Background: Blood–brain barrier permeability (BBBp) is a key process involved in ischemic stroke pathophysiology. However, there is a lack of consensus on how BBBp evolves after the ischemia injury, and its clinical relevance at different timepoints post stroke. Aims: The main objective of this study is to assess BBBp evolution through stroke phases and its implications on patient outcomes. Methods: We screened PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials up to 31 December 2021. We included research quantitatively using neuroimaging to assess BBBp in stroke patients. BBBp in the different phases was evaluated by a random-effect model based on the standardized mean difference (SMD) between the ipsilateral and contralateral sides of the brain. We performed a subgroup analysis on clinical outcome, reperfusion treatment, haemorrhagic transformation, and imaging method. Results: We identified 3761 studies, of which 22 (1592 patients and 1787 evaluations) were included in our study. Overall, 17 studies reported BBBp for the hyperacute phase, 8 for the acute, 5 for the subacute, and 2 for the chronic phase. All phases were associated with increased BBBp: 0.74 (0.48–0.99), 1.68 (0.94–2.42), 1.98 (0.96–3.00), and 1.00 (0.45–1.55), respectively. An increase in BBBp was associated with hemorrhagic transformation in the hyperacute phase and with improved functional outcomes in the late subacute phase. Conclusion: BBBp is persistently increased after stroke, peaking in the acute and subacute phases. The degree of BBBp influences patient outcomes depending on stroke phase. Our findings support the clinical relevance of BBBp dynamics in stroke care.

BACKGROUND: The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined. PURPOSE: The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs. DATA SOURCES: We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006). STUDY SELECTION: A total of 12 studies reporting accuracy values of CTA and/or CTP were included, comprising 2607 patients with 479 cases (18.3%) of DMVOs. DATA ANALYSIS: Pooled sensitivity and specificity of both imaging methods were compared using a random-effects model. Subgroup analyses were performed based on the technique used in CTA (multi or single-phase) and the subtype of DMVOs (M2-only vs. M2 and other DMVOs). We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria. DATA SYNTHESIS: CTA demonstrated significantly lower sensitivity compared to CTP in detecting DMVOs [0.74, 95%CI (0.63–0.82) vs. 0.89, 95% CI (0.82–0.93), P < 0.01]. When subgrouped into single-phase and multi-phase CTA, multi-phase CTA exhibited higher sensitivity for DMVO detection than single-phase CTA [0.91, 95%CI (0.85–0.94) vs. 0.64, 95%CI (0.56–0.71), P < .01], while reaching similar levels to CTP. The sensitivity of single-phase CTA substantially decreased when extending from M2 to other non-M2 DMVOs [0.74, 95%CI (0.63–0.83) vs. 0.61, 0.95%CI (0.53–0.68), P = .02]. LIMITATIONS: We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies. CONCLUSIONS: Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.

Introduction Ischaemic stroke is the most prevalent type of stroke and is characterised by a myriad of pathological events triggered by a vascular arterial occlusion. Disruption of the blood-brain barrier (BBB) is a key pathological event that may lead to fatal outcomes. However, it seems to follow a multiphasic pattern that has been associated with distinct biological substrates and possibly contrasting outcomes. Addressing the BBB permeability (BBBP) along the different phases of stroke through imaging techniques could lead to a better understanding of the disease, improved patient selection for specific treatments and development of new therapeutic modalities and delivery methods. This systematic review will aim to comprehensively summarise the existing evidence regarding the evolution of the BBBP values during the different phases of an acute ischaemic stroke and correlate this event with the clinical outcome of the patient. Methods and analysis We will conduct a computerised search on Medline, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science. In addition, grey literature and ClinicalTrials.gov will be scanned. We will include randomised controlled trials, cohort, cross-sectional and case-controlled studies on humans that quantitatively assess the BBBP in stroke. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias of the selected studies. If possible, data will be combined in a quantitative meta-analysis following the guidelines provided by Cochrane Handbook for Systematic Reviews of Interventions. We will assess cumulative evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Ethics and dissemination Ethical approval is not needed. All data used for this work are publicly available. The result obtained from this work will be published in a peer-reviewed journal and disseminated in relevant conferences. PROSPERO registration number CRD42019147314.

Introduction: After several uncontrolled studies and one randomized clinical trial, there is still uncertainty regarding the role of endovascular treatment (EVT) in cerebral venous thrombosis (CVT). This study aims to describe and assess different acute management strategies in the treatment of CVT. Methods: We performed a retrospective analysis of an international two-center registry of CVT patients admitted since 2019. Good outcome was defined as a return to baseline modified Rankin scale at three months. We described and compared EVT versus no-EVT patients. Results: We included 61 patients. Only one did not receive systemic anticoagulation. EVT was performed in 13/61 (20%) of the cases, with a median time from diagnosis to puncture of 4.5 h (1.25–28.5). EVT patients had a higher median baseline NIHSS [6 (IQR 2–17) vs 0 (0–2.7), p = 0.002)] and a higher incidence of intracerebral hemorrhage (53.8% vs 20.3%, p = 0.03). Recanalization was achieved in 10/13 (77%) patients. Thrombectomy was performed in every case with angioplasty in 7 out of 12 patients and stenting in 3 cases. No postprocedural complication was reported. An improvement of the median NIHSS from baseline to discharge [6 (2–17) vs 1(0–3.75); p < 0.001] was observed in EVT group. A total of 31/60 patients (50.8%) had good outcomes. Adjusting to NIHSS and ICH, EVT had a non-significant increase in the odds of a good outcome [aOR 1.42 (95%CI 0.73–2.8, p = 0.307)]. Conclusions: EVT in combination with anticoagulation was safe in acute treatment of CVT as suggested by NIHSS improvement. Selected patients may benefit from this treatment.

Objective: The Mediterranean diet (MedDiet) is characterized by its emphasis on plant-based foods, olive oil, and fish products, and has been associated with providing relevant fatty acids (FAs) for adolescent physiology. This study aims to investigate the relationship between adherence to the MedDiet and the FA composition of red blood cell (RBC) membranes in an adolescent population. Methods: The current research examines the relationship between MedDiet adherence, assessed using the KIDMED questionnaire, and the composition of RBC membranes, specifically measuring 22 FAs in a cross-sectional analysis of adolescents from two cohorts (mean age = 14.55). Baseline data from 552 participants with complete dietary adherence and FA information were analyzed using multivariable regression models and principal component analysis (PCA) as confirmatory analysis. All regression models were adjusted by age, sex, body mass index, physical activity, maternal education and cohort enrollment. Results: Main results shown that “Good adherence” to the MedDiet was positively associated with omega-3 FAs, including eicosapentaenoic acid (β = 0.34; 95% CI: 0.17, 0.52; p-value < 0.001) and docosahexaenoic acid (β = 0.29; 95% CI: 0.11, 0.46; p-value = 0.001), and inversely associated with specific omega-6 FAs, such as arachidonic acid (β = −0.28; 95% CI: −0.46, −0.11; p-value = 0.002) and adrenic acid (β = −0.19; 95% CI: −0.30, −0.08; p-value < 0.001). PCA identified distinct FA patterns, with “Good adherence” to the MedDiet being associated with an increase in the omega-3 FAs pattern (β = 0.32; 95% CI: 0.14, 0.49; p-value < 0.001). These findings remained robust after multiple test comparisons. Conclusions: This study underscores the potential of the MedDiet to promote optimal RBC FA composition in healthy adolescents, characterized by high levels of omega-3 FAs and reduced levels of arachidonic acid and adrenic acid in RBC membranes.

Introduction: The increasing number of stroke survivors underscores the need for coordinated post-discharge care and systematic outcome monitoring. HARMONICS aimed to provide standardised follow-up, integrating clinician-reported (CROMs) and patient-reported outcomes (PROMs) into a value-based care model. Patients and methods: Using lean methodology, post-stroke care pathways were mapped, and a harmonised workflow was implemented across 6 comprehensive stroke centres (CSCs) in Spain and Portugal. Consecutive patients discharged home or to socio-rehabilitation facilities with an mRS < 5 were offered participation. Follow-up was conducted via a smartphone app or telephone, enabling bidirectional communication with a case manager for health education, vital sign monitoring and PROMs collection. Feasibility required meeting 4 predefined indicators: inclusion > 60%, 3-month retention > 75%, PROMs completion > 60% and satisfaction > 70% measured by patient-reported experience measurement (PREM). Secondary analyses compared outcomes with historical cohorts. Results: Between 2022 and 2024, 4209 patients were recruited (40.2% women; median age 73 [IQR 62–81]; 75.6% ischaemic; median admission NIHSS 3 [1–6]; median discharge mRS 2 [1–3]). App use occurred in 59.9% (56% independently). Feasibility was achieved for inclusion (82.8%), retention (84.6%) and satisfaction (72.9%), but PROMs completion was 53.7% at 90 days. Despite mild severity, many reported suboptimal PROMs at 3 months, improving modestly by 1 year. Compared with historical controls, HARMONICS patients showed a better 3-month mRS distribution (OR 1.124; 95% CI, 1.042–1.213; P = .0026) and improved PROMs (P < .05). Discussion and Conclusion: HARMONICS is a feasible multicentre value-based follow-up model that promotes education, engagement and self-responsibility, with high rates of healthcare satisfaction reported by stroke survivors.