Sung Hyuk Heo

Background: Whether comprehensive prestroke risk factor (RF) management—defined by the extent to which existing major RFs meet prespecified treatment and biomarker criteria—is associated with 3‐month functional outcomes after ischemic stroke remains unclear. Methods: We analyzed patients with ischemic stroke from the CRCS‐K‐NIH (Clinical Research Collaborations for Stroke in Korea‐National Institutes for Health) registry (2011–2022), a multicenter stroke registry in Korea. Hypertension, diabetes, dyslipidemia, and atrial fibrillation were considered as major RFs for ischemic stroke. Comprehensive prestroke RF management was categorized as well controlled (all present RFs meeting study‐defined control criteria), partially controlled (some RFs meeting this criteria), or poorly controlled (no RFs meeting this criteria). The primary outcome was 3‐month modified Rankin Scale score of 0 to 2, indicating functional independence (good outcome). Results: Among 63 570 patients with ≥1 major RFs, 28.6% were poorly controlled, 35.6% partially controlled, and 35.8% well controlled. The rate of 3‐month good outcome was 66.0% among those with 1 RF, 60.8% in 2, and 55.0% in ≥3. After multivariable adjustment, both well‐controlled and partially controlled groups had significantly higher odds of achieving good 3‐month outcomes compared with poorly controlled patients, consistently across RF burden strata(well controlled: adjusted odds ratio, 1.16 [95% CI, 1.08–1.25] for 1 RF, 1.34 [95% CI, 1.21–1.48] for 2, and 1.23 [95% CI, 1.03–1.48] for ≥3; partially controlled: 1.16 [95% CI, 1.06–1.26] for 2; 1.22 [95% CI, 1.05–1.42] for ≥3) and in the overall cohort (well controlled: 1.22 [95% CI, 1.15–1.29], partially controlled: 1.14 [95% CI, 1.07–1.22]). Conclusions: Comprehensive prestroke RF management, defined by study‐specific treatment‐ and biomarker‐based criteria, was independently associated with a higher likelihood of favorable 3‐month outcomes across levels of RF burden. These findings suggest that effective prestroke management of existing RFs may improve poststroke functional outcomes, regardless of the number of RFs present.

Previous studies have reported mixed findings regarding sex differences in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), with some indicating earlier ischemic events in men, whereas others found no significant difference in stroke onset. However, evidence from Asian populations remains limited, where clinical manifestations and NOTCH3 variant distribution differ substantially from those in European cohorts. We investigated sex-specific variations in clinical phenotypes and brain MRI characteristics among Korean patients with CADASIL. In this nationwide retrospective study, 577 patients were screened for CADASIL across 26 centers in South Korea. After excluding those with benign or uncertain variants or insufficient clinical or MRI data, 368 individuals with pathogenic NOTCH3 variants were included in the final analysis. Clinical features, vascular risk factors, and NOTCH3 variant positions classified by epidermal growth factor–like repeat (EGFr) domains were compared between sexes. Brain MRI findings—including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds, and atrophy—were evaluated. Sex differences in the onset of ischemic stroke and dementia were analyzed using Kaplan-Meier and Cox proportional hazards models. The mean age of the patients at data collection was 61.7 ± 11.9 years, and 48.6% were male. Thirty-six distinct pathogenic variants were identified. The most frequent variant was R544C (40.8%) located at the EGFr 13/14 interdomain boundary (corresponding to exon 11). Other recurrent variants were R75P (17.9%), C542R (5.4%), and R587C (4.6%). Men exhibited a higher prevalence of ischemic stroke (70.9% vs 44.4%, p < 0.001) and experienced their first event at an earlier age (median 53 vs 59 years, log-rank p < 0.001). On brain MRI, male sex was independently associated with a greater lacune burden (odds ratio 3.03, 95% CI 1.70–5.38, p < 0.001) while female sex tended to show higher WMH volume. This nationwide study highlights distinct sex differences in CADASIL presentation within a Korean population. Male patients exhibited a higher prevalence and earlier onset of ischemic stroke not fully explained by conventional vascular risk factors. These findings underscore the importance of integrating sex, hormonal, and genetic-epigenetic factors into future research to guide precision phenotyping and sex-informed clinical management in CADASIL.

Background: This study aimed to evaluate secular trends in the control of major risk factors at the time of ischemic stroke to assess the real‐world implementation of prevention guidelines and identify areas needing greater clinical attention for improved early stroke outcomes. Methods: We retrospectively analyzed data from a prospective, multicenter, nationwide registry of consecutive patients with acute ischemic stroke between 2011 and 2022. For risk factor controls of interest, hypertension, diabetes, dyslipidemia, and atrial fibrillation (AF) were considered. Well‐controlled risk factors were defined as follows: “well‐controlled hypertension”: hypertension with prior antihypertensive medication and systolic blood pressure P _trend P _trend <0.001). Conclusions: Our study confirmed a continuous increase in prestroke risk factor control, including diabetes, dyslipidemia, and AF, but the rate remained suboptimal at stroke onset. These findings may help inform strategies to improve risk factor management by identifying priority areas that warrant targeted intervention in clinical practice and population‐level guidelines.

BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended within 24 hours for patients with minor ischemic stroke or high-risk transient ischemic attack. However, the optimal timing for initiating DAPT remains unclear. METHODS: From a prospective multicenter cohort involving 20 stroke centers between January 2011 and April 2023, patients with minor noncardioembolic ischemic stroke (National Institutes of Health Stroke Scale score ≤5) or high-risk transient ischemic attack who presented within 7 days of symptom onset were included. We evaluated outcomes based on in-hospital initiation of DAPT versus monotherapy (aspirin or clopidogrel alone). The primary outcome was a composite of recurrent stroke, myocardial infarction, and death within 90 days. Patients were grouped by time from symptom onset to hospital arrival: 0 to 24 hours, 24 to 72 hours, and >72 hours. Time-to-treatment effects were analyzed using Cox proportional hazards models, with inverse probability of treatment weighting based on propensity scores. The adjusted models incorporated demographic factors, baseline clinical characteristics, vascular risk factors, stroke subtype, relevant arterial status, and prior antiplatelet use. RESULTS: Among the 41 530 patients (mean age, 66.3 years; 25 771 [62%] male), 25 112 (60.5%) received DAPT. The 90-day primary outcome occurred in 2663 (10.7%) of the DAPT group versus 1900 (11.6%) in the monotherapy group (hazard ratio, 0.82 [95% CI, 0.77–0.87]). The benefit of DAPT was most pronounced when initiated within 24 hours (hazard ratio, 0.74 [95% CI, 0.69–0.79]). No significant benefit was observed when DAPT was initiated between 24 and 72 hours (hazard ratio, 1.00 [95% CI, 0.88–1.15]), and a higher risk was suggested for initiation beyond 72 hours (hazard ratio, 1.25 [95% CI, 1.01–1.55]). Time-dependent analysis showed a benefit crossing the null at ≈42 hours. CONCLUSIONS: Early initiation of DAPT was associated with the greatest clinical benefit, consistent with current guideline recommendations. The therapeutic effect appeared to decline progressively beyond this period, with an estimated threshold around 42 hours.

Moon D, et al. J Clin Neurol. 2026 Nov;22(6):637-645. https://doi.org/10.3988/jcn.2026.0283

Integrated medical service (IMS) refers to the collaborative treatment of conventional medicine and Korean medicine in Korea. IMS for stroke is recognized for its efficacy, however, there are many barriers to obtaining therapeutic effects in clinical settings. This study was aimed to investigate the current perceptions of IMS among Korean stroke patients to provide a basis for exploring ways to universalize IMS in real-world stroke clinical practice. We conducted a self-reported web-based survey in December 2021. We recruited 100 Korean patients who had been diagnosed with stroke. The questionnaire developed by the research team was composed of 5 sections: demographic information, stroke history, perceptions of IMS for acute stroke and stroke sequelae, and other perceptions of IMS for stroke treatment. For both acute stroke and stroke sequelae, half of the patients agreed (45% and 52%) and about 15% of the patients disagreed to receive IMS (18% and 12%), had positive expectations of IMS effects (49% and 53%), and feel the economic burdensome of IMS (50% and 52%); National Health Insurance (NHI) covered treatments such as acupuncture and electroacupuncture (69.5% and 69.3%) were the most common types of KM treatment desired; private insurance subscribers had higher preference for NHI uncovered treatments such as NHI uncovered herbal medicines; the most common reason for reluctance to receive IMS was economic burden (38.9% and 58.3%) and treatment not being recommended by a conventional medicine doctor in acute stroke (38.9%) even though most patients had positive expectations of IMS effects (49% and 53%). Stroke patients were favorable to IMS and had high expectations for its effectiveness. Cost and lack of cooperation from conventional medicine doctors were barriers to patients’ access to IMS. Policy reform and active cooperation between conventional and traditional doctors may improve IMS access and satisfaction.

Introduction: This multicenter, double-blind, placebo-controlled trial, commissioned by South Korea’s Ministry of Food and Drug Safety, evaluated the effect of oxiracetam for preventing post-stroke cognitive impairment (PSCI) and explored potential interaction with physical activity using neuroimaging. Patients and methods: Patients at high risk of PSCI, reporting subjective cognitive decline ⩾3 months after stroke, were randomized 1:1 to receive oxiracetam or placebo for 36 weeks. Physical activity was tracked via wrist-worn actigraphy. Coprimary endpoints were changes in Mini-Mental State Examination (MMSE) and Clinical Dementia Rating–Sum of Boxes (CDR-SB). Secondary outcomes included neuropsychological assessments and resting-state functional magnetic resonance imaging network metrics. Results: Of 500 enrolled participants (mean age 68.9 years; median 32 months post-stroke), 457 completed the study. There were no statistically significant differences between groups in changes in MMSE (oxiracetam: +0.13 ± 2.27 vs placebo: +0.27 ± 2.09; p = 0.49) or CDR-SB scores (–0.14 ± 0.70 vs −0.08 ± 0.80; p = 0.38). No evidence of interaction was observed between oxiracetam and physical activity. Exploratory analyses suggested favorable trends in functional segregation and CDR-SB scores among highly active oxiracetam participants. Discussion and conclusion: Oxiracetam did not demonstrate benefit in preventing PSCI in high-risk patients. These findings support the recent regulatory decision to suspend its use in South Korea.

Background: The relationship between admission hemoglobin A _1c (HbA _1c ) levels, estimated glomerular filtration rate (eGFR) stages, and early outcomes may provide key insights into the need for individualized glycemic control based on kidney function in patients with ischemic stroke and diabetes. Methods: We analyzed data from a multicenter, nationwide, prospective stroke registry in South Korea, including patients with ischemic stroke within 7 days of onset and diabetes. Admission HbA _1c levels (prestroke glycemic status) were categorized as 1c groups was included to evaluate potential effect modification. Results: A total of 27 496 patients (age, 69.6±11.4 years; men, 60.3%) were included. The 3‐month cumulative all‐cause mortality rates differed significantly by admission HbA _1c levels: 8.9% in HbA _1c 1c ≥8.0%. In adjusted analyses, while no association between HbA _1c 1c levels (7.0%–8.0% in eGFR stages 1, 3, and 5, and ≥8.0% in stages 2 and 5) were significantly associated with increased mortality risk. Notably, in stage 4, there was no significant association between HbA _1c and mortality ( P =0.027 for interaction). Conclusions: The association between admission HbA _1c and 3‐month mortality varied among eGFR stages. These findings suggest that eGFR stage may need to be considered when tailoring glycemic control strategies in patients with ischemic stroke and diabetes.