Vasospasm occurs in up to 20% of patients with acute ischemic stroke undergoing endovascular treatment, but its clinical impact remains controversial. Intraarterial nimodipine is administered occasionally to treat vasospasm, though its efficacy is uncertain. We aimed to identify factors associated with vasospasm, delineate the impact on clinical outcomes, and assess the effects of intraarterial nimodipine use.

Most people with spontaneous intracerebral hemorrhage (ICH) have hypertension, which is the strongest modifiable predisposing (risk) factor. However, multiple long-term medical conditions and other known predisposing factors for ICH usually coexist with hypertension, indicating that the causal pathway is multifactorial, and the term hypertensive ICH is oversimplistic. In this review, we integrate the highest quality evidence and our clinical experience in a framework to attribute multiple predisposing factors, underlying pathologies, and precipitating factors as the cause of ICH. In clinical practice, this framework supports physicians to take a holistic approach to treatment and prevention of ICH. In research, this framework shows how existing classification systems for the cause of ICH include underlying macrovascular, microvascular, and other structural pathologies but few predisposing or precipitating factors. Furthermore, this framework can inform the development of a more holistic classification system and expose knowledge gaps, including how predisposing factors lead to underlying pathologies and why only some people with these pathologies experience ICH.

Rapid evaluation, triage, and transport of patients with stroke for thrombolytics, thrombectomy, and other acute treatments have become a vital part of cerebrovascular care. As such, there is a need for technology to facilitate interinstitutional coordination of care. This scientific statement describes how technology expands stroke systems of care. Through remote care, virtual access to health care information, and improved interconnectedness across distant facilities, a virtual stroke network acts to bring professionals, specialty expertise, and the gold standard of acute stroke care to the patient regardless of location. We summarize current virtual stroke care components, describe potential integrations, and consider regulatory and ethical concerns. From this analysis, we propose a framework to guide future research and policy.

The utility of 24- to 48-hour follow-up infarct volume (FIV) as a surrogate outcome in late time-window acute ischemic stroke is unclear. We aimed to determine associations of 24- to 48-hour FIV and clinical outcome in patients presenting >6 hours from last known well with and without endovascular treatment (EVT).

In patients with cryptogenic stroke, the characteristics of multiterritory brain infarcts, the recurrent stroke risk, and the response to anticoagulation remain unclear.

Evidence on the association between the stress hyperglycemia ratio (SHR) and adverse outcomes in patients with mild ischemic stroke (IS) or high-risk transient ischemic attack remains limited.

Digital health solutions are being increasingly used to support care delivery across various medical fields. In stroke care, technology has contributed to enhancing prehospital workflows, facilitating communication among health care professionals, and enabling fast-track systems for hyperacute stroke management. Furthermore, digital tools are used to improve etiological diagnosis and allow for more tailored long-term follow-up of stroke patient survivors. Digital technologies have become an integral part of stroke management, and the rapid evolution of artificial intelligence continues to accelerate and drive this transformation. However, ethical and privacy considerations are central and represent a major challenge for the design and implementation of digital solutions in health care. Health care professionals involved in stroke care require a clear understanding of the digital tools they use, including their potential, limitations, and biases, and must be aware of the responsibilities inherent in relying on such systems for treatment decisions and outcome prediction. This topical review aims to examine current digital innovations in stroke care, with a particular focus on the key ethical and privacy challenges they raise.

The HEADS-4 (Fourth Hemorrhagic Stroke Academia Industry) roundtable discussed topics related to the importance of time in the diagnosis and treatment of intracerebral hemorrhage. The goal was to address the shortcomings in current evidence and identify priorities for research to provide stronger data to support implementation of code intracerebral hemorrhage initiatives. The meeting focused on these aspects of intracerebral hemorrhage: diagnosis in the field; reversal of coagulopathy; blood pressure lowering; surgical evacuation; and reorganizing systems of care.

Patients who experience an ischemic stroke while on aspirin therapy present a clinical dilemma about optimal long-term secondary prevention. While switching to an alternative antithrombotic agent is often considered, the effectiveness of switching remains uncertain.

Depression is common after stroke and is associated with increased mortality. However, there are few data on the prevalence, predictors, or prognosis of depression after transient ischemic attack (TIA). Although poststroke depression is often assumed to be due to the brain lesion or disability, patients with TIA may also be susceptible due to shared risk factors, lifestyle/medication changes, or worries about stroke.

This study aimed to investigate whether net water uptake (NWU) is associated with 3-month catastrophic functional outcome (modified Rankin Scale score, 5-6) and to develop predictive models with preprocedural factors, including NWU, in patients with large infarcts who underwent endovascular thrombectomy.

Despite a rising public health burden, there have been few population-based studies of chronic subdural hematomas (cSDH) in the United States. We provide the first estimates of cSDH incidence and mortality in a large, representative U.S. population.

The nonimmunogenic staphylokinase is a recombinant staphylokinase with low immunogenicity, high thrombolytic activity, and fibrin selectivity approved in Russia for the acute ischemic stroke (AIS) thrombolytic therapy within 4.5 hours after symptom onset. We evaluated safety and efficacy outcomes of the nonimmunogenic staphylokinase usage in patients with AIS in the Fortelyzin Population Investigation registry.