Intravenous Thrombolysis Research Articles

Systemic inflammation response index as a predictor of 3-month functional outcomes in acute ischemic stroke patients following intravenous thrombolysis.

Systemic inflammation response index as a predictor of 3-month functional outcomes in acute ischemic stroke patients following intravenous thrombolysis.

Cardiac Events After Mechanical Thrombectomy in Acute Ischemic Stroke: A Nation-Wide Cohort Study.

Mechanical thrombectomy (MT) markedly improves the outcome in patients with large vessel occlusion stroke. Given the cardiovascular risk profile of these patients, we wanted to investigate their post-MT risk of cardiac events compared to other patients with acute ischemic stroke (AIS). All hospitalizations for AIS in Denmark from 2014 to 2021 were included in this registry-based cohort study. Patients were categorized by reperfusion treatment: MT with or without intravenous thrombolysis (IVT), IVT alone, or no reperfusion treatment (NRT). Cardiac events included ischemic heart disease, heart failure, or cardiac death within 6 months of AIS. Pair-wise group comparisons were performed after inverse probability treatment weighting (IPTW). Among 76,092 AIS patients, 4.4% received MT, 15.2% received IVT alone, and 80.4% received NRT. In the MT group, 9.6% of patients experienced cardiac events. After IPTW, MT patients had the highest risk of cardiac events compared to IVT (absolute risk difference [ARD] 4.6%, cause-specific hazard rate ratio [HRR] 1.42 [95% CI: 1.27-1.60]) and NRT (ARD 4.6%, HRR 1.35 [95% CI: 1.22-1.49]). Pre-existing cardiac disease was similar across groups (9.2%-11.8%) and after exclusion of patients with prior cardiac disease, the HRR of cardiac events remained consistent with the primary analysis (MT vs. IVT: HRR 1.48 [95% CI: 1.31-1.68]; MT vs. NRT: 1.39 [95% CI: 1.24-155]). 10% of patients with AIS undergoing MT experienced cardiac events within 6 months compared to 5% of other AIS patients. This study identified an unrecognized burden of cardiac disease in this group of AIS patients treated with MT.

Safety and efficacy of mechanical thrombectomy in distal medium vessel occlusions: Experience and real-world data from an Italian stroke hub centre.

Safety and efficacy of mechanical thrombectomy in distal medium vessel occlusions: Experience and real-world data from an Italian stroke hub centre.

Development of a deep neural network model for ultra-early neurological deterioration in ischemic stroke and analysis of associated risk factors.

Development of a deep neural network model for ultra-early neurological deterioration in ischemic stroke and analysis of associated risk factors.

Exploring the association between plasma lipids changes and embolization recurrence following intravenous thrombolysis with alteplase in acute ischemic stroke based on lipidomics.

Exploring the association between plasma lipids changes and embolization recurrence following intravenous thrombolysis with alteplase in acute ischemic stroke based on lipidomics.

The diagnosis and treatment of asymptomatic and symptomatic patients with carotid artery stenosis.

The diagnosis and treatment of asymptomatic and symptomatic patients with carotid artery stenosis.

High mimic rate among recipients of intravenous thrombolysis for acute minor ischemic stroke presenting with disabling symptoms.

High mimic rate among recipients of intravenous thrombolysis for acute minor ischemic stroke presenting with disabling symptoms.

Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis

The role of intravenous thrombolysis (IVT) in combination with endovascular thrombectomy (EVT) for the treatment of large vessel occlusion acute ischemic stroke has been evaluated exclusively outside the US, in randomized clinical trials which failed to demonstrate non-inferiority of skipping IVT. Because practice patterns and IVT dosing differ within the US, and prior observational US-based cohorts suggested improved clinical outcomes in patients who received IVT before EVT, a US-based evaluation is needed. This is a quasi-experimental study of a large US cohort using a regression discontinuity design (RDD) that enables the estimation of causal effects when randomization is not feasible. In this multi-center prospective cohort of patients undergoing EVT, we observed a sharp drop (65%) in the probability of receiving IVT at the cutoff of IVT eligibility time window while there were no significant differences in potential confounders including age, NIHSS, and ASPECTS at the cutoff. We found no association between IVT treatment and functional independence (mRS 0–2) at 90-days in patients undergoing EVT, nor in the secondary outcomes of excellent outcomes (mRS 0–1) at 90 days, mortality, symptomatic intracranial hemorrhage, first pass reperfusion, or final reperfusion.

Recognizing bilateral sudden hearing loss as a sentinel sign of basilar artery occlusion: insights from endovascular case series.

To improve early diagnosis of patients who have basilar artery occlusion (BAO) and to provide evidence for treatment decisions based on clinical characteristics, treatment strategies, and prognostic outcomes of cases of bilateral hearing loss as a prodromal symptom. We conducted a retrospective analysis of six patients who had BAO with an initial symptom of hearing loss. This analysis encompassed demographic data, clinical symptoms, examination findings, treatment approaches, and prognostic outcomes. Six patients (mean age 62±16.5 years) presented with bilateral sudden hearing loss and were diagnosed with proximal BAO. All had subtle initial symptoms, leading to diagnostic delays (mean 13 ± 5.4 hours). Five underwent endovascular treatment (EVT), and all patients required rescue balloon angioplasty because of underlying atherosclerotic stenosis. Intravenous tirofiban was administered perioperatively. At discharge, hearing had normalized in four patients; one patient (patient 3) had persistent profound bilateral sensorineural hearing loss. The patient who did not undergo EVT (patient 6) died on day 5 of hospitalization. At 90 days, five EVT-treated patients achieved favorable functional outcomes (modified Rankin Scale score 0-1). Univariate analysis did not show statistically significant differences between outcome groups in baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation Alberta Stroke Program Early CT score, onset-to-arrival time, or age, although patients with unfavorable outcomes tended to be older and have higher NIHSS scores. Sudden bilateral hearing loss should serve as a critical warning sign of BAO, a potentially life-threatening condition. Without rapid intervention, such as intravenous thrombolysis or EVT to re-establish perfusion, the occlusion may progress, leading to severe and potentially fatal outcomes.

Predictors of Futile Recanalization in Patients With Basilar Artery Occlusion With Large Versus Nonlarge Infarcts.

Basilar artery occlusion is associated with high rates of disability and mortality, and despite advances in endovascular treatment, futile recanalization remains a challenge. This study aims to identify predictors of futile recanalization in patients with basilar artery occlusion, focusing on large and nonlarge infarcts. This multicenter retrospective study included patients from 65 centers across China. Patients were categorized based on posterior circulation Alberta Stroke Program Early CT [Computed Tomography] Score (pc-ASPECTS) into 2 groups: large infarcts (pc-ASPECTS ≤6) and nonlarge infarcts (pc-ASPECTS >6). Predictors of futile recanalization-defined as a modified Rankin Scale score of 4 to 6 at 90 days despite successful recanalization-were analyzed using logistic regression models. Among the 2075 patients, 1113 (53.6%) experienced futile recanalization. In patients with pc-ASPECTS >6, predictors of futile recanalization included older age (odds ratio [OR], 1.18 [95% CI, 1.06-1.31]), higher National Institute of Health Stroke Scale scores (OR, 1.75 [95% CI, 1.58-1.94]), and prolonged time from puncture to reperfusion (OR, 1.24 [95% CI, [1.12-1.38]). Intravenous thrombolysis (OR, 0.85 [95% CI, [0.77-0.94]) and achieving modified Thrombolysis in Cerebral Infarction grade 3 (OR, 0.81 [95% CI, [0.74-0.90]) were associated with a lower likelihood of futile recanalization. In patients with pc-ASPECTS ≤6, being male (OR, 0.75 [95% CI, 0.58-0.96]) and having higher pc-ASPECTS scores (OR, 0.65 [95% CI, 0.48-0.85]) were protective against futile recanalization, whereas higher National Institute of Health Stroke Scale scores increased the risk (OR, 1.81 [95% CI, 1.42-2.32]). This study identifies distinct predictors of futile recanalization in patients with basilar artery occlusion based on infarct size. The findings underscore the importance of individualized treatment strategies and timely intervention to optimize endovascular treatment outcomes in high-risk patients.

Enhancing Thrombolysis Times in Acute Ischemic Stroke With Regional Dashboards: Results From the Florida Stroke Registry.

Reducing time to intravenous thrombolysis (IVT) is crucial for effective ischemic stroke treatment. Through grassroots efforts, the FSR (Florida Stroke Registry) developed regional dashboards (RDs) displaying reperfusion metrics within local Stroke Coalitions to improve acute stroke care quality. We sought to evaluate whether RD use is associated with faster IVT times and improved hospitalization outcomes. We compared IVT-treated cases of ischemic stroke at FSR hospitals participating in the RD initiative versus nonparticipating hospitals from January 2016 to December 2023. Primary outcomes were door-to-treatment time <20 minutes and onset-to-treatment time <60 minutes. Secondary outcomes included intracerebral hemorrhage after IVT, discharge disposition, and in-hospital death. Logistic regression models, adjusted for calendar year, patient characteristics, and hospital factors, assessed the association between RD use and study outcomes. By the end of the study period, 92 of 172 FSR hospitals (53.5%) were participating in stroke coalitions and using RDs. Among 32 320 IVT-treated cases (mean age, 69±15 years, 48.4% women), 10 666 (33.0%) were treated in RD-participating hospitals. RD participation was independently associated with door-to-treatment time <20 minutes (12.7% versus 7.3%; adjusted odds ratio, 1.48 [95% CI, 1.35-1.63]) and onset-to-treatment time <60 minutes (13.9% versus 9.0%; adjusted odds ratio, 1.63 [95% CI, 1.49-1.80]), as well as increased likelihood of being discharged directly to home (adjusted odds ratio, 1.15 [95% CI, 1.07-1.23]). The implementation of the FSR RD initiative within stroke coalitions was associated with faster IVT times and higher likelihood of home discharge. This quality improvement initiative, adaptable to local needs, could emerge as a valuable tool for enhancing stroke systems of care.

Intravenous tirofiban in acute ischemic stroke patients not receiving reperfusion treatments: a systematic review and meta-analysis of randomized controlled trials.

Reperfusion treatments with intravenous thrombolysis and endovascular thrombectomy after acute ischemic stroke (AIS) can improve patients' outcomes significantly. Yet, a substantial portion of patients miss the opportunity to receive reperfusion treatments. In this study, we aimed to assess the role of intravenous tirofiban in this specific population. A search was performed in Embase, Cochrane Central Register of Controlled Trials, Medline, and Web of Science databases from inception until August 2024. The random-effects model was used to calculate odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). Efficacy endpoints included excellent (modified Rankin scale of 0-1) and good (modified Rankin scale of 0-2) functional outcomes at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (sICH), any ICH, and 90-day mortality. Four randomized clinical trials, including a total of 1,199 patients, were included. Of these, 599 patients (50%) received tirofiban. The meta-analysis demonstrated that tirofiban was associated with significantly higher rates of both excellent (OR 1.63 [95% CI, 1.24-2.13]; I2 = 0) and good (OR 1.65 [95% CI, 1.19-2.29]; I2 = 0) functional outcomes at 90 days. No significant differences were observed in sICH, any ICH, or 90-days mortality. Treatment with intravenous tirofiban can be beneficial without increased risk in patients with AIS who are not eligible for reperfusion treatment. Further studies are still needed to validate the generalizability of these findings. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024590097, CRD42024590097.

Nationwide analysis of Routine Clinical Practices in the Management of Acute Ischemic Stroke Patients in China.

Despite stroke center advancements in China, real-world adherence to acute care protocols remains understudied. We aimed to systematically investigate the clinical characteristics and in-hospital treatment of acute ischemic stroke (AIS) patients, and explore their association with prognosis. We developed a nationwide cohort of AIS using data from the China National Electronic Disease Surveillance System. Patients were identified from the first discharge diagnosis. Comorbidities and prescription names were standardized by natural language processing and manual verification. Stepwise Cox regression models with fixed and time-dependent covariates explored the possible association between treatments and in-hospital mortality. This cohort included 14,046 patients with AIS from 111 hospitals between 2015 and 2020. Only a small proportion of patients received intravenous thrombolysis (2.76%) or endovascular interventional therapy (3.23%). Neuroprotective agents were used by 59.90% of patients, and dual antiplatelet therapy by 45.77%. Most patients (80.79%) received traditional Chinese medicine, including Chinese patent medicines (79.04%), Chinese herbal medicine slices (10.95%), and acupuncture (7.35%). Rehabilitation services were provided to 7.48% of patients. Cox regression analysis showed that neuroprotective agents (HR 0.73, 95% CI 0.61-0.88), Chinese patent medicine (circulate blood and transform stasis: 0.49, 0.41-0.59; clear heat and remove toxins: 0.71, 0.52-0.98), Chinese herbal medicine slices (0.28, 0.17-0.44), acupuncture (0.58, 0.41-0.84), and rehabilitation therapies (0.95, 0.93-0.97) were potentially associated with reduced in-hospital mortality risk. Our findings showed relatively low utilization rates of thrombolytic (2.76%) and interventional therapies (3.23%) in China, highlighting the urgent need to improve access to these evidence-based reperfusion strategies. The use of neuroprotective agents, Chinese herbal medicine, acupuncture and rehabilitation might be associated with reduced in-hospital mortality in AIS patients, however, future high-quality prospective studies are still warranted to confirm the clinical effects of these treatments.

Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies

BackgroundWhile neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) have been associated with acute ischemic stroke (AIS) outcomes, their differential predictive value across etiological subtypes (TOAST classification) in thrombolysis-treated patients remains underexplored.MethodsIn this retrospective cohort study, we analyzed 381 AIS patients receiving intravenous thrombolysis. Hematological indices were calculated from pre-thrombolysis. Using multivariable logistic regression adjusted for age, NIHSS, and comorbidities, we assessed associations between baseline ratios and 90-day unfavorable outcomes (mRS 3–6). Receiver operating characteristic (ROC) analysis was used to determine optimal cutoffs stratified by TOAST subtypes.ResultsA total of 381 patients were included in the study. NLR showed superior predictive performance: large-artery atherosclerosis: AUC = 0.702 (aOR = 1.35, 95%CI = 1.14–1.61, p = 0.001), small-artery occlusion: AUC = 0.750 (aOR = 1.51, 95%CI = 1.08–2.10, p = 0.015), cardioembolic stroke: AUC = 0.679 (aOR = 1.82, 95%CI = 1.07–3.10, p = 0.028). LMR showed predictive value only in large-artery atherosclerosis (AUC = 0.632, p = 0.004). Optimal NLR cutoffs: 3.19 (large-artery), 3.94 (small-artery), 3.17 (cardioembolic stroke).ConclusionNLR emerged as a robust, subtype-specific predictor of post-thrombolysis outcomes, particularly in atherosclerotic stroke variants. These findings supported NLR’s clinical utility for risk stratification in thrombolysis-eligible AIS patients.

Feasibility of emergent single-step intracranial self-expanding stent deployment using over-the-wire coronary balloons in intracranial atherosclerosis-related large vessel occlusion thrombectomy.

The currently US Food and Drug Administration approved intracranial stent delivery system involves a multistep deployment process that requires the use of an exchange length microwire (ELW). In this study, we describe a single-step approach to deploy the Neuroform Atlas stent without the need for ELW or lesion re-access, using the MINI TREK II over-the-wire (OTW) semi-compliant coronary balloon. We performed a retrospective review of prospectively maintained mechanical thrombectomy databases from two comprehensive stroke centers. The study included consecutive large vessel occlusion (LVO) stroke patients who underwent single-step angioplasty with the MINI TREK II OTW balloon followed by deployment of the Neuroform Atlas intracranial stent, without the use of an ELW. A total of 12 patients met the inclusion criteria. Among them, the median age was 67 years (IQR: 58-73) and 50% were female. Most patients had middle cerebral artery (MCA) M1 occlusion (75%). One-third of the patients received intravenous thrombolysis. All patients achieved successful reperfusion (modified Treatment in Cerebral Ischemia (mTICI) 2b/3) with a median of two passes. The median National Institutes of Health Stroke Scale (NIHSS) score decreased from 14 (IQR: 10-19) at baseline to 4 (IQR: 1-9) at discharge, and the median modified Rankin Scale (mRS) score was 1 (IQR: 1-4) at discharge and 3 (IQR: 2-4) at 90 days. None of the patients in this series experienced symptomatic intracranial hemorrhage, though two patients (16.7%) were dead at 90 days but there was no procedural-related mortality. This preliminary experience demonstrates the technical feasibility and success of single-step deployment of the Neuroform Atlas stent following angioplasty with the MINI TREK II OTW balloon, without the need for an ELW or lesion re-access. Larger prospective studies with extended clinical follow-up are needed to validate these findings.

Advances in treatments for acute ischemic stroke.

Acute ischemic stroke is a leading global cause of death and disability. Intravenous thrombolysis was the first acute treatment developed for ischemic strokes. First with alteplase and now with tenecteplase, intravenous thrombolysis has remained a cornerstone of acute ischemic stroke management. In large vessel occlusions, endovascular thrombectomy has become the standard of care in acute stroke management for anterior and posterior circulation strokes. The boundaries for these treatments have expanded, which has improved outcomes in patients who were previously ineligible. This review summarizes the latest advances in interventions for acute ischemic stroke, extending beyond existing guidelines and review articles to explore emerging strategies and treatments currently under investigation.

Unaddressed palliative care needs of ischemic stroke patients treated with reperfusion therapies after age 80

BackgroundThe implementation of acute stroke care programs with dedicated multidisciplinary stroke teams has revolutionized access to care and improved survival among older adults. However, the integration of specialized palliative support within acute stroke services remains uncommon in many developing countries. This study highlights the emerging challenges faced by patients with ischemic stroke aged ≥ 80 years treated with reperfusion therapies, identifies early palliative care needs, and underscores the importance of comprehensive support in the acute setting.MethodsWe selected consecutive patients with ischemic stroke aged ≥ 80 years who received reperfusion therapies (intravenous thrombolysis or mechanical thrombectomy) at the time of stroke unit admission. Clinical and demographic data were prospectively collected and analyzed.ResultsA total of 52 patients aged ≥ 80 years received reperfusion therapies. The in-hospital mortality rate was 5/52 (9.6%). Key challenges identified during hospitalization included dysphagia in 32 patients (61.5%), dyspnea in 7 patients (13.5%), delirium in 14 patients (26.9%), and mobility impairment and/or speech disturbance in 22 patients (42.3%).ConclusionDespite the increasing use of reperfusion therapies in patients aged ≥ 80 years, symptoms requiring comprehensive support and early palliative interventions persist in the acute stroke setting. Our findings emphasize the need for early palliative assessments to address stroke-related symptoms such as dysphagia, delirium, and mobility or speech disturbances, ultimately enhancing patient comfort. Future research is necessary to better understand stroke-specific symptom burden in the aging population and to develop strategies for integrating palliative care into acute stroke management.

Switch to tenecteplase for intravenous thrombolysis in stroke patients: experience from a German high-volume stroke center

BackgroundTenecteplase (TNK) offers promising efficacy and safety data for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) and pharmacological advantages over alteplase (rt-PA), justifying its gradual adoption as primary thrombolytic agent. At our tertiary care center, we transitioned from rt-PA to TNK, providing valuable real-world insights into this process, including its use beyond the 4.5-hour time window.MethodsWe retrospectively analyzed our stroke registry to compare clinical and procedural data from AIS patients treated with rt-PA (up to 6 months before transition) and those treated with TNK (up to 6 months after transition, starting June 2024). Primary endpoints included treatment metrics, such as door-to-needle (DTN), door-to-imaging (DTI), imaging-to-needle (ITN), door-to-groin and door-to-recanalization times. Safety outcomes comprised rate of any intracranial hemorrhage (ICH), symptomatic ICH (sICH), parenchymatous hematoma type 2 (PH 2) and post-thrombolysis angioedema. A semiquantitative questionnaire evaluated satisfaction with TNK and changes in lysis behavior among nurses and physicians 3 months post-implementation.ResultsDuring the twelve-month period (December 1, 2023 - November 30, 2024), 276 patients underwent IVT. Median DTN times were significantly shorter with TNK (n = 138) compared to rt-PA (n = 138) (TNK 27 min [IQR 19–39] vs. rt-PA 34 min [IQR 25–62]; p = 0.011). No significant differences were observed in safety outcomes, including any ICH (TNK 9% vs. rt-PA 6%; p = 0.30), sICH (2% vs. 1%; p = 0.31), PH 2 rates (1% in both groups), or angioedema (3% vs. 1%; p = 0.18). Staff satisfaction with TNK was high, citing advantages in preparation, administration, and time efficiency. Importantly, no changes in lysis behavior were reported following the transition.ConclusionsTransitioning to TNK in routine practice at a tertiary care center seems feasible with reduced ITN and consequently DTN times. Functional outcomes at discharge were comparable without significant difference in the rate of (s)ICH. Overall, the transition to TNK was well-received by medical staff, highlighting TNK’s practical advantages in acute stroke care.Trial registrationN.A.

Trends in revascularization therapies for patients with acute stroke with large infarcts: a population-based study.

Evidence from randomized clinical trials shows that mechanical thrombectomy (MT) enhances functional outcomes in patients with large core ischemic stroke. To evaluate trends in the use of revascularization therapies, particularly MT, and their impact on functional outcomes in patients with large core ischemic stroke in routine clinical settings. Observational data from the Stroke Code Registry of Catalonia (CICAT, 2016-2024) were analyzed. Patients with anterior circulation ischemic stroke and Alberta Stroke Program Early CT Score (ASPECTS) <6, whether treated with reperfusion therapies or not, were included. Statistical analyses included trend analysis and multivariable logistic regression to identify predictors of favorable outcomes (modified Rankin Scale score 0-3 at 90 days) and mortality. Among 599 patients, MT use increased significantly from 22% pre-2022 to 36% post-2022. This increase was associated with improved functional outcomes, with favorable outcomes rising from 29% to 43% post-2022. MT was a significant independent predictor of favorable outcomes (OR 3.4, 95% CI 2.1 to 5.5) and reduced mortality (OR 0.46, 95% CI 0.32 to 0.68). Intravenous thrombolysis also improved outcomes (OR 2.1, 95% CI 1.3 to 3.5). The benefit of MT was consistent across ASPECTS subgroups (0-2 and 3-5). Mediation analysis indicated that 88% of improvement could be attributed to increased MT use. Increased MT use significantly improved outcomes for patients with large core ischemic stroke, particularly after 2022. Benefits were observed across subgroups, including those with very low ASPECTS. These findings support broadening MT access and suggest the need to update treatment guidelines to consider patients with large ischemic cores, aiming to optimize outcomes in routine clinical practice.

Temporal Trends in Public Stroke Awareness in Korea, 2009 to 2023.

No large-scale survey on public stroke awareness has been conducted in Korea since 2009. This study assessed temporal trends in awareness of stroke warning signs (WSs) and risk factors (RFs) from 2009 to 2023. We hypothesized that stroke awareness remains inadequate and that changes in information sources have influenced the depth of knowledge. Surveys were conducted nationwide in 2009 (n=1000) and 2023 (n=1012) assessing participants' knowledge of WSs, RFs, stroke treatment, response to stroke symptoms, and information sources. Multivariable logistic regression was used to analyze trends in RF knowledge and factors associated with adequate stroke response, which is contacting emergency medical services immediately. Between 2009 and 2023, the percentage of participants unable to identify any WS or RF significantly decreased (WSs: 38.5% to 22.6%, RFs: 43.9% to 37.2%; P<0.01). However, recognition of multiple RFs declined significantly (51.4% to 40.2%, P<0.01), with a more pronounced decrease among those without vascular RFs (adjusted odds ratio, 0.33 [95% CI, 0.21-0.51]; P=0.03 for the interaction term). In contrast, the decline was less pronounced among individuals with vascular RFs (adjusted odds ratio, 0.56 [95% CI, 0.42-0.74]). Intravenous thrombolysis awareness increased (30.4% to 55.6%, P<0.01), and adequate stroke response improved (32.5% to 48.9%, P < 0.01). Information sources shifted, with an increase in the use of digital platforms. Adequate stroke response was significantly associated with intravenous thrombolysis knowledge (adjusted odds ratio, 1.54 [95% CI, 1.09-2.18]; P=0.02) and recognition of ≥2 WSs (adjusted odds ratio, 1.43 [95% CI, 1.09-1.86]; P=0.01). Although stroke awareness has seen some improvements, it remains insufficient, highlighting the need for targeted educational strategies.