Search Results (332)

Background: Sex-related disparities in long-term outcomes after large vessel occlusion (LVO) following mechanical thrombectomy (MT) have been repeatedly shown. Notably, a lower likelihood of achieving functional independence 90 days post-stroke has been found in women. However, most studies showed equal outcomes for both sexes after MT. It remains unclear whether there are sex differences in the prognostic values of clinical and neuroradiological parameters. Our investigation aimed to discern the divergent prognostic values of multiple markers between sexes. Methods: We retrospectively examined 183 stroke patients with LVO who received MT. Using multivariable logistic regression models, we investigated sex-specific associations of various parameters, including ASPECTS, lesion core volume, penumbra volume, collateral status, and time to reperfusion, concerning outcomes at discharge and 90 days post-stroke. Results: We observed no significant difference between men and women in achieving a favorable outcome defined as modified Rankin Scale (mRS) 0–2. However, when considering the full mRS, women exhibited less favorable overall outcomes. In women, NIHSS, TICI score, and penumbra volume were associated with outcome, whereas in men, core lesion volume and ASPECTS were associated. Age was the only factor associated with outcome in both sexes. Conclusions: Considering the full spectrum of mRS may provide more sophisticated understanding of sex-related outcome differences. Further, these findings highlight the importance sex-specific prognostic factors in outcome assessment. Unraveling sex-specific prognostic biomarkers of recovery has the potential to advance precision medicine and personalized clinical management in stroke. Full article

Background: Hemorrhagic transformation (HT) is a major complication of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Objectives: To investigate the factors as sociated with HT in patients with successful recanalization and examine the impact of collateral status (CS) on ischemic progression and outcomes. Methods: We retrospectively analyzed patients with AIS with successful recanalization (modified treatment in cerebral infarction (mTICI) 2B-3) who underwent dual-energy CT (DECT) within 24 h and MRI within 10 days post-EVT. Patients with posterior circulation stroke, missing multiphase CT angiography (CTA) collateral scores, or missing 3-month modified ranking scale scores were excluded from the study. Results: Among the 86 patients, those with HT had a significantly lower proportion of 3-month excellent outcomes and worse imaging scores, including non-contrast CT (NCCT)-Alberta Stroke Program Early CT Score (ASPECTS), virtual non-contrast (VNC)-ASPECTS, and diffusion-weighted imaging (DWI)-ASPECTS. Patients with HT with poor CS had a significantly lower proportion of 3-month excellent outcomes, poorer post-EVT National Institutes of Health Stroke Scale (NIHSS) score, worse imaging scores, including VNC-ASPECTS, and DWI-ASPECTS. In the predictive factor analysis, post-EVT NIHSS and VNC-ASPECTS scores were significantly associated with 3-month excellent functional outcomes (modified Rankin Scale (mRS) 0-1). Conclusions: In patients with successfully recanalized AIS, HT with poor CS was associated with poorer functional outcomes and worse imaging scores, and a 24 h combined measure (post-EVT NIHSS and DECT VNC-ASPECT) show promise for early risk stratification; prospective external validation is warranted before routine use. Full article

Background/Objectives: The amino acid cysteine (Cys) plays an important role in the neuronal injury process in stroke. Cys is present in blood plasma in various forms. The relationship between Cys and its forms and the severity of acute stroke has not been sufficiently studied. We investigated the levels of total Cys and two of its forms (reduced Cys and its disulfide (cystine, CysS)) in blood plasma and their influence on stroke severity in patients at admission. Methods: A total of 210 patients (39–59 years old) with ischemic stroke and intracerebral or subarachnoid hemorrhage were examined. The contents of the different forms of Cys were determined in the first 10–72 h. Stroke severity was estimated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRs). Results: CysS levels < 54 μM were associated with severe (NIHSS > 13) neurological deficit (ischemic stroke: RR = 5.58 and p = 0.0021; hemorrhagic stroke: RR = 3.56 and p = 0.0003). Smoking and high levels of total Cys and other thiols (glutathione and homocysteine) appear to be factors determining this relationship. Conclusions: Low CysS levels may serve as a potential biomarker of acute stroke severity. Full article

Background: The ongoing discourse surrounding the connection between atrial fibrillation (AF) and stroke continues to be a topic of considerable discussion. Atrial fibrillation (AF) is a well-established risk factor for ischemic stroke, yet the prognostic significance of paroxysmal AF in functional recovery remains uncertain. While persistent AF has consistently been associated with more severe strokes and poorer outcomes, evidence regarding paroxysmal AF is limited and conflicting. This research examines how paroxysmal AF influences the severity of post-stroke disability in individuals experiencing acute ischemic stroke. Materials and Methods: A total of 236 patients presenting with acute ischemic stroke and cardiovascular risk factors were evaluated upon admission to the Neurology Department. Of these, 118 patients with paroxysmal AF were assigned to Group A, and 118 patients without AF were assigned to Group B. To determine the severity of disability, clinical, neurological, and imaging assessments were performed utilizing the modified Rankin Scale (mRS), Activities of Daily Living (ADL) score, National Institutes of Health Stroke Scale (NIHSS), and Medical Research Council (MRC) scale. Results: Patients in Group A exhibited significantly poorer outcomes in comparison to those in Group B, evidenced by lower ADL scores, elevated NIHSS and MRC scores, and increased levels of disability (p < 0.05). Within Group A, a stronger correlation was observed between mRS scores and neurological symptoms, motor deficits, and daily functioning. Logistic regression analysis indicated that among all stroke patients (comprising Groups A and B), the probability of experiencing moderate to severe disability (mRS ≥ 3) escalated by 31.6% for each unit increase in NIHSS and diminished by 64.5% for every unit increase in MRC. In Group A, an increase of one unit in ADL correspondingly lowered the risk of mRS ≥ 3 by 22.7%, in contrast to a reduction of 17.8% in the overall stroke population (Groups A and B combined). Additionally, an enhancement in MRC score led to an 83.5% decrease in the risk of disability within Group A, compared to a 75.8% reduction in Group B. Moreover, in Group A, each unit increment in the HAS-BLED score was associated with a 32.5% rise in the risk of severe disability (OR = 1.325; 95% CI: 1.015–1.729; p < 0.05). Conclusions: Paroxysmal atrial fibrillation was significantly associated with a higher risk of moderate to severe disability following acute ischemic stroke compared to patients without AF. The severity of post-stroke disability in Group A is closely linked to reduced functional independence (lower ADL), more pronounced neurological impairment (higher NIHSS), greater motor deficits (lower MRC), and increased bleeding risk (higher HAS-BLED score). These findings highlight the importance of early identification and comprehensive monitoring of functional, neurological, and cardiovascular parameters in stroke patients with paroxysmal AF. Tailored rehabilitation strategies aimed at improving motor function, daily living activities, and controlling hemorrhagic risk can play a crucial role in reducing long-term disability and enhancing the reintegration of these patients into family and social life. Full article

Background: Deep vein thrombosis (DVT) is a serious thromboinflammatory complication of acute ischemic stroke (AIS). The true incidence, mechanistic risk factors, and optimal prophylactic strategies remain uncertain, particularly in the era of reperfusion therapy. Methods: This systematic review and meta-analysis (IRIS-DVT) searched PubMed, Embase, Cochrane, Scopus, and Web of Science for studies reporting DVT incidence, risk factors, or prophylaxis in AIS (2004–2025). Random-effects models were used to generate pooled prevalence and effect estimates, and the certainty of evidence was graded using the GRADE framework. Results: Forty-two studies (n = 6,051,729 patients) were included. The pooled prevalence of DVT was 7% (95% CI, 6–9%), approximately seventy-fold higher than in the general population, with wide heterogeneity influenced by screening timing and diagnostic modality. Pathophysiological risk factors included higher stroke severity (NIHSS; SMD 0.41; 95% CI, 0.38–0.43), older age (SMD 0.32; 95% CI, 0.18–0.46), elevated D-dimer (SMD 0.55; 95% CI, 0.38–0.72), female sex (OR 1.33; 95% CI, 1.19–1.50), and malignancy (OR 2.69; 95% CI, 1.56–5.22), supported by moderate-certainty evidence. Respiratory infection and admission hyperglycemia showed weaker, low-certainty associations. Traditional vascular risk factors (hypertension, diabetes, atrial fibrillation, dyslipidemia) were not significantly related to DVT risk. Evidence for prophylaxis with low-molecular-weight heparin, direct oral anticoagulants, or intermittent pneumatic compression was limited and graded very low certainty. Conclusions: DVT complicates approximately one in fourteen AIS cases, reflecting a distinct thromboinflammatory process driven more by acute neurological severity, systemic hypercoagulability, and malignancy than by conventional vascular risk factors. Early systematic screening (≤72 h) and consistent use of mechanical prophylaxis are warranted. Dedicated AIS-specific mechanistic and interventional trials are urgently needed to refine prevention strategies and improve post-stroke outcomes. Full article

Background: Stroke is a major cerebrovascular disease characterized by disrupted cerebral blood flow, leading to neuronal damage and significant physical, cognitive, and emotional sequelae. While advancements in acute stroke management have improved survival rates, long-term complications such as cognitive impairment and depression continue to hinder recovery. This study addresses these dimensions within the context of ischemic stroke. Aim: The aim of this study was to analyze the cognitive status, functionality, and depressive symptoms in patients with ischemic stroke, exploring interrelations between cognitive, functional, and emotional outcomes to prioritize clinical interventions. Design: This was an analytical, observational, cohort, and prospective study. Methods: The study included 81 subjects diagnosed with ischemic stroke admitted to the Neurology Department of Lucus Augusti University Hospital. Data were collected at three time points—admission, discharge, and follow-up—using validated instruments such as the National Institutes of Health Stroke Scale, Mini-Mental State Examination, Barthel Index, and Beck Depression Inventory. Statistical analyses included Spearman’s correlation, Kruskal–Wallis, and Mann–Whitney tests. Results: Patients with greater cognitive impairment at admission showed poorer functional recovery and higher depressive symptoms during follow-up. Depressive symptoms remained minimal in most cases, but correlations with cognitive and functional deficits were significant. NIHSS scores at admission strongly predicted both functional and emotional recovery, reinforcing its value in early prognosis and therapeutic planning. Conclusions: This study highlights the importance of integrating cognitive, functional, and emotional dimensions into stroke care protocols to optimize patient recovery and improve long-term outcomes. Full article

Malignant cerebral infarction (MCI) is rare but often fatal. Early identification helps guide monitoring and decompressive surgery. This study evaluated whether serum biomarkers add predictive value beyond clinical and imaging data in severe stroke patients with anterior circulation large vessel occlusion (LVO). In this prospective study, 73 acute severe LVO stroke patients underwent whole-brain CT perfusion (CTP) with rCBV-based core measurement at admission and follow-up MRI at 24 ± 12 h for infarct and edema volume assessment. Serum biomarkers (s100b, NSE, VEGF, ICAM1) were sampled a median of 20.5 h after baseline imaging. Logistic regression models predicted MCI using baseline variables (NIHSS, ASPECTS, rCBV < 30%), adding treatment data (rtPA, mTICI, NIHSS posttreatment), and adding serum biomarkers. Performance was assessed by AUC, accuracy, F1, and cross-validated R². MCI occurred in 18/73 (24%) patients. Baseline models showed an AUC of 0.72; adding treatment improved the AUC to 0.88. Biomarkers slightly increased the AUC (0.90) but did not improve F1. Higher s100b was associated with more severe injury but did not enhance the prediction of MCI. Models with baseline imaging and treatment best explained infarct (R² ≈ 0.27) and edema (R² ≈ 0.58). In conclusion, admission severity, CTP, and early treatment response are the main predictors of MCI and aid early risk stratification of patients. Despite their pathophysiologic relevance, serum biomarkers do not add substantial predictive value. Full article

Background/Objectives: Blood vessel tortuosity can complicate endovascular procedures such as endovascular thrombectomy in acute ischemic stroke. This study aimed to assess the morphometric characteristics of carotid arteries and investigate the association between the tortuosity of the carotid arteries and the technical aspects of endovascular thrombectomy, patient demographics and clinical characteristics, and treatment outcome. Methods: This retrospective study included 84 patients with ischemic stroke treated by endovascular thrombectomy at the newly established thrombectomy-capable stroke center. The following data were collected from prethrombectomy computed tomography angiography: aortic arch type, type of carotid artery tortuosity, and tortuosity index (TI). The technical aspects of the procedure, as well as patient demographics, were collected from the radiological information system. Results: Time from arterial puncture to the first pass was significantly shorter in patients with a nontortuous carotid artery compared to a tortuous one (p = 0.006). There were no significant differences in the number of passes, total duration of the procedure, and the difference in National Institutes of Health Stroke Scale (NIHSS) score before and after the procedure regarding the form of tortuosity. Patients with hypertension had significantly higher tortuosity index values compared to those without hypertension (p = 0.008), and patients with a nontortuous carotid tree were significantly younger compared to those with all forms of tortuosity (p = 0.003). Conclusions: The majority of patients had tortuous carotid arteries, which were associated with older age and hypertension. A high index of tortuosity was associated with a longer time from arterial puncture to the first pass, but not to the treatment outcome. Preprocedural recognition of carotid artery tortuosity may aid in endovascular thrombectomy procedural planning. Full article

Background and Objectives: The aim of this study was to evaluate the potential predictive value of VKORC1, CYP4F2, and GGCX polymorphisms, as well as other clinical and demographic factors, for 5-year mortality in patients with acute ischemic stroke (AIS). Materials and Methods: The study enrolled 252 patients who were consecutively hospitalized for AIS. Demographic data, comorbidities, and laboratory tests were collected. Genotyping of the VKORC1 rs9923231 (-1639G > A; VKORC1*2), CYP4F2 rs2108622 (1347C > T), and GGCX rs11676382 (12970C > G) polymorphisms was performed. Mortality was noted if it occurred within five years following the 30 days after discharge, using the National Health Insurance House registry. Results: Death was recorded in 71 (28.1%) patients. In multivariate analysis the following variables were independent variables associated with 5-year mortality: age > 72 years (OR 2.83 (95%CI 1.32; 6.08), p = 0.007), a lesion volume > 12.6 mL (OR 4.05 (95%CI 2.05; 7.99), p < 0.001), and an NIHSS score > 7 (OR—2.64 (95%CI 1.31; 5.31), p = 0.006). VKORC1 (-1639G > A) SNP m/m variant was only marginally associated with mortality. Conclusions: In this study which included AIS patients, VKORC1, CYP4F2, and GGCX polymorphisms did not independently predict mortality. The VKORC1 variant was only marginally associated with mortality, but this was attenuated after correction for multiple testing. Advanced age, NIHSS score, and the lesion volume were independent predictors of long-term mortality in AIS patients. Full article

Background/Objective: Malnutrition and sarcopenia are common complications after ischemic stroke and have a negative impact on prognosis. The C-reactive protein/albumin ratio (CAR) reflects both inflammation and nutritional status, but its predictive role in this setting has not been widely studied. This study aimed to investigate the predictive value of CAR (C-reactive protein/albumin ratio) for malnutrition risk and probable sarcopenia in patients with ischemic stroke. Methods: In this prospective observational study, 197 patients with acute ischemic stroke were evaluated. Patients with chronic renal or hepatic failure, malignancy, active infection, and hand disability preventing grip strength measurement were excluded. Demographic data (age, sex), vascular risk factors, the NIHSS score, and laboratory parameters were recorded. The nutritional status of patients was assessed using the Nutritional Risk Screening-2002 (NRS-2002), and sarcopenia risk was evaluated with the SARC-F questionnaire. Handgrip strength was measured in patients with high SARC-F scores to define probable sarcopenia. CAR was calculated from serum CRP and albumin levels. Logistic regression was applied to identify independent predictors, and receiver operating characteristic (ROC) analyses were performed to determine the discriminatory ability and cut-off values of CAR. The nutritional status of patients admitted to the neurology clinic with acute ischemic stroke was assessed using the Nutritional Risk Screening-2002 (NRS-2002), and sarcopenia risk was evaluated with the SARC-F questionnaire. Handgrip strength was measured in patients with high SARC-F scores to define probable sarcopenia. CAR was calculated from serum CRP and albumin levels. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: Malnutrition risk was identified in 32.5% of patients, and probable sarcopenia was identified in 19.3% of patients. ROC analysis showed that CAR had acceptable discriminatory power for both conditions. In multivariate analysis, CAR was consistently identified as an independent predictor of malnutrition risk and possible sarcopenia. ROC analysis for malnutrition risk showed an AUC of 0.750 (cut-off: 0.306; sensitivity 68.8%; specificity 75.2%). In regression analysis, CAR (OR = 2.13; 95% CI: 1.39–3.26; p < 0.001), age (OR = 1.05; 95% CI: 1.02–1.09; p = 0.003), and NIHSS (OR = 1.11; 95% CI: 1.01–1.23; p = 0.026) were independent predictors. For probable sarcopenia, ROC analysis revealed an AUC of 0.814 (cut-off: 0.320; sensitivity 81.6%; specificity 71.7%). Multivariate analysis identified CAR (OR = 1.73; 95% CI: 1.19–2.52; p = 0.004), age (OR = 1.11; 95% CI: 1.05–1.18; p < 0.001), and NIHSS (OR = 1.19; 95% CI: 1.05–1.35; p = 0.007) as independent predictors. Conclusions: CAR was identified as an independent predictor of both malnutrition risk and probable sarcopenia in ischemic stroke patients. CAR may serve as a reliable biomarker for early nutritional and functional risk stratification in clinical practice. Full article

Background/Objectives: Acute ischemic stroke (AIS) remains a major cause of morbidity and mortality worldwide. Although advanced imaging modalities, such as CT perfusion (CTP), are increasingly being used in clinical decision-making, the necessity and added value of perfusion imaging prior to intravenous thrombolysis (IVT) within early time windows remains uncertain. We aim to evaluate the safety and functional outcomes of IVT in AIS patients without perfusion deficits on CTP. We question the requirement of perfusion mismatch for IVT eligibility and hypothesize that IVT is safe and beneficial even in the absence of a perfusion deficit. Methods: A retrospective analysis was conducted using data from the Giessen Stroke Registry, focusing on AIS patients who underwent CTP imaging and received IVT between 01/2018 and 12/2020. Patients who underwent endovascular therapy were excluded. Clinical data, including demographics, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores, and complications, were collected. Patients were dichotomized based on the presence of perfusion lesions and compared in terms of efficacy outcomes (i.e., NIHSS or mRS improvement during the hospital stay) and safety outcomes (i.e., post-thrombolytic hemorrhagic complications). Results: Of the 89 AIS patients with available CTP data who received IVT, 34 (38%) had a perfusion deficit and 55 (62%) did not. There were no significant differences between the groups in terms of hemorrhagic complications or functional outcomes at discharge (NIHSS and mRS). Clinical improvement from admission to discharge was similar in both groups. Conclusions: Our findings suggest that IVT is safe and clinically effective even in AIS patients without detectable perfusion deficits on CTP within the standard therapeutic window. These results support current guideline recommendations that do not mandate perfusion imaging for early presenters. Routine use of CTP in this context may be of limited clinical utility and could unnecessarily delay treatment or introduce additional risks in the first 4.5 h. Full article

Background and Objectives: Stroke is widely recognised for its physical consequences. However, cognitive and emotional impairments, such as depression, anxiety, and vascular cognitive impairment (VCI), are often under-recognised and under-treated. Our study aimed to identify and characterise cognitive and emotional sequelae in patients hospitalised for acute ischemic stroke. Materials and Methods: We conducted a cross-sectional study involving 73 patients within seven days of an acute ischemic stroke. Patients were assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Hachinski Ischemic Score (HIS), and the Clinical Assessment of Depression (CAD) questionnaire, which includes four subscales (Depressed Mood (DM), Anxiety/Worry, Disinterest, and Physical Fatigue). K-means clustering was applied to ten standardised clinical and psychometric variables. In addition, multiple linear regression was performed to determine independent predictors of cognitive and affective outcomes, with MoCA and CAD-DM as dependent variables. Results: Three distinct patient profiles emerged: (1) Mild Impairment Profile, characterised by minimal cognitive or emotional symptoms; (2) Depressive Profile, marked by elevated emotional symptom scores despite mild physical impairment; and (3) Vascular Cognitive Impairment Profile, comprising older patients with the most severe cognitive and functional deficits. ANOVA confirmed significant differences between groups in NIHSS, mRS, MoCA, HIS, and CAD scores, but not for age or education. Linear regression revealed that older age (β = –0.10, p = 0.012) and higher NIHSS at discharge (β = –0.72, p = 0.020) predicted lower MoCA scores, whereas years of education (β = 0.58, p = 0.013) predicted better cognition (R² = 0.29). No demographic or clinical factors predicted depressive symptoms (all p > 0.29). Conclusions: Our study highlights the heterogeneity of post-stroke outcomes. Neuropsychiatric impairments may be present even in patients with minimal physical deficits and require targeted evaluation and management. Full article

Background and Objectives: Long COVID has been linked with persistent neurological symptoms, but data on its effects on acute stroke presentation, management, and outcomes remain unclear. This study aimed to compare the clinical profile, management, and short-term outcome of acute ischemic stroke patients with and without Long COVID. Materials and Methods: A retrospective cohort study was conducted on 132 patients who presented at admission with code stroke alert in our Emergency Department (ED). Out of those, 26 were identified to have the Long COVID condition and assigned to the Long COVID group, and 106 were without the Long COVID condition and assigned to the No Long COVID group. Baseline demographics, stroke severity by NIHSS (National Institutes of Health Stroke Scale), risk factors, admission symptoms, laboratory findings, Emergency department time targets, reperfusion treatments received, and outcomes between the two groups were compared. Results: There were no significant differences between the two groups in age, gender, baseline NIHSS scores, ED time targets, or laboratory values. The proportion of patients with Long COVID significantly increased among non-smokers (Fisher’s Exact Test chi-squared, p = 0.027). Also, patients suffering from Long COVID exhibited higher incidences of headache (19.2% compared to 5.7%, OR = 3.97, p = 0.040) and facial drooping (42.3% compared to 19.8%, OR = 2.97, p = 0.022). The mechanical thrombectomy was more frequent among the group with Long COVID (30.8% vs. 16.0%), but this difference was not statistically significant. More hemorrhagic transformations happened in the Long COVID group (26.9% vs. 14.2%, p = 0.143). Discharge rates and hospital length of stay in days were similar between groups. Conclusions: Long COVID patients did not present notable differences in emergency department time targets, baseline stroke severity, or short-term outcomes when presenting with code stroke alert. Nevertheless, specific clinical characteristics—such as elevated occurrences of headache and facial drooping—were more frequently observed in patients with Long COVID, alongside non-significant trends indicating a greater utilization of mechanical thrombectomy and increased rates of hemorrhagic transformation. These results imply that Long COVID may have a subtle impact on stroke presentation and potentially on underlying cerebrovascular susceptibility. Further prospective studies with larger sample sizes are necessary to investigate Long COVID’s long-term neurological and vascular consequences. Full article

Objective: Stroke is one of the leading causes of death and disability worldwide. Compared to developed countries, the prognosis of stroke is less favourable in developing countries. The objective of this study is to identify inter-ethnic variation in risk profiles and stroke outcomes amongst Bangladeshi, Indian, Nepalese, Pakistani, and Sri Lankan expatriates living in Qatar. Methods: Data from the Qatar Stroke Registry were retrospectively analyzed from April 2014 to June 2025. A total of 8825 patients were included. The chi-square test was used to analyze sociodemographic variables, while the Kruskal–Wallis test was used to analyze continuous variables. Post hoc analysis was performed. Multivariate logistic regression and multivariate multiple regression were used to identify the predictors associated with poor clinical outcomes and mortality at 90 days. Results: Ischemic stroke was the predominant stroke type in all groups, with Nepalese patients presenting with stroke at a younger age, whilst Pakistanis tended to be older (p < 0.001). In terms of stroke outcomes, Nepalese patients had the highest proportion of a poor functional outcome at 90 days as well as NIHSS at discharge (p < 0.05). However, Bangladeshis had the highest proportion of mortality at 90 days compared to the other cohorts. Multivariable logistic regression revealed that undiagnosed dyslipidemia, Nepalese ethnicity, and moderate and severe NIHSS admission scores were independent predictors of a poor functional outcome at 90 days, whilst male sex and prior antidiabetic therapy were protective factors (p < 0.001). In terms of mortality at 90 days, only a severe NIHSS admission score (>10) was a significant predictor (p < 0.001). A severe NIHSS admission score was also the only predictive factor of mortality and poor functional outcome at 90 days (p < 0.05). Conclusions: There was a significant variation in stroke presentation and outcomes among South Asian subpopulations in Qatar, suggesting the importance of tailored public health strategies as a uniform approach to stroke care is insufficient for this diverse population. Full article

Background/Objectives: Acute ischemic stroke is a leading cause of mortality and long-term disability globally, with limited reliable early predictors of functional outcomes and survival. This study aimed to assess the prognostic value of two novel predictors: the hypoperfusion intensity ratio calculated from mean transit time and time-to-drain maps (HIR-MTT–TTD), derived from computed tomography perfusion (CTP) imaging parameters, and the Inflammation–Coagulation Index (ICI), which integrates systemic inflammatory (C-reactive protein and white blood cell count) and hemostatic (D-dimer) markers. Methods: This prospective, single-center observational study included 60 patients with acute ischemic stroke treated with intravenous thrombolysis and underwent pre-treatment CTP imaging. HIR-MTT–TTD evaluated collateral status and perfusion deficit severity, while ICI integrated C-reactive protein (CRP), white blood cell (WBC) count, and D-dimer levels. Functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index, and modified Rankin Scale (mRS) at 24 h, 3 months, and 1 year. Results: Of 60 patients, 53.3% achieved functional independence (mRS 0–2) at 1 year. Unadjusted Cox models showed HIR-MTT–TTD (HR = 6.25, 95% CI: 1.48–26.30, p = 0.013) and ICI (HR = 1.08, 95% CI: 1.00–1.17, p = 0.052) were associated with higher 12-month mortality, worse mRS, and lower Barthel scores. After adjustment for age, BMI, smoking status, and sex, these associations became non-significant (HIR-MTT–TTD: HR = 2.83, 95% CI: 0.37–21.37, p = 0.314; ICI: HR = 1.07, 95% CI: 0.96–1.19, p = 0.211). Receiver operating characteristic (ROC) analysis indicated moderate predictive value, with ICI (AUC = 0.756, 95% CI: 0.600–0.867) outperforming HIR-MTT–TTD (AUC = 0.67, 95% CI: 0.48–0.83) for mortality prediction. Conclusions: The study introduces promising prognostic tools for functional outcomes. Elevated HIR-MTT–TTD and ICI values were independently associated with greater initial stroke severity, poorer functional recovery, and increased 1-year mortality. These findings underscore the prognostic significance of hypoperfusion intensity and systemic thrombo-inflammation in acute ischemic stroke. Combining the use of the presented indices may enhance early risk stratification and guide individualized treatment strategies. Full article