Introduction: Mobile stroke units (MSUs) have demonstrated important clinical benefits in acute ischemic stroke, but broad implementation remains constrained by resource, staffing, and operational barriers. This article describes an emergency medical services (EMS)-integrated diagnostic-focused MSU (DF-MSU) model designed to improve implementation feasibility and scalability. Methods: A conceptual design approach was used based on findings from a previous global survey of MSU programs. The model was guided by three design principles: cost reduction, operational simplification, and integration with existing EMS while preserving the CT-based diagnostic function of MSUs. Conclusion: The DF-MSU model separates CT-based diagnosis from treatment and transport, which are integrated with existing EMS systems. After CT evaluation in the DF-MSU at the emergency scene or rendezvous point, the patient is transferred to an EMS vehicle, where the physician and, when available, the nurse provide diagnosis-specific treatment and continued care during transport. This EMS-integrated model may reduce resource requirements, staffing needs, and operational complexity, and may offer a feasible and scalable alternative in regions where conventional MSU deployment is challenging.
PURPOSE:Non-stenotic carotid plaques, despite being considered low risk for stroke, are increasingly recognized to contribute to embolic strokes of undetermined source (ESUS). Emerging evidence indicates that rather than the degree of stenosis, high-risk plaque characteristics like plaque irregularity and intraplaque haemorrhage may increase the embolic risk. We analysed the prevalence and characteristics of non-stenotic carotid plaques in ESUS and their implications for stroke recurrence risk. METHODS:We retrospectively identified 274 patients with ESUS between 2012 and 2022. The CT angiograms were analyzed for non-stenotic carotid plaques (<50% stenosis, as per NASCET criteria) by blinded neuroradiologists. The infarct patterns and plaque characteristics were evaluated. The stroke recurrence at 3 months and one year were noted. RESULTS:The mean age of the study population was 57.99 ± 12.86 years, and 65.3% were males. The non-stenotic plaques (30-50% stenosis) were more common on the symptomatic side of stroke (13.3% vs. 7.3%, p = 0.026). Plaques with irregularity were also more frequent on the symptomatic side (16.4% vs. 9.7%, p = 0.023). Patients with symptomatic non-stenotic plaques had a higher incidence of embolic (25% vs. 5%, p = 0.000) and watershed infarcts (16.7% vs. 4.6%, p = 0.005). The stroke recurrence risk and mortality at 3 months and one year did not differ between the 2 groups. CONCLUSION:In this single-centre retrospective study, non-stenotic carotid plaques with 30-50% stenosis were more prevalent on the symptomatic side, suggesting a potential role in stroke mechanism. The higher rates of embolic and watershed infarcts and the presence of plaque irregularity on the symptomatic side, support this association.
Introduction Acute ischaemic stroke and primary intracerebral haemorrhage are complicated by oropharyngeal dysphagia in more than 50% of patients. Currently, there are no definitive treatments for post-stroke dysphagia. Pharyngeal electrical stimulation (PES) can drive long-term beneficial changes in the cortical control of swallowing with functionally relevant reorganisation of the swallowing cortex correlating with reduced dysphagia. Methods The pharyngeal electrical stimulation for acute stroke dysphagia trial (PhEAST) is an international prospective randomised open-label blinded-endpoint parallel-group phase-4 superiority effectiveness trial. 638 patients with post-stroke dysphagia and dependency on nasogastric tube feeding are being recruited within 2 to 31 days of ictus. Participants are recruited from UK and Austria and randomised to six days of optimised PES (given for 10 minutes each day) versus no PES on top of standard care. The primary outcome is the dysphagia severity rating scale (DSRS), an assessment of swallowing impairment, measured locally on day 14 and centrally at day 90 by trained observers masked to treatment and analysed using repeated measures regression analysis. Secondary outcomes include: functional oral intake scale, feeding status scale, international dysphagia diet standardisation initiative scale, presence of a feeding tube, pneumonia, antibiotic use, health-related quality of life, dependency, disability, frailty, mood, cognition, global impact and health economics at days 14, 90, 180 and 365. Safety measures include death and serious adverse events. Discussion PhEAST has recruited more than 574 participants from 45 hospitals in the UK and Austria; recruitment will complete at end October 2026. The attached Supplement summarises the protocol and follows the EQUATOR SPIRIT guideline.
INTRODUCTION:Despite the established benefit of mechanical thrombectomy (MT), data on the incidence, risk factors, and longer-term outcomes of stroke-associated infections (SAIs) in this population remain limited. This retrospective, single-centre cohort study evaluated the frequency of SAI, associated variables, and longer-term mortality post-MT. METHODS:Data for acute ischaemic stroke patients undergoing MT at Manchester Centre for Clinical Neurosciences were extracted from the Sentinel Stroke National Audit Programme (April 2016-March 2024) and linked to electronic patient records. Routinely collected admission and procedural variables were analysed. Primary outcome measures were the proportion of patients developing SAI and subtypes of SAI post-MT. Multifactorial regression analysis was performed to evaluate associations between clinical variables and SAI and also between SAI and 1-year mortality. RESULTS:Of 589 patients, 179 (30%) developed SAI. Stroke-associated pneumonia (SAP) accounted for 73% of SAI (131 cases, 22% of patients); urinary tract infections comprised 9%. Admission NIHSS, dysphagia, C-reactive protein (CRP), neutrophil-lymphocyte ratio, and premorbid mRS were independently associated with SAI (p < 0.05). Similar associations were observed for SAP, though CRP association was attenuated. Crude 1-year mortality was higher in patients with SAI (34%, 60/179), including those with SAP (36%, 47/131), compared with 12% (49/410) in non-SAI patients. However, multivariable regression did not reach statistical significance. CONCLUSIONS:SAI occurred in nearly one-third of patients post-MT, predominantly as SAP. While crude mortality was increased with SAI, adjusted analyses were non-significant. Several variables were independently associated with SAI, enabling opportunities for identification of high-risk patients for enhanced monitoring or preventive strategies.
INTRODUCTION:The CHA2DS2 VASc score is widely used for stroke risk stratification in atrial fibrillation (AF). Efforts to improve prediction using demographic refinements have uncertain incremental value, particularly in multi-ethnic populations. We evaluated whether demographic modification or AF type provides additional discriminatory value. METHODS:We conducted a retrospective nested case-control study of patients with AF diagnosed prior to the fifth Auckland Regional Community Stroke Study (September 2020-August 2021). Cases with ischaemic stroke or transient ischaemic attack were identified from this population-based registry with central adjudication. Controls were randomly selected from the National Minimum Dataset, stratified by ethnicity. Predictors included CHA2DS2 VASc components, demographic refinements (alternative age transformations, ethnicity, and exclusion of sex), and AF type. The primary baseline model was a multivariable logistic regression model using standard CHA2DS2 VASc predictors as covariates. The traditional point-based CHA2DS2 VASc score was evaluated separately for comparison. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS:The study included 1,908 patients (300 cases). A logistic regression model using standard CHA2DS2 VASc predictors demonstrated moderate discrimination {AUC 0.68 (95% confidence interval [CI]: 0.65-0.71)}. The traditional point-based CHA2DS2 VASc score showed lower discrimination (AUC 0.63 [95% CI: 0.60-0.66]; ΔAUC +0.05; p = 0.0003). Demographic refinements did not improve discrimination (ΔAUC ≤ 0.01). Addition of AF type modestly increased discrimination (AUC 0.71; ΔAUC +0.03; p = 0.015), with greater improvement in non-anticoagulated patients (ΔAUC +0.05). CONCLUSION:Demographic refinements, including ethnicity, provide limited incremental value beyond CHA2DS2 VASc, whereas AF type offers a modest discriminatory signal. This finding is hypothesis-generating and requires external validation before clinical implementation is considered.
