":null},{"paper_doi":"10.1177/0271678x261449017","tag_type":"warning","value":"The study design is preclinical (mouse FMT model); causal claims about human stroke-to-AD progression require validation in clinical cohorts.","value_numeric":null}],"summaries":{"what_studied":"This study tested whether stroke-induced gut dysbiosis drives Alzheimer's disease (AD) pathology by transplanting fecal microbiota from post-stroke patients (n=5) or healthy donors (n=6) into young, presymptomatic 3xTg-AD mice (~3 months old), then following them for ~2 months (to 6.5 months of age). Multi-omics readouts included 16S microbiome sequencing, GC/LC-MS metabolomics, immunohistochemistry (p-tau, GFAP, IBA1), single-cell spatial transcriptomics (CosMx), and behavioral testing.","key_result":"Stroke-FMT mice showed significantly higher hippocampal p-tau (8.7% vs 5.2%; effect size 3.60, p=0.001), hippocampal GFAP (13.6% vs 8.6%; effect size 5.07, p=0.006), and hippocampal IBA1 (0.77% vs 0.49%; p=0.015) compared to healthy-FMT mice, alongside broad metabolic disruption (redox, nucleotide, and energy pathways) and upregulation of AD-related transcripts (Apoe, Bace1, Trem2, Il1b) with downregulation of neuroprotective genes (Clu, Pten, Calm1/2). Behavioral deficits trended toward impairment in stroke-FMT mice but did not reach significance.","limitations":"- Healthy donor cohort was exclusively female (n=6), creating a sex mismatch with the mixed-sex stroke donor group and limiting cross-sex microbial comparisons.\n- No direct blood-brain barrier permeability assays were performed; vascular compromise was inferred from transcriptomics and microbial composition only.\n- Behavioral testing at ~6 months likely predates peak AD phenotype in 3xTg-AD mice; longer follow-up may be needed to detect significant cognitive deficits.","practice_takeaway":"Post-stroke gut dysbiosis may act as a causal accelerant of Alzheimer's-like pathology through the gut–brain axis, suggesting that microbiome-targeted interventions (prebiotics, probiotics, dietary fiber) after stroke could be a modifiable strategy to reduce dementia risk. Clinicians managing stroke survivors should be aware that gut health may be a meaningful, actionable contributor to long-term cognitive outcomes."}},{"doi":"10.1016/j.jacc.2026.03.084","pmid":"42126358","title":"ECG Signatures and Long-Term Ischemic Stroke Risk","journal_title":"JACC","journal_issn":"0735-1097","published_at":"2026-05-13T00:00:00.000Z","url":"https://doi.org/10.1016/j.jacc.2026.03.084","source_score":28,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-16T13:22:28.281Z","updated_at":"2026-05-16T13:22:28.281Z","tags":[{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"condition","value":"Atrial Cardiopathy","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"condition","value":"Cardioembolic Stroke","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"modality","value":"Artificial Intelligence / Deep Learning","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"modality","value":"Electrocardiography","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"sample_size","value":"n=204033","value_numeric":204033},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"warning","value":"All cohorts are from Boston-area academic medical centers; external generalizability to community or non-US populations is uncertain.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"warning","value":"Study design is labeled as 'Retrospective Cohort' based on longitudinal care data use; the paper does not explicitly state this term—there is minor ambiguity.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the novelty and performance parity with FSRP, but prospective validation of clinical utility has not yet been demonstrated.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.084","tag_type":"warning","value":"The total sample size combines the development cohort (101,496) and three test cohorts; the n=204,033 tag is an approximation of the full study population. The paper reports test cohort sizes separately.","value_numeric":null}],"summaries":{"what_studied":"A deep learning model (ECG2Stroke) trained on 12-lead ECGs was evaluated for predicting 10-year incident ischemic stroke risk across three independent hospital cohorts (MGH, BWH, BIDMC; total >200,000 patients), and compared against the revised Framingham Stroke Risk Profile (FSRP).","key_result":"ECG2Stroke achieved moderate discrimination across all sites (10-year AUCs: 0.795 at MGH, 0.774 at BWH, 0.772 at BIDMC) with low calibration error, performing similarly to FSRP. It was strongly associated with cardioembolic stroke (cause-specific HR 2.17 per 1-SD; 95% CI 1.64–2.87) but not noncardioembolic stroke; saliency maps pointed to the P-wave as the key signal.","limitations":"- Training and validation cohorts are all from a single academic health system network in Boston, limiting generalizability to diverse populations.\n- The model's associations are observational; causality and impact on clinical outcomes if acted upon are unproven.\n- Stroke subtype classification (cardioembolic vs. noncardioembolic) was only available in a subset, potentially introducing ascertainment bias.","practice_takeaway":"A routine 12-lead ECG, analyzed by AI, can stratify 10-year ischemic stroke risk as well as the Framingham Stroke Risk Profile—without requiring lab values or clinical history. Clinicians may consider AI-ECG screening as an efficient, low-burden tool to flag patients who warrant further workup for cardioembolic stroke prevention."}},{"doi":"10.1161/strokeaha.125.052311","pmid":"42101654","title":"Sarcopenia, Grip Strength, Walking Pace, and New-Onset Stroke Risk: A UK Biobank Study","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-05-08T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.125.052311","source_score":44,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-12","doi":"10.1161/strokeaha.125.052311","days":"7","issn":"0039-2499","rank":"7","field":"Clinical Medicine","score":"44","category":"Clinical Neurology","categories":["Clinical Neurology"],"_categories":["Clinical Neurology"]},"pubmed":{"doi":"10.1161/STROKEAHA.125.052311","title":"Sarcopenia, Grip Strength, Walking Pace, and New-Onset Stroke Risk: A UK Biobank Study.","journal":"Stroke","methods":"","results":"The cohort (mean age±SD: 56.4±8.1 years; 45.37% were men; n=219 015) had a probable sarcopenia prevalence of 4.7% and a confirmed sarcopenia prevalence of 0.4%. Participants with probable sarcopenia had a higher risk of any stroke (adjusted hazard ratio [aHR], 1.30 [95% CI, 1.21-1.39]), ischemic stroke (aHR, 1.31 [95% CI, 1.22-1.42]), and hemorrhagic stroke (aHR, 1.41 [95% CI, 1.20-1.67]) than those without. Among those who had a stroke, probable or confirmed sarcopenia was associated with increased all-cause mortality. Higher risk of any stroke was associated with lower grip strength (absolute: aHR, 1.07 [95% CI, 1.06-1.09] per 5 kg; relative: aHR, 1.36 [95% CI, 1.28-1.44] per 1 kg/[kg/m","abstract":"$30","keywords":["hand strength","hemorrhagic stroke","ischemic stroke","sarcopenia","stroke","walking speed"],"pubmed_id":"42101654","conclusions":"","publication_date":"2026-05-08T00:00:00"},"crossref":{"DOI":"10.1161/strokeaha.125.052311","URL":"https://doi.org/10.1161/strokeaha.125.052311","ISSN":["0039-2499","1524-4628"],"link":[{"URL":"https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.125.052311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Sarcopenia, Grip Strength, Walking Pace, and New-Onset Stroke Risk: A UK Biobank Study"],"author":[{"given":"Li-Li","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (L.-L.T., Y.-J.J., K.-C.Y., F.G., L.-S.T.)."}]},{"given":"Yu-Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China (Y.-H.H., C.Y.)."}]},{"given":"Yu-Jia","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (L.-L.T., Y.-J.J., K.-C.Y., F.G., L.-S.T.)."}]},{"given":"Kai-Cheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (L.-L.T., Y.-J.J., K.-C.Y., F.G., L.-S.T.)."}]},{"given":"Qing","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Taizhou First People’s Hospital, China (Q.L.)."}]},{"given":"Zien","family":"Zhou","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (Z.Z.)."},{"name":"Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China (Z.Z.)."}]},{"given":"Feng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (L.-L.T., Y.-J.J., K.-C.Y., F.G., L.-S.T.)."}]},{"given":"Bing","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China (B.X.)."}]},{"given":"Changzheng","family":"Yuan","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China (Y.-H.H., C.Y.)."},{"name":"Department of Nutrition, Harvard T.H. 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Grip Strength, Walking Pace, and New-Onset Stroke Risk: A UK Biobank Study","updated":"2026-05-09T14:24:07+00:00","published_date":"2026-05-08","best_oa_location":null}},"created_at":"2026-05-14T13:22:57.575Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"condition","value":"Hemorrhagic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"condition","value":"Sarcopenia","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"condition","value":"Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"modality","value":"Physical Function Assessment","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"sample_size","value":"n=482699","value_numeric":482699},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"sample_size","value":"n=482,699","value_numeric":482699},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"study_design","value":"Prospective Cohort Study","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"warning","value":"Follow-up duration and event counts are not reported in the excerpt.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"warning","value":"Mendelian randomization provides causal inference support for walking pace but not directly for grip strength or sarcopenia; causal claims for those variables rest on observational data only.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"warning","value":"'Practice_changing' flag applied cautiously — findings support adding physical function screening to stroke prevention, but formal guideline changes are pending.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"warning","value":"Relative grip strength metric is truncated in the provided text, limiting interpretability of that effect size.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"warning","value":"Study includes a Mendelian randomization component in addition to the cohort; design label reflects the primary cohort analysis.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.052311","tag_type":"warning","value":"The reported cohort size in the abstract is inconsistent: the full cohort is stated as 482,699 but the results section cites n=219,015 (men only, 45.37%). The full analytic sample size should be verified in the methods.","value_numeric":null}],"summaries":{"limitations":"- Sarcopenia confirmed in only 0.4% of participants, limiting power for that subgroup.\n- UK Biobank is a volunteer cohort with known healthy-volunteer bias, which may underestimate true effect sizes.\n- Sarcopenia and muscle metrics were measured at baseline only, so changes over time are not captured.","what_studied":"A prospective UK Biobank cohort (n=482,699) assessed whether sarcopenia (EWGSOP2), grip strength, and walking pace are associated with incident stroke (any, ischemic, hemorrhagic) and poststroke all-cause mortality using multivariable Cox models and Kaplan-Meier analyses. A 2-sample Mendelian randomization was also conducted to explore causal associations.","key_result":"Probable sarcopenia (prevalence 4.7%) was associated with higher risk of any stroke (aHR 1.30, 95% CI 1.21–1.39), ischemic stroke (aHR 1.31, 95% CI 1.22–1.42), and hemorrhagic stroke (aHR 1.41, 95% CI 1.20–1.67). Each 5‑kg lower grip strength was associated with higher any-stroke risk (aHR 1.07, 95% CI 1.06–1.09); among those with stroke, probable or confirmed sarcopenia was associated with increased all-cause mortality.","practice_takeaway":"Sarcopenia and low grip strength mark higher stroke risk and worse poststroke survival in a large population cohort; consider incorporating muscle strength and sarcopenia status into stroke risk assessment and prognostic discussions."}},{"doi":"10.1097/aog.0000000000006306","pmid":"42096712","title":"Combined Oral Contraceptives and Stroke Risk in Individuals With Migraine With Aura","journal_title":"Obstetrics & Gynecology","journal_issn":"0029-7844","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1097/aog.0000000000006306","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-14T13:22:52.302Z","updated_at":"2026-05-14T13:22:52.302Z","tags":[{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"condition","value":"Migraine With Aura","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"modality","value":"Combined Oral Contraceptive","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"modality","value":"Progestogen-Only Pill","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"sample_size","value":"n=54413","value_numeric":54413},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"study_design","value":"Cohort Study","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously — while findings challenge existing contraindication guidance, the wide confidence intervals mean the study cannot definitively rule out a clinically meaningful increase in stroke risk with COCs.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"warning","value":"The study design is observational (active comparator new-user cohort); it was tagged as a cohort study rather than RCT, which limits causal inference despite sophisticated weighting methods.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006306","tag_type":"warning","value":"The study population is female (reproductive-age individuals using contraception), but sex is not explicitly labeled in the abstract; this inference is clinically reasonable.","value_numeric":null}],"summaries":{"what_studied":"This study compared stroke risk in individuals aged 15–49 with migraine with aura who initiated combined oral contraceptives (COCs) vs. progestogen-only pills (POPs), using UK primary care records (CPRD) from 2000–2024, with up to 1 year of follow-up.","key_result":"1-year ischemic stroke risk was low and nearly identical: 17.36/100,000 (COCs) vs. 17.62/100,000 (POPs). After weighting, the risk difference was 9.53/100,000 (95% CI −38.65 to 57.71) — a small, statistically imprecise difference with confidence intervals spanning zero.","limitations":"- Confidence intervals are very wide, reflecting limited statistical power to detect small absolute differences in this rare outcome.\n- Individuals were censored at medication discontinuation in primary analyses, which may not reflect real-world patterns of continued use or switching.\n- Residual confounding from unmeasured variables in observational data cannot be excluded.","practice_takeaway":"For reproductive-age patients with migraine with aura, absolute stroke risk was very low and not meaningfully different between COC and POP users in this large real-world study. Clinicians can use this data to support shared decision-making, though current guidelines restricting COC use in this population should be revisited in light of these findings."}}],"initialOffset":31,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Ischemic Stroke"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Ischemic Stroke"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Ischemic Stroke"}}}]]

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