Daily deep-dive on stroke neurology literature.
GBD 2021 stroke burden across 204 countries: age-standardised incidence -21.8%, deaths -39.4%, DALYs -38.7% (1990-2021), but absolute counts up; 84.1% of stroke DALYs attributable to 23 risk factors (metabolic 68.8%, environmental 36.7%, behavioural 35.2%).
Preclinical study in male Wistar rats showing that the 35 kDa claudin-5 (CLDN5) isoform 1, produced by a novel intra-exonic splice junction conserved in human hypoxic endothelial cells, correlates with edema, neurological deficit, and hemorrhage at 24 h after thromboembolic stroke.
A longitudinal Oxford cohort found that cognitive recovery after stroke is common but heterogeneous: acute cognitive burden was the strongest predictor of chronic impairment, while a small subgroup declined over time.
In the HOPE randomized trial, reperfusion-guided systolic blood pressure targets after successful thrombectomy improved 90-day functional independence and reduced hemorrhagic transformation without increasing symptomatic intracranial hemorrhage or mortality.
In adults 3 to 18 months after stroke, adding action observation to virtual-reality training improved paretic-hand dexterity more than virtual reality alone, with the between-group advantage persisting at 6 months.
In 4,765 patients receiving oral antithrombotic therapy, severe MRI-defined cerebral small vessel disease was associated with functional decline over 24 months even after accounting for major bleeding and ischemic events.
In the MIND trial, minimally invasive surgery with the Artemis device within 72 hours did not significantly reduce 30-day mortality or improve 180-day disability in supratentorial ICH versus medical management alone.
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In a matched multicenter cohort of 746 large-vessel-occlusion patients undergoing bridging therapy, tenecteplase produced nearly twice the thrombus migration of alteplase (19.3% vs 11.3%), concentrated in the first 60 minutes after IVT, and migration independently predicted functional independence.
Argatroban + antiplatelet in END (n=601): 90-d mRS 0–3 80.5% vs 73.3% (aRR 1.10, P=0.03); sICH 0.9% vs 0.7% (P=0.78); mRS shift OR 0.71 (P=0.02).
ANNEXA-I secondary analyses: andexanet benefit amplifies in highest-risk HE quartiles (NNT ~4) without amplifying thrombotic-event risk; authors propose an 11-to-1 rule.
Argatroban+DAPT vs DAPT alone in high-risk branch atherosclerosis disease (n=100): END 20.4% vs 47.1% (P=0.006), mRS 0–1 87.8% vs 68.6% (P=0.025), no excess bleeding.
JX10 phase 2a (n=90) — late-window (5–12h) thrombolytic met its primary safety endpoint (0% sICH vs 2.6% placebo) and showed a day-90 mRS 0–1 signal (40.4% vs 18.4%, P=0.03).
ANNEXA-I biomarker substudy: 1-hour reduction in anti-FXa (OR 0.69/100 ng/mL) and rise in ETP (OR 0.94/100 nmol/L-min) both predict fewer hematoma expansions; the ETP rise also independently predicts more thrombotic events (OR 1.08).
Post-hoc analysis of MR CLEAN-MED + MR CLEAN-NO IV: perforator-territory infarcts after LVO thrombectomy (n=397) triple the odds of worse 90-day mRS without affecting 24-h NIHSS.
MR CLEAN Registry M2 analysis (n=539): bridging IV thrombolysis before EVT improves 90-day mRS vs direct EVT (aOR 1.52, P=0.03); sICH and recanalization similar.
OPTIMAS subgroup analysis: in 3,619 stroke patients with AF, neither the time of AF diagnosis nor AF subtype modifies the effect of early DOAC initiation versus delayed initiation.
ETLAS-2 phase II: tadalafil 20 mg daily for 3 months in CSVD fails feasibility (compliance 68% vs 94% placebo) with 2-fold more AEs; per-protocol WMH volume trend suggests mechanistic signal at lower doses.
ZODIAC phase III RCT (n=92, stopped early for efficacy): 0° vs 30° head-of-bed positioning before thrombectomy — END HR 34.40 (95% CI 4.65–254.37), P<0.001; exploratory mortality P=0.03.
T-FLAVOR Japanese phase 2 (n=218): tenecteplase vs low-dose alteplase for LVO bridging — substantial reperfusion 10.3% vs 3.6% (90% CI 0.89–12.1; 95% CI −0.19% to 13.2%; mRS shift favors TNK numerically).
LAMP post-hoc: liraglutide reduced recurrent stroke in insulin-resistant T2D stroke/TIA patients (HOMA-IR ≥ 2.5) but not in those with preserved insulin sensitivity.
First RCT of home-based HIIT for poststroke fatigue: 8-week intervention cut S-FAS by 5.35 points and improved VO2peak by 4.48 mL/kg/min in 43 completers.
ACTISAVE failed to confirm a beneficial effect of glenzocimab on mRS in patients with acute ischemic stroke treated by thrombolysis ± thrombectomy.