STROKE卒中
STROKE(英文缩写 STROKE),ISSN 0039-2499,eISSN 1524-4628,中文译名:卒中 是一本学术期刊。本页汇总该期刊的最新影响因子、分区信息以及最新收录于 PubMed 的文献,帮助您快速了解期刊全貌。
发文量统计区间：2025-10-01 至 2026-09-30，按本站收录文献的发表日期统计。
期刊介绍
历年影响因子趋势
| JCR 数据年份 | 影响因子 | JCR 分区 |
|---|---|---|
| 2021 | 10.170 | Q1 |
| 2022 | 8.300 | Q1 |
| 2023 | 7.800 | Q1 |
| 2024 | 8.900 | Q1 |
| 2025 | 11.100 | Q1 |
STROKE 最新收录文献
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1. Prehospital Stroke Treatment Trials in Conventional EMS Settings: An Expert Consensus Statement on Operational, Ethical, and Technological Priorities.
PMID:日期:2026-09-28Prehospital stroke trials enable assessments of ultraearly administration of treatments and management strategies, but face unique challenges in their design, conduct, and analysis. We outline important considerations and recommendations for planning prehospital stroke trials, focusing on patient identification, consent models, randomization strategies, end point selection, and statistical frameworks. As this field evolves, multidisciplinary collaboration, pragmatic study design, and scalable technology integration are critical to ensuring scientific rigor and equitable access. This framework is intended to inform and support future investigators in designing effective, ethically sound, and operationally feasible prehospital stroke trials in conventional emergency medical services settings.
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2. Deterioration of Peri-Infarct Microvascular Hemodynamics Following Successful Reperfusion in Acute Ischemic Stroke Predicts Infarct Growth.
PMID:日期:2026-09-28Microvascular hemodynamic deterioration is a proposed mechanism underlying the no-reflow phenomenon in acute ischemic stroke. Experimental studies suggested that relative heterogeneity of capillary transit time (RTH) is a potential imaging biomarker of microvascular impairment. We investigated the relationship between peri-infarct RTH and infarct growth, measured on immediate post-thrombectomy (PT) perfusion magnetic resonance imaging (MRI), and functional outcomes in patients with acute ischemic stroke with successful reperfusion. In this retrospective case-control study from the University of California, Los Angeles, patients with acute ischemic stroke from 2015 to 2020 were included if they had excellent reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2c) and diffusion- and perfusion-weighted MRIs at baseline, immediately PT, and 24 to 48 hours after thrombectomy. Peri-infarct regions were defined as time to maximum ≥6-second regions on baseline MRI that were not infarcted on immediate PT MRI. Following image coregistration, quantitative values of perfusion parameters, including RTH, were obtained from peri-infarct regions on immediate PT MRI. Two primary outcomes were assessed: (1) infarct growth ≥10 mL and (2) poor functional outcome (90-day modified Rankin Scale score >2). Associations between clinical and imaging parameters and outcomes were evaluated using univariate analysis. Age, sex, and covariates that were significant in univariate analysis were included in logistic regression analyses. Among 47 patients included in the analysis (62% female; mean age, 72±13 years; median National Institutes of Health Stroke Scale score, 14), 20 (43%) patients had substantial infarct progression and poor functional outcome. Peri-infarct RTH was significantly (=0.005) higher in patients with infarct growth >10 mL than those without and remained as an independent predictor (odds ratio, 1.4 per 10% increase [95% CI, 1.0-2.0]; =0.04). Similarly, the peri-infarct RTH was significantly higher (<0.001) in patients with poor functional outcomes than those with good functional outcomes and remained as a significant predictor of poor functional outcome (odds ratio, 1.4 per 10% increase [95% CI, 1.0-1.9]; =0.03). Increased peri-infarct RTH on immediate PT MRI predicts substantial infarct progression and poor functional outcomes in successfully reperfused patients with acute ischemic stroke. Results highlight the role of microvascular dysfunction depicted by elevated RTH as a potential marker of no-reflow phenomenon despite excellent macrovascular reperfusion.
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3. Responsible AI for Acute Stroke Management.
PMID:日期:2026-09-17Artificial intelligence is increasingly integrated into acute stroke management, demonstrating strong performance in tasks such as large vessel occlusion detection, Alberta Stroke Program Early Computed Tomography Score scoring, and functional outcome prediction. However, concerns persist regarding both the black-box nature of these models and algorithmic bias that may exacerbate disparities in stroke incidence, treatment, and outcomes across racial and socioeconomic subgroups. This review synthesizes the current literature on explainable artificial intelligence and fairness in artificial intelligence applications for acute stroke management, identifies persistent challenges, and outlines recommendations for the development of equitable and trustworthy systems in stroke care. Recent studies have increasingly adopted post hoc explainability methods, though these are limited by approximation and misleading interpretations, especially since explanations are rarely formally tested. Explainability and fairness remain largely disconnected, with fairness evaluation remaining uncommon due to limited demographic metadata, regulatory constraints, and the absence of stroke-specific fairness criteria. Generalizability also remains a concern due to suboptimal data set partitioning strategies and inadequate reporting practices. Responsible artificial intelligence for acute stroke management requires unified evaluation frameworks that jointly assess explainability, fairness, and generalizability.
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4. Plasma Feeding Protects the Blood-Brain Barrier Post-Asphyxia While the Blood-CSF Barrier Remains Spared.
PMID:日期:2026-09-17Metabolic and neurovascular disturbances contribute to brain injury after birth asphyxia. We previously showed that plasma feeding attenuated neuropathology after transient umbilical cord occlusion in piglets. This study explored the metabolic and molecular consequences of birth asphyxia and whether plasma feeding preserves metabolic homeostasis and brain barrier integrity. Piglets (n=89) delivered by cesarean section on gestational day 113 underwent umbilical cord occlusion (asphyxia) or remained nonasphyxiated (control). Asphyxia and control piglets were randomly assigned to receive formula reconstituted with either water (vehicle-treated group) or sow plasma (plasma-treated group). Animals were euthanized at 1 hour, 24 hours, or day 4 after insult. Cerebrospinal fluid metabolites were profiled by untargeted liquid chromatography-mass spectrometry metabolomics at 24 hours. Expression of metabolite transporters and structural components of the blood-brain barrier in the caudate nucleus and the blood-cerebrospinal fluid barrier at the choroid plexus was assessed by reverse transcription quantitative polymerase chain reaction and Western blotting. The CSF/plasma Na ratio was assessed, and cell-specific expression was confirmed with RNAscope. Data were analyzed using linear and linear mixed-effects models. Birth asphyxia dysregulated the CSF metabolic profile, with reductions in multiple metabolites and increases in a smaller subset, consistent with impaired amino acid and lipid metabolism. This was accompanied by reduced expression of substrate transporters, including , , , , , and . In the caudate nucleus, expression of blood-brain barrier structural proteins and ion transporters, including Na/K-ATPase, was reduced, whereas the choroid plexus blood-CSF barrier remained largely preserved. Plasma feeding partially restored transporter expression at both brain interfaces and increased and ion transporter expression at the blood-brain barrier by day 4. Increased VE-cadherin (vascular endothelial cadherin) and ZO-1 (zonula occludens-1) expression and elevated CSF Na concentrations suggested early modulation of the integrity of the 2 brain barriers. Plasma feeding preserves metabolic homeostasis and supports brain barrier integrity after birth asphyxia, highlighting plasma-derived factors as potential therapeutic targets to reduce neurodevelopmental impairment after perinatal asphyxia.
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5. Global Burden of Pediatric Stroke (1990-2023): A Shift From Mortality Toward Disability.
PMID:日期:2026-09-17Pediatric stroke is a significant cause of long-term disability worldwide, with outcomes influenced by age, stroke subtype, and access to care. Our objective was to define the global burden of pediatric stroke by its impact on mortality and disability. The Global Burden of Disease study uses advanced statistical modeling to analyze health across locations, synthesizing data on mortality, morbidity, and risk factors. We examined 2023 data from the study to assess deaths, years of life lost, and years lived with disability during 3 eras (1990-2001, 2002-2013, and 2014-2023) across high-income and low- and middle-income countries. We stratified the analysis by sex, age group, and stroke subtype. We calculated the proportion of burden attributable to disability (years lived with disability/[years lived with disability+years of life lost]) to assess shifts from fatal to nonfatal disease over time. Between 1990 and 2023, global age-standardized pediatric stroke incidence declined only modestly, whereas age-standardized years of life lost rates declined significantly, indicating that the lower mortality burden reflected better survival rather than a large reduction in disease occurrence. Because years lived with disability rates remained comparatively stable as mortality declined, the proportion of disease burden attributable to disability rose from 14.6% (1990-2001) to 21.7% (2014-2023). This transition was uneven across settings: high-income countries achieved faster mortality declines and reached a higher disability share, whereas low- and middle-income countries retained a higher mortality burden, reflecting a dual burden of ongoing premature death and rising disability. These patterns were consistent across age and sex strata. These data indicate that pediatric stroke is undergoing an epidemiological transition from a mortality-dominant burden to one increasingly driven by disability, reflecting improved survival but with uneven distribution worldwide. Reducing the disability burden, through better stroke recognition education and expanded access to prevention, acute stroke care systems, reperfusion, and rehabilitation, particularly in low- and middle-income countries, should be prioritized alongside efforts to close persistent global inequities in outcomes.
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6. Early Life Vascular Risk and Midlife Markers of Brain Aging.
PMID:日期:2026-09-15Early-life vascular risk factors are increasingly linked to midlife cognitive decline, though critical risk periods remain unclear. These factors also relate to structural brain changes, yet midlife alterations tied to cognitive decline are poorly defined. We leveraged data from the CARDIA study (Coronary Artery Risk Development in Young Adults) to identify critical periods and factors associated with midlife cognition and neuroimaging signatures. We utilized longitudinal cognitive and neuroimaging data from the prospective CARDIA study with vascular risk factor data spanning 35 years (1985-2020). K-means clustering of cognitive trajectories identified Declined and Stable clusters. A gradient boosting classifier identified factors predictive of cluster membership. Linear mixed-effects models assessed cluster differences in structural brain changes, and structural covariance analyses identified brain network remodeling linked to cognitive decline. Cross-sectional late-midlife cognitive data were used to examine associations between early adulthood (ages 18-40 years) systolic blood pressure strata and cognitive outcomes. Among 280 participants with longitudinal data (mean age, 50±3.5 years at baseline; 52% to 56% female, 40% to 41% Black race) followed for a median of 10 years, higher systolic blood pressure and smoking before age 40 years were critical factors for cognitive cluster membership in late midlife (feature importance ≈0.3 and 0.2, respectively). Accelerated accumulation of white matter hyperintensities, gray matter volume changes involving frontal and temporal association cortices, occipital pole and thalamus (β range, -0.0006 to -0.002; ≤0.02), and network-level reorganization predominantly involving the basal forebrain spanning early- to late-midlife distinguished clusters. A stepwise, dose-dependent association between early-life systolic blood pressure strata and late-midlife cognitive performance was replicated in 720 participants (mean age, 61±3.5 years). Before age 40 years may be a critical window to manage vascular risk factors and preserve midlife cognition. Linked white matter hyperintensity and gray matter changes suggest that vascular factors drive both cerebrovascular and neurodegenerative injury. A basal forebrain-centered neuroimaging signature, possibly reflecting cholinergic and glial responses to early vascular stress, may serve as an early biomarker for prevention trials.
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7. Transcarotid Artery Revascularization Versus Carotid Artery Stenting for Asymptomatic Carotid Stenosis.
PMID:日期:2026-09-14The CREST-2 trial demonstrated superiority of carotid artery stenting (CAS) over intensive medical management for asymptomatic carotid stenosis, but it did not evaluate transcarotid artery revascularization (TCAR). Herein, we compared ischemic stroke outcomes between TCAR and CAS among patients with asymptomatic carotid stenosis in contemporary real-world practice. We identified adults with asymptomatic carotid stenosis undergoing TCAR versus CAS using the 2016 to 2024 TriNetX database, which is a multicenter federated database of electronic health records. Propensity score matching was performed for demographics, laboratory values, risk factors, comorbidities, and medications. The primary outcome was ischemic stroke within 4 years. Among 7303 identified patients, 2207 patients remained in each group after matching. TCAR did not demonstrate a significantly different stroke risk compared with CAS (hazard ratio, 0.68 [95% CI, 0.44-1.06]). The absolute risk difference was numerically but nonsignificantly lower for patients with TCAR throughout the follow-up period, progressively widening over time: 0.35% at 6 months (0.61% versus 0.96%; =0.18) to 1.55% at 4 years (3.26% versus 4.81%; =0.086). TCAR did not significantly lower stroke risk compared with CAS for asymptomatic carotid stenosis. Although nonsignificant trends towards lower stroke risk were observed for TCAR, the widening of absolute risk differences over time suggests residual confounding rather than potential procedural benefit.
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8. Sodium-Glucose Cotransporter 2 Inhibitor Use and Functional Outcomes After Endovascular Thrombectomy in Diabetic Stroke.
PMID:日期:2026-09-14Although preclinical studies and limited clinical evidence suggest potential benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) after acute ischemic stroke, their effects in patients with moderate-to-severe acute ischemic stroke requiring endovascular thrombectomy remain unclear. This study aimed to evaluate whether SGLT2i use after endovascular thrombectomy is associated with improved 3-month functional outcomes in diabetic patients with acute ischemic stroke. This retrospective cohort study analyzed prospectively collected data from January 2020 to March 2025 across 4 comprehensive stroke centers in Korea, Italy, and Switzerland. Consecutive adult patients with diabetes were grouped according to whether SGLT2i was used after their endovascular thrombectomy. Propensity score-based methods-including overlap weighting, inverse probability of treatment weighting, and 1:1 propensity score matching-were applied. Outcomes included the shift in 3-month modified Rankin Scale score, favorable (modified Rankin Scale score 0-2), and excellent outcomes (modified Rankin Scale score 0-1) at 3 months. Ordinal and binary logistic regression analyses were performed. Of 429 eligible patients (mean [SD] age, 73.5 [11.1] years; 249 [58.0%] men; median [interquartile range] initial National Institutes of Health Stroke Scale score, 12 [6-18]), 51 (11.9%) received SGLT2i poststroke. Successful recanalization was achieved in 85.3%. In the overlap weighting model (weighted n=37 per group), SGLT2i use was associated with improved 3-month modified Rankin Scale score distribution (common odds ratio, 2.31 [95% CI, 1.30-4.10]) and higher odds of a favorable outcome (odds ratio, 2.26 [95% CI, 1.15-4.43]). Results were consistent across inverse probability of treatment weighting and propensity score matching models, with inverse probability of treatment weighting analyses additionally demonstrating significant associations with excellent outcomes. No significant effect modification was observed across key clinical subgroups. Poststroke SGLT2i therapy after endovascular thrombectomy was associated with improved 3-month functional outcomes in this multicenter retrospective analysis of diabetic patients. These findings suggest a potential therapeutic role for SGLT2i in poststroke diabetes management and support future prospective trials.
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9. Circulating Metabolites Are Biomarker Candidates for Stroke Risk Prediction: Results From the BiomarCaRE Project.
PMID:日期:2026-09-11Stratification of stroke risk remains challenging, but metabolomic profiling offers the potential to detect new biomarkers and to improve early risk assessment of incident stroke. The objective of this study was to evaluate the association between circulating metabolites and the incidence of stroke in a case-cohort study conducted across several large population-based European cohorts. Following the case-cohort design, a subset of 10 299 individuals, including all individuals with incident stroke, was selected from the original cohort of >70 000 individuals. The case-cohort design used a random subsample of the selected population cohorts, supplemented with cases not sampled in this random subcohort. A total of 141 circulating metabolites were measured from serum samples of the selected individuals, and associations of these metabolites with risk of incident stroke were estimated and compared with those of classic risk factors (sex, age at examination, systolic blood pressure, total cholesterol, body mass index, diabetes, daily smoking status, and antihypertensive treatment). Associations with time to stroke were assessed using weighted Cox proportional hazards models adjusted for the classic risk factors. Hazard ratios (HRs) for the log-transformed metabolites were reported per 1 SD increase. Of the 70 195 individuals in the original cohort, 1516 (2.2%) experienced incident strokes during a median follow-up time of 8.9 years (interquartile range, 4.4-14.7). Median age was 56.8 years (interquartile range, 49.5-62.4), and 39.5% were female. Six of the 141 metabolites (2 diacyl-phosphatidylcholines, 2 lyso-phosphatidylcholines, 1 hydroxysphingomyelin, and glutamic acid) remained significantly associated with incident stroke after correction for multiple comparisons (adjusted HRs [95% CIs] per SD: lyso-phosphatidylcholines a C18:2 HR, 0.88 [95% CI, 0.82-0.93], lyso-phosphatidylcholines a C17:0 HR, 0.88 [95% CI, 0.83-0.94], hydroxysphingomyelin C14:1 HR, 0.90 [95% CI, 0.85-0.94], diacyl-phosphatidylcholines C34:1 HR, 1.10 [95% CI 1.05-1.16], diacyl-phosphatidylcholines C32:1 HR, 1.14 [95% CI, 1.08-1.21], glutamic acid HR, 1.23 [95% CI 1.11-1.37]). The strengths of these associations were similar to those for classic cardiovascular risk factors (C statistics for 10-year prediction ranging from 0.782 to 0.785 for metabolites compared with 0.781 to 0.792 for classic cardiovascular risk factors). Among 10 299 individuals from the general European population, we identified 6 metabolites from 4 different metabolite classes that were associated with future risk of stroke. The application of specific circulating metabolites may improve early stroke risk prediction before the onset of potentially irreversible cerebrovascular pathological processes.
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10. High-Resolution Disconnectome Predicts Outcome and Response to Thrombectomy in Basilar Artery Occlusion.
PMID:日期:2026-09-11Acute basilar artery occlusion causes devastating strokes. Despite the benefit of endovascular treatment, the optimal management remains controversial in specific subgroups, particularly patients with mild deficits, and would benefit from robust prognostic tools. Given the dense white matter networks within the posterior fossa, we tested whether quantifying disconnections from acute diffusion-weighted imaging could improve outcome prediction and identify responders to recanalization compared with conventional metrics. We conducted a secondary analysis of a prospective multicenter stroke registry in France, including consecutive patients (2017-2024) with basilar artery occlusion and admission magnetic resonance imaging. Ultra-high-resolution diffusion magnetic resonance imaging was acquired in 2 healthy participants to build normative tractograms with optimized posterior fossa quality. Patient infarcts delineated on diffusion-weighted imaging were projected onto these tractograms to estimate disconnected fiber volume. The primary outcome was 90-day modified Rankin Scale score (0-3 versus 4-6). Predictive performance of disconnected fiber volume was compared with baseline National Institutes of Health Stroke Scale (NIHSS), infarct volume, and posterior circulation Alberta Stroke Program Early Computed Tomography Score using logistic regressions and area under the receiver operating characteristic curves. Ordinal regressions tested associations between dichotomized disconnection status and the full modified Rankin Scale spectrum, stratified by recanalization status. Analyses were repeated in patients with an NIHSS score ≤10. Among 201 patients (median age, 70; NIHSS score, 10), 97 (48.3%) had a poor outcome. Despite a small median infarct volume (4.75 mL), disconnected fiber volume was substantial (median 25.15 mL). Disconnected fiber volume achieved an area under the receiver operating characteristic curves of 0.84, outperforming NIHSS score (0.67; <0.0001), infarct volume (0.75; =0.00059), and posterior circulation Alberta Stroke Program Early Computed Tomography Score (0.76; =0.0127). Patients without significant disconnection had better outcomes across the full modified Rankin Scale spectrum (odds ratio, 0.12 [95% CI, 0.065-0.204]) and derived greater benefit from successful recanalization (odds ratio, 0.33 [95% CI, 0.15-0.70]). In patients with an NIHSS score ≤10 (n=102), disconnected fiber volume remained the strongest predictor (area under the receiver operating characteristic curves of 0.83). Disconnected fiber volume derived indirectly is a robust prognostic marker of basilar artery occlusion outcomes that outperforms conventional predictors and may support future treatment decisions after prospective validation. URL: https://clinicaltrials.gov; Unique identifier: NCT03776877.