Prior Reperfusion Strategy Does Not Modify Outcome in Early Versus Late Start of Anticoagulants in Patients With Ischemic Stroke: Prespecified Subanalysis of the Randomized Controlled ELAN Trial.

Background: Early initiation of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation and acute ischemic stroke is beneficial and safe. Whether prior acute reperfusion therapy modifies the treatment effect of early versus late DOAC initiation is unknown.

Methods: For this post hoc analysis of the multicenter, randomized controlled ELAN trial (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation), all participants with data concerning reperfusion treatment were included.

Time-dependency of test-retest reliability and measurement error of center-of-pressure synchronization and symmetry during quiet standing within specific frequencies in early sub-acute stroke.

Background: People with unilateral sensorimotor impairments after a stroke exhibit poor between-limb synchronization and asymmetries in balance control by relying on their less-affected side to maintain stability during standing. Therefore, there is a growing consensus to include center-of-pressure metrics as between-limb synchronization and dynamic control asymmetry when investigating balance improvements poststroke. However, the test-retest reliability of these metrics remains under-investigated, hindering uptake of these assessments in future stroke rehabilitation and recovery studies.

Carotid Artery Stenting during Endovascular treatment of acute ischemic Stroke (CASES) study protocol for a multicenter randomized clinical trial.

Background: The optimal acute management of patients with acute ischemic stroke and a tandem lesion, defined as intracranial large vessel occlusion (LVO) with concomitant carotid artery stenosis or occlusion, remains unclear. Our aim is to assess the efficacy and safety of immediate carotid artery stenting (CAS) compared to delayed management in patients undergoing endovascular treatment (EVT) for acute ischemic stroke due to tandem lesions.

Study Design: CASES is a phase 3 multicenter prospective randomized open-label blinded endpoint (PROBE) non-inferiority clinical trial.

Unique Needs and Challenges Experienced by Young People With Stroke: An International Qualitative Analysis.

Background And Objectives: Stroke in young adults has a lifelong impact on activities of daily life, including driving, leisure, and community-based activities; social participation; and reduced productivity. The needs of young people with stroke (YPwS) are likely to vary across different countries, and the development of age-adapted information and interventions is therefore critical in addressing those needs. This study aims to (1) identify the unmet needs of people with stroke aged 18 to 55 years across countries with varied income levels and cultural backgrounds and (2) determine their preferred means to access knowledge and information about stroke in the young.

Association between white matter integrity and lower limb motor impairment after stroke: A systematic review: White matter integrity and lower limb motor impairment after stroke.

Background: There is no clear consensus on the anatomical substrates required for recovery from lower limb (LL) impairment after stroke. Knowledge of biomarkers, such as white matter integrity (WMI), could fill this knowledge gap.

Objectives: To analyze the associations between WMI of the corticospinal tract (CST) and corticoreticulospinal pathway (CRP) and LL motor impairment after stroke, in terms of synergistic control and muscle strength.

Are standing balance and walking ability deficits poststroke related to the integrity of the corticospinal and non-corticospinal tracts? A meta-analysis.

Background: The importance of corticospinal tract (CST) integrity in upper limb recovery poststroke is well established, but its association with standing balance and walking remains unclear. This meta-analysis aimed to establish the relationship between CST and non-CST motor tract integrity, and clinical scores of standing balance and walking poststroke.

Methods: In July 2024, five databases were searched for studies, focusing on diffusion MRI metrics and clinical scores of standing balance and/or walking independence poststroke.

Is a portable pressure plate an alternative to force plates for measuring postural stability and interlimb coordination of quiet standing balance control?

Introduction: Center-of-pressure (COP) synchronization and symmetry can inform adaptations in balance control following one-sided sensorimotor impairments (e.g., stroke).

Safety and efficacy of factor XIa inhibition with milvexian for secondary stroke prevention (AXIOMATIC-SSP): a phase 2, international, randomised, double-blind, placebo-controlled, dose-finding trial.

Background: People with factor XI deficiency have lower rates of ischaemic stroke than the general population and infrequent spontaneous bleeding, suggesting that factor XI has a more important role in thrombosis than in haemostasis. Milvexian, an oral small-molecule inhibitor of activated factor XI, added to standard antiplatelet therapy, might reduce the risk of non-cardioembolic ischaemic stroke without increasing the risk of bleeding. We aimed to estimate the dose-response of milvexian for recurrent ischaemic cerebral events and major bleeding in patients with recent ischaemic stroke or transient ischaemic attack (TIA).

A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization.

Background: There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines.

Aims: To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced).

Time Course and Mechanisms Underlying Standing Balance Recovery Early After Stroke: Design of a Prospective Cohort Study With Repeated Measurements.

Introduction: Although most stroke survivors show some spontaneous neurological recovery from motor impairments of the most-affected leg, the contribution of this leg to standing balance control remains often poor. Consequently, it is unclear how spontaneous processes of neurological recovery contributes to early improvements in standing balance.

Objective: We aim to investigate (1) the time course of recovery of quiet stance balance control in the first 12 weeks poststroke and (2) how clinically observed improvements of lower limb motor impairments longitudinally relate to this limb's relative contribution to balance control.

The impact of COVID-19 on acute stroke care in Belgium.

A worldwide decline in stroke hospitalizations during the COVID-19 pandemic has been reported. Information on stroke care during the pandemic in Belgium is lacking. This study aims to analyze the impact of COVID-19 on acute stroke care in eight Belgian stroke centers.

Vessel territory mapping after cerebral revascularization surgery using selective angiographic flat detector perfusion imaging.

The technical feasibility and diagnostic potential of angiographic flat-detector perfusion imaging technique, combining digital subtraction angiography with a flat-detector computed tomography steady-state perfusion imaging, was explored in patients treated with direct or indirect revascularization surgery. This short communication is about an imaging modality with great potential for evaluation, comparison and grading of vascular perfusion territory areas and anatomical location selectively perfused by direct and indirect cerebral bypasses.

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis.

Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.

Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.

Cerebral venous thrombosis in women of childbearing age: diagnosis, treatment, and prophylaxis during a future pregnancy.

Sex-specific risk factors for cerebral venous thrombosis (CVT) in women include oral contraceptives, pregnancy, puerperium, and hormone replacement therapy. The acute treatment of CVT is anticoagulation using therapeutic doses of low molecular weight heparin, which is also the preferred treatment in the post-acute phase in pregnancy and during breastfeeding. In patients with imminent brain herniation decompressive surgery is probably life-saving.

Characteristics of patients with atrial fibrillation prescribed edoxaban in Belgium and The Netherlands: insights from the ETNA-AF-Europe study.

Background: Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban.

Methods: With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15-50 mL/min, weight ≤60 kg, and/or use of strong p-glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC).

Results: Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe.

Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study.

Background: We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients.

Methods: Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days.

Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians.

Background: With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly.

Methods: Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT).

Caring for a stroke patient: The burden and experiences of primary caregivers in Uganda - A qualitative study.

Aim: We assessed the burden and experiences of caregivers looking after stroke patients in Kampala, Uganda.

Design: We conducted a qualitative cross-sectional study between May 2018-July 2018 among primary caregivers of stroke patients.

Methods: The primary caregiver was defined as the person spending most of the time providing daily care for the stroke patient for at least four months.

Complete Transection of Optic Nerve After Endovascular Coiling of a Large Ophthalmic Artery Aneurysm.

Background: We describe a patient who developed delayed blindness of the left eye at 5 weeks after endovascular coiling of a large ophthalmic aneurysm.

Case Description: A 44-year-old male was admitted with visual decline due to compression of the optic nerve by a large ophthalmic aneurysm. The aneurysm was treated by endovascular coiling, but visual function was unchanged.

Current concepts in imaging and endovascular treatment of acute ischemic stroke: implications for the clinician.

During the last decade, the management of acute ischemic stroke has changed dramatically, from an expectant bedside "wait and see" attitude towards active treatment, thanks to the continuous improvement of new therapeutic options. In addition to the use of intravenous (IV) thrombolysis in emergent large vessel occlusion (ELVO), endovascular therapy (EVT) has proven to be very efficient in selected acute stroke patients. The indications for EVT have progressed from the era of thrombolysis to individual patient profiling.