Jong S. Kim

BACKGROUND: The best revascularization strategy for acute ischemic stroke from isolated vertebral artery occlusion remains unclear. METHODS: This retrospective, international, multicenter cohort study included patients from 30 comprehensive stroke centers across Europe (n=23), North America (n=5), and Asia (n=2) between 2016 and 2022. Eligible patients presented with acute ischemic stroke within 24 hours of last seen well and had imaging-confirmed isolated vertebral artery occlusion. Two treatment comparisons were analyzed: intravenous thrombolysis (IVT)-only versus conservative treatment (Cx), and endovascular treatment (EVT)±IVT versus medical management (Cx and IVT). The primary outcome was the shift in 3-month modified Rankin Scale (mRS) score; secondary outcomes included early neurological improvement (24-hour-delta National Institutes of Health Stroke Scale score), recanalization, early neurological deterioration of ischemic origin, symptomatic intracerebral hemorrhage, and 3-month mortality. Analyses were adjusted using inverse probability of treatment weighting (IPTW). RESULTS: Among 494 patients, 143 (29%) received Cx, 218 (44%) IVT-only, and 133 (27%) EVT±IVT. Compared with Cx, IVT-only showed similar 3-month mRS score (IPTW-adjusted odds ratio [aOR] mRS shift score, 1.32 [95% CI, 0.80–2.18]), greater early neurological improvement (IPTW-adjusted-β coefficient, −1 [95% CI, −2.05 to 0.05]), and higher recanalization rates (IPTW-aOR, 4.33 [95% CI, 1.36–13.78]). Compared with MM (=IVT+Cx), EVT±IVT was associated with an unfavorable mRS shift score (IPTW-aOR mRS shift score, 0.51 [95% CI, 0.35–0.74]), higher early neurological deterioration of ischemic origin (IPTW-aOR, 9.06 [95% CI, 2.86–28.67]), and symptomatic intracerebral hemorrhage (IPTW-aOR, 6.05 [95% CI, 1.14–32.1]) though recanalization was over 4-fold higher (OR, 4.64 [95% CI, 1.90–11.33]). Patients with National Institutes of Health Stroke Scale score ≥10 showed point estimates favoring EVT+IVT ( P _interaction =0.025). CONCLUSIONS: IVT-only appeared safe and was associated with better early recovery and recanalization. EVT±IVT showed overall worse outcomes, potentially due to increased early neurological deterioration of ischemic origin and symptomatic intracerebral hemorrhage rates, but may confer benefit in moderate-to-severe strokes, warranting prospective trials in symptomatic isolated vertebral artery occlusion.

Headache is a common disorder that is usually unaccompanied by focal neurological dysfunction. Less commonly, headache may be associated with central nervous system diseases such as stroke. Headache can occur at the time of stroke onset, but it may also precede or follow the onset of stroke. Nevertheless, headaches associated with stroke have not been sufficiently studied, in part because stroke physicians are primarily focused on diagnosis, risk factors, pathophysiological mechanisms, imaging findings, and treatment (e.g., thrombolysis and endovascular therapy) rather than on headache. In this narrative review, I describe the frequency and characteristics of headache across various stroke subtypes, including ischemic stroke, transient ischemic attack, intracerebral hemorrhage, subarachnoid hemorrhage, and other miscellaneous conditions such as venous infarction, arterial dissection, and reversible cerebral vasoconstriction syndrome.

Jeong S, et al. J Clin Neurol. 2026 Jan;22(1):50-58. https://doi.org/10.3988/jcn.2025.0216

In 2020, clinical experts from leading Asian-Pacific cardiology and neurology centers published an expert opinion and consensus statement on transcatheter patent foramen ovale (PFO) closure for patients in the Asian-Pacific region. Given recent evidence and new insights, an update of this expert opinion is necessary on certain topics. This focused update reviews evidence on PFO closure in elderly and migraine patients, along with the use of contrast transcranial Doppler ultrasound as a screening tool. This update reflects the consensus reached by Asian-Pacific clinical experts during the Asia-Pacific Heart-Brain Summit (October 3, 2024, Bangkok, Thailand).

We investigated serial changes in intracranial artery dissection (ICAD) from the baseline to 12 months on vessel wall MRI. This prospective study enrolled 17 participants with clear onset of 20 unruptured ICADs between April 2016 and May 2018, and underwent vessel wall MRI within 1 week, and at 1-, 3-, 6-, and 12-months following symptom onset. Detection rates of imaging features, imaging time showing stable morphology and measurements were assessed, and compared between 1- and 3-month using exact McNemar’s and Wilcoxon signed-rank test. Detection rates of imaging features and quantitative measurements in 17 participants with 20 ICADs did not decrease from baseline to 1 month but decreased after 1-month (1 vs.3-months: dissecting flap [20/20 vs. 10/20, P = 0.002; 19/20 vs. 9/20, P = 0.002], double lumen [9/20 vs. 1/20, P = 0.008; 7/20 vs. 1/20; P = 0.031], intramural hematoma [18/20 vs. 9/20, P = 0.004; 17/20 vs. 9/20; P = 0.008], increased outer diameter [15/20 vs. 7/20, P = 0.008; 15/20 vs. 8/20, P = 0.016], normalized wall index [mean, 0.7 vs. 0.6, P = 0.008; 0.8 vs. 0.6, P < 0.001], quantitative susceptibility mapping [mean, 0.5 vs. 0.3, P = 0.004; 0.4 vs. 0.2 ppm, P = 0.031], relative T1-weighted signal intensity [mean, 2.5 vs. 1.5, < 0.001; 2.8 vs. 2.0, P = 0.007]). However, the decrease and stabilization did not occur in the progressive ICAD (n = 2). Stable morphology most frequently appeared at 3 months (8–9/18). Most of dissecting imaging features in ICAD were preserved within 1 month and resolved after 1 month following symptom onset, whereas progressive ICAD may not. Vessel wall MRI in ICAD is suggested to be performed within 1 month. If the dissecting imaging features persist or worsen after 3 months, further progression may be considered. Trial registration https://clinicaltrials.gov/, NCT03213470.

Background and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.Methods Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death.Results Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis.Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.