Abstract Introduction Dementia is a common and disabling complication after stroke. Exercise-based cardiac rehabilitation (EXCR) may influence vascular and inflammatory mechanisms relevant to cognitive decline. We investigated the association between EXCR initiation after stroke and incident dementia. Patients and methods Using TriNetX, we identified adults with ischaemic stroke or TIA. Patients with recorded ICD-10-CM codes indicating an NIHSS score ≥ 16 were excluded from the primary analysis. Patients initiating EXCR within 6 months were compared with those without documented post-index EXCR. Propensity score matching balanced demographics, comorbidities, medication use and available stroke-severity measures. Outcomes were assessed at 3 and 5 years. Results The unmatched cohorts included 4226 patients initiating EXCR (mean age, 64.7 years; 60.8% male) and 1,889,796 without EXCR (mean age, 66.3 years; 48.2% male). After matching, 4138 patients remained in each cohort. At 5 years, EXCR was associated with lower hazards of incident dementia (HR, 0.70; 95% CI, 0.59–0.82), all-cause mortality (HR, 0.50; 95% CI, 0.45–0.55) and recurrent stroke (HR, 0.75; 95% CI, 0.61–0.91), but a higher hazard of rehospitalisation (HR, 1.21; 95% CI, 1.06–1.38); no significant association was observed for acute myocardial infarction. The association with incident dementia remained consistent across sensitivity analyses. Discussion The observed association with lower dementia risk suggests that the potential benefits of post-stroke EXCR may extend beyond cardiovascular and functional outcomes. Conclusions EXCR initiation after ischaemic stroke or TIA was associated with a lower hazard of incident dementia. This association remained consistent across the 3-year, 30-day landmark, 1-year lagged and all-stroke-severity sensitivity analyses.
Abstract Objective To evaluate the effects of oral hygiene care on swallowing-related outcomes in hospitalised patients with post-stroke dysphagia (PSD). Methods A systematic literature search was conducted in MEDLINE, Embase, Web of Science, Scopus, CINAHL, CENTRAL and ClinicalTrials.gov up to May 2026. Randomised controlled trials (RCTs) and non-RCTs with a comparison group that reporting swallowing-related outcomes were included. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. Where appropriate, meta-analyses were conducted using random-effects models to estimate mean differences (MDs), odds ratios (ORs) and risk differences (RDs) with 95% confidence intervals (CIs). The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results Nine studies, comprising 7 RCTs and two non-RCTs, were included, with risk-of-bias ratings ranging from low risk to some concerns for RCTs and moderate risk for non-RCTs. Oral hygiene care increased the odds of achieving independent oral intake compared with usual care (OR = 2.54, 95% CI, 1.80; 3.59; I2 = 0%), corresponding to a 13% absolute increase (RD = 0.13, 95% CI, 0.03; 0.23; I2 = 0%). Functional Oral Intake Scale (FOIS; scores 1–7), with higher scores indicating more independent and unrestricted oral intake, favoured oral hygiene care (MD = 0.40, 95% CI, 0.07; 0.72; I2 = 0%). Similarly, Gugging Swallowing Screen (GUSS; scores 0–20), assessing swallowing safety and dysphagia severity, favoured oral hygiene care (MD = 2.93, 95% CI, 1.01; 4.85; I2 = 0%). The certainty of the evidence for achieving independent oral intake was rated as high. Conclusion Oral hygiene care supports swallowing recovery in patients with PSD, particularly independent oral intake and should be considered an active component of dysphagia rehabilitation.
Abstract Introduction In adult endovascular thrombectomy (EVT), first-pass success is associated with better outcomes, but whether this “first-pass effect” also holds true in childhood stroke remains unknown. We investigated the association of thrombectomy pass counts with 90-day outcomes after paediatric EVT. Patients and methods We analysed prospectively collected data from the international Save ChildS Pro registry (ages 0–17 years). All EVT-treated patients were included irrespective of the reperfusion grade achieved. Successful reperfusion was defined as expanded thrombolysis in cerebral infarction (eTICI) ≥ 2b and complete/near-complete reperfusion as eTICI 2c–3. The primary outcome was ordinal 90-day mRS in a proportional odds model. Single-pass and multiple-pass patients were then compared with each other within the subgroup achieving eTICI 2c–3. Logistic regression for mRS > 2 was fitted with pass count and eTICI grade as covariates. Results Of 103 patients (median age 11 years [IQR 6–15]; 55/102 [53.9%] male), median passes were 2 (IQR 1–3); 39 (37.9%) had 1 pass, 61 (59.2%) more than 1 and 3 (2.9%) recanalised without a thrombectomy pass. Multiple passes were associated with lower eTICI 2c–3 rates (30.0% vs 82.1%; P < .001), and worse 90-day mRS (common odds ratio 3.47; 95% CI, 1.63–7.38; P = .001). However, among patients achieving eTICI 2c–3 (n = 50), we detected no difference by pass count (mRS 0–2: 93.8% vs 94.4%; risk difference − 0.6%, 95% CI, −15% to +20%; P = 1.000). After accounting for eTICI, pass count was not independently associated with mRS > 2, while eTICI remained significant. Conclusions In this analysis of the first-pass effect in paediatric thrombectomy, multiple passes were associated with worse functional outcomes, but this effect appeared to be largely mediated through recanalisation quality. Subgroup analyses were underpowered to exclude a clinically relevant residual effect of pass count, and these findings should be considered hypothesis-generating.
Abstract Objectives In the hyperacute setting of mechanical thrombectomy (MT) for large-vessel-occlusion stroke, periprocedural platelet inhibition may be required in cases of refractory occlusions or underlying cervical or intracranial arterial disease at risk of reocclusion. Cangrelor is increasingly used in this context, although its use remains largely supported by observational evidence, and the impact of concomitant aspirin remains uncertain. This study investigated the safety and efficacy of the addition of intravenous aspirin to cangrelor during MT. Methods We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry across 34 French comprehensive stroke centres. All consecutive MT patients receiving intraoperative cangrelor between July 2018 and April 2025 were included, irrespective of the indication for intravenous antiplatelet therapy. The primary endpoint was 90-day favourable outcome (modified Rankin Scale [mRS] 0–2 or equal to pre-stroke mRS). Secondary outcomes included excellent outcome, early neurological improvement, angiographic recanalisation, day-1 arterial patency and intracranial haemorrhage (ICH). Propensity-score overlap weighting was used to adjust for confounding. Results A total of 644 patients were analysed (cangrelor + aspirin combination: 226; cangrelor alone: 418). Favourable outcomes at 90 days were similar between groups (57.1% vs 58.8%; adjusted odds ratio [aOR] = 0.93; 95% confidence interval, 0.67–1.30; P = 0.69), as were excellent outcomes and early neurological improvement. Rates of successful and complete reperfusion were similar across groups. No differences were observed for symptomatic ICH (6.2% vs 9.2%; aOR = 0.66), any ICH, intra- and extracranial arterial patency on day-1 imaging, or 90-day mortality (22.3% vs 23.9%; aOR = 0.91). Conclusions No significant differences in clinical, angiographic or safety outcomes were observed between cangrelor monotherapy and cangrelor combined with intravenous aspirin during MT. These findings provide comparative evidence on two cangrelor-based strategies currently used in clinical practice, although they should not be interpreted as demonstrating equivalence or excluding a potential benefit of adjunctive aspirin. Further prospective studies are needed to clarify the role of aspirin coadministration in this setting.
