Outcomes in acute ischemic stroke (AIS) depend critically on rapid and accurate early diagnosis in the emergency department. Traditional prehospital tools and large vessel occlusion–focused scales facilitate triage but have limited capacity to distinguish ischemic from hemorrhagic stroke, a distinction essential for acute-phase treatment decisions. Recent advances include mobile stroke units equipped with computed tomography (CT), point-of-care laboratories, and telemedicine systems, as well as the emergence of biomarkers that enable field-based diagnosis and faster initiation of therapy. In-hospital imaging strategies incorporating CT, CT perfusion, and magnetic resonance imaging (MRI)-based tissue clocks have expanded eligibility for endovascular thrombectomy to include patients with large-core infarction or unclear-onset wake-up strokes. Prolonged cardiac monitoring and high-resolution vessel wall MRI have improved the detection of embolic sources and high-risk atherosclerotic plaques. Artificial intelligence now supports rapid imaging interpretation, workflow optimization, and treatment selection. Tenecteplase, a novel thrombolytic, provides a practical alternative to alteplase with comparable safety and efficacy, while post-thrombectomy management emphasizes individualized blood pressure control. In patients with minor stroke or high-risk transient ischemic attack, short-term dual antiplatelet therapy reduces early recurrence, and early initiation of lipid-lowering agents after AIS may stabilize vulnerable plaques and enhance vascular outcomes. Collectively, these innovations represent a shift toward integrated, time-sensitive, and precision-based AIS care spanning prehospital assessment, emergency department management, and post-reperfusion management.
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Current status and advances in comprehensive treatment of acute ischemic stroke in China: from evidence-based guidelines to clinical practice Ze-Ying Wang, Qin-Bao Zhang, Xiao-Ming Zheng Frontiers in Neurology.2026;[Epub] CrossRef
Research progress of artificial intelligence in the diagnosis and treatment of acute ischemic stroke Yan Pan The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.2026;[Epub] CrossRef
Objective The diagnosis of acute ischemic stroke (AIS) is time-sensitive and reliant on neuroimaging, which is not always immediately accessible. This systematic review aims to identify and evaluate bloodbased biomarkers with potential to support early diagnostic decision-making and facilitate prompt referral for confirmatory imaging and treatment.
Methods Following the PRISMA guidelines, a systematic search of PubMed, Web of Science, LILACS, Medline, Scopus, Scielo, Epistemonikos and TRIP Data Base was conducted for primary studies published in the last five years. Original studies evaluating blood-based biomarkers collected within 12 hours of symptom onset for early diagnosis of AIS were included. The methodological quality of included studies was assessed using the QUADAS-2 tool.
Results Ten studies met the inclusion criteria, investigating a range of biomarkers including proteins, non-coding RNAs, and lipids. Most studies were case-control in design, with overall risk of bias rated as low to moderate. Multi-marker panels combining biomarkers with clinical scales (e.g., D-dimer and GFAP with FAST-ED; AUC = 0.95), and lipidomics-based models (AUC = 0.968), demonstrated the highest diagnostic performance. Several individual non-coding RNAs also showed promising accuracy (AUC > 0.85).
Conclusion Blood-based biomarkers, especially when used in multi-marker panels, demonstrate considerable potential as triage tools for early AIS diagnosis. Their application in point-of-care settings could reduce diagnostic uncertainty and accelerate time to treatment. However, prospective validation in real-world emergency environments is essential prior to clinical implementation.
Objective Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not well understood, and its relationship with the functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes. Methods In this multicenter cohort study, we retrospectively analyzed data from 27 hospitals that contributed to the Saiseikai Stroke Database (2013–2021). We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of BAD compared with lacunar infarction (LI) for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included, and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI. Results Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (aOR, 2.77; 95% CI, 2.42–3.17; relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients. Conclusion BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.
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Predicting early neurological deterioration in acute branch atheromatous disease without reperfusion therapy: a machine learning model Li Zeng, Wei He, Xiuxiu Lu, Liangbing Zhang Frontiers in Neuroscience.2026;[Epub] CrossRef
Dual Antiplatelet Therapy in Acute Branch Atheromatous Disease (BAD)‐Related Stroke: A Multicenter Propensity‐Matched Cohort Analysis Haizhou Hu, Shengde Li, Yu Zhang, Yuhui Sha, Yaping Zhou, Feng Feng, Yicheng Zhu, Lixin Zhou, Bin Peng, Jun Ni CNS Neuroscience & Therapeutics.2026;[Epub] CrossRef
Impact of non-amyloid cerebral small vessel disease on the efficacy and safety of argatroban in acute ischemic stroke: a retrospective cohort study Fen Liu, Qiang Wu, Yan Lin, Jie Chen Frontiers in Neurology.2026;[Epub] CrossRef
Impact of Preemptive vs. Conventional Tirofiban Administration on the Outcomes in Acute Branch Atheromatous Disease: A Propensity Score‐Weighted Cohort Study Chunying Li, Ying Jin, Xing Liu, Ying Liu, Weikang Yang, Yue Wang, Dongsheng Ju CNS Neuroscience & Therapeutics.2026;[Epub] CrossRef
Intravenous Thrombolysis for Minor Ischemic Stroke in Chinese Populations: A Secondary Meta-Analysis of Comparative Cohort Studies João Vitor Andrade Fernandes, João Victor de Oliveira Ramos, Maurus Marques de Almeida Holanda The Neurohospitalist.2026;[Epub] CrossRef
Cerebral autoregulation in patients with acute lacunar infarction: a reliable predictor of outcome Xiang‐Kun Si, Song Xue, Xin Zhou, Ya‐Nan Guo, Wen‐Yu Du, Yang Qu, Xin Sun, Zhen‐Ni Guo Annals of Clinical and Translational Neurology.2025; 12(4): 724. CrossRef
Association Between Argatroban and Outcomes of Branch Atheromatous Disease: A Propensity‐Matched Analysis From MRI‐Based Study Shengde Li, Haizhou Hu, Yaping Zhou, Ping Zhang, Guofang Chen, Hongying Bai, Bin Liu, Lixin Zhou, Yicheng Zhu, Bin Peng, Jun Ni CNS Neuroscience & Therapeutics.2025;[Epub] CrossRef
Efficacy and Safety of Tenecteplase in the Treatment of Acute Branch Atheromatous Disease: A Retrospective Multicenter Case–Control Study Lili Zhu, Shengqi Fu, Ying Zhang, Baoyang Shi, Haoran Li, Fanchao Meng, Peng Ji, Dongya Zhang, Yanjun Zhang, Yuan Xu, Bo Jiang, Xiaofei Gao, Lijuan Liu, Weifeng Chen, Li Ruan, Shaolei Zhang, Yang Yang Neurology and Therapy.2025; 14(5): 2187. CrossRef
Blood Pressure Variability and 90‐Day Functional Outcome in Branch Atheromatous Disease‐Related Stroke: A Multicenter Prospective Study Yaping Zhou, Shengde Li, Haizhou Hu, Yi‐Cheng Zhu, Bin Peng, Lixin Zhou, Jun Ni The Journal of Clinical Hypertension.2025;[Epub] CrossRef
Objective To investigate differences in the effect of intravenous (IV) thrombolysis regarding the mismatch of diffusion-weighted imaging–fluid-attenuated inversion recovery (DWI-FLAIR) among acute ischemic stroke patients who visited the emergency department (ED) within 3 hours from the onset of symptoms.
Methods Among ED patients presenting with an acute ischemic stroke between January 2011 and May 2013 at a tertiary hospital, those who underwent magnetic resonance imaging before IV thrombolytic therapy were included in this retrospective study. Patients were divided into DWI-FLAIR mismatch and match groups. National Institutes of Health Stroke Scale (NIHSS) scores obtained initially, 24 hours after thrombolytic therapy, and on discharge, and early neurologic improvement (ENI) and major neurologic improvement (MNI) were compared.
Results During the study period, 50 of the 213 acute ischemic stroke patients who presented to the ED were included. The DWI-FLAIR mismatch group showed a statistically significantly greater reduction in NIHSS both at 24 hours after thrombolytic therapy and upon discharge than did the match group (5.5 vs. 1.2, P<0.001; 6.0 vs. 2.3, P<0.01, respectively). Moreover, ENI and MNI were significantly greater for the DWI-FLAIR mismatch group than for the match group (27/36 vs. 2/14, P<0.001; 12/36 vs. 0/14, P=0.012, respectively).
Conclusion Among acute ischemic stroke patients who visited the ED within 3 hours from the onset of symptoms, patients who showed DWI-FLAIR mismatch showed a significantly better response to IV thrombolytic therapy than did the DWI-FLAIR match group in terms of neurologic outcome.
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Association of FLAIR Positivity and Worse Outcomes After Intravenous Thrombolysis in Known-Onset Strokes: A Systematic Review and Meta-Analysis Esra Zhubi, Azamat Bissenov, Anna Sára Lengyel, Réka Tóth, András Attila Horváth, Szabolcs Kéri, Marie Anne Engh, Péter Hegyi, Bence Gunda Journal of Clinical Medicine.2025; 14(22): 8031. CrossRef
Fluid-Attenuated Inversion Recovery Hyperintense Ischemic Stroke Predicts Less Favorable 90-Day Outcome after Intravenous Thrombolysis Yongwoo Kim, Marie Luby, Nina-Serena Burkett, Gina Norato, Richard Leigh, Clinton B. Wright, Kyle C. Kern, Amie W. Hsia, John K. Lynch, Malik M. Adil, Lawrence L. Latour Cerebrovascular Diseases.2021; 50(6): 738. CrossRef
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