Atrial fibrillation (AF) is a major contributor to cardioembolic stroke. Anticoagulation, guided by CHA2DS2-VASc and HAS-BLED scores, is critical for secondary prevention, yet challenges persist in timing, patient-specific tailoring, and balancing efficacy with bleeding risk. This umbrella review synthesizes evidence on anticoagulation strategies for secondary prevention of cardioembolic stroke in AF patients. We searched PubMed, Scopus, Cochrane Library, Web of Science, and Embase for systematic reviews and meta-analyses (inception to May 2025) assessing oral anticoagulants (OACs) [vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs)] in AF patients with prior stroke or transient ischemic attack (TIA). Outcomes included recurrent stroke, systemic embolism, major bleeding, intracranial hemorrhage (ICH), and mortality. Quality was assessed using AMSTAR-2. Data were narratively synthesized, with quantitative metrics extracted where feasible. Eight reviews (2007–2025) were included, comprising 4–52 studies and 6893–94 656 participants. DOACs demonstrated superior efficacy over VKAs [apixaban odds ratio (OR) 0.79, 95% confidence interval (CI) 0.66–0.94], and VKAs outperformed antiplatelets (relative risk reduction 64%, absolute risk reduction 8.4%/year). DOACs showed lower major bleeding and ICH rates than VKAs, with apixaban exhibiting the most favorable safety profile (OR 0.71, 95% CI 0.61–0.81). Early versus delayed OAC initiation post-stroke improved efficacy (OR 0.68, 95% CI 0.55–0.84) with comparable safety. Identified knowledge gaps include optimal timing of OACs, outcomes in high-risk subgroups (elderly, renal impairment, and post-ICH), and cost-effectiveness. DOACs are superior to VKAs for secondary prevention of cardioembolic stroke in AF. However, individualized approaches are needed for timing and high-risk subgroups.

Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease primarily affecting upper and lower motor neurons. Although cerebrovascular disease (CVD) and ALS have traditionally been studied as distinct entities, a growing body of evidence indicates meaningful epidemiological, pathophysiological, and clinical overlap between the two conditions. This narrative review synthesizes current evidence on the coexistence of ALS and cerebrovascular disease, examines shared mechanistic pathways, addresses diagnostic challenges, including stroke mimicry, considers clinical management implications, and identifies priorities for future research. A search of PubMed, Scopus, Web of Science, and EMBASE was conducted through February 2026 using the terms “amyotrophic lateral sclerosis,” “motor neuron disease,” “cerebrovascular disease,” “stroke,” “ischemic stroke,” “blood-brain barrier,” “neuroinflammation,” and “neurovascular coupling,” alone and in combination. Peer-reviewed original research, systematic reviews, meta-analyses, population-based studies, registry analyses, and expert consensus statements were included. Studies were assessed for methodological quality and relevance to the review objectives. This review is reported as a narrative synthesis. Population-based data demonstrate a bidirectional relationship between ALS and cerebrovascular events. ALS patients face an approximately 2.6-fold elevated risk of ischemic stroke, and prior cerebrovascular injury modestly increases subsequent ALS risk. Shared pathophysiological mechanisms include neuroinflammation with microglial M1/M2 polarization imbalance, pro-inflammatory cytokine cascades mediated via NF-κB signaling, oxidative stress and SOD1 pathway dysregulation, glutamate excitotoxicity, blood–brain barrier (BBB) dysfunction, and impaired neurovascular coupling. Diagnostic confusion arises because upper motor neuron–predominant ALS can closely mimic acute ischemic stroke. Concurrent cerebrovascular disease appears to accelerate functional decline and reduce survival in ALS. Resource-limited settings face compounded challenges from diagnostic misclassification, restricted EMG access, and limited specialist availability. The ALS–cerebrovascular overlap is clinically relevant, biologically plausible, and systematically understudied. Integrated multidisciplinary management, prospective longitudinal cohort studies, and linked registry analyses are urgently needed to clarify causal relationships, characterize shared disease mechanisms, and improve patient outcomes.

Mechanical thrombectomy (MT) is an established treatment for acute ischemic stroke (AIS) due to large vessel occlusion. However, evidence from multiple systematic reviews and meta-analyses varies across patient populations and clinical subgroups. This umbrella review aimed to synthesize and critically appraise the existing evidence on the efficacy and safety of MT in AIS. An umbrella review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Database of Systematic Reviews were searched from inception to December 2025. Eligible reviews evaluated MT, with or without intravenous thrombolysis (IVT), in adults with AIS and reported outcomes including functional independence, mortality, recanalization, or hemorrhagic complications. Methodological quality was assessed using the AMSTAR-2 tool. Ten systematic reviews and meta-analyses published between 2015 and 2025 were included and were rated as high-to-moderate methodological quality. MT was consistently associated with improved functional independence and higher recanalization rates compared with standard medical therapy or IVT alone. Mortality outcomes were heterogeneous, with some reviews demonstrating reduced mortality and others showing no significant difference. Safety analyses generally showed no significant increase in symptomatic intracranial hemorrhage, although increased hemorrhagic risk was reported in certain populations, including anticoagulated and thrombocytopenic patients. Overall, current evidence from high- to moderate-quality systematic reviews supports the efficacy of MT in improving functional outcomes and recanalization in AIS. However, this umbrella review identifies persistent uncertainty across key clinical subgroups and highlights inconsistencies in mortality and safety outcomes.