{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:25:27Z","timestamp":1791588327132,"version":"4.3.4"},"reference-count":91,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>During acute ischemic stroke, cerebral tissue undergoes different stages of ischemic damage and evolves towards irreversible injury at a varying pace depending on local perfusion and metabolic factors. This complex ischemic pathological process represents a dynamic continuum that has been historically conceptualized as a binary ischemic core-penumbra model. Although this simplification has proven useful for explaining the evolution of tissue damage in acute stroke, important nuances with clinical implications might be underappreciated. In this review, we critically appraise the pathophysiology and conventional clinical concepts adopted to explain infarct evolution in the early phases of ischemic stroke. We discuss recent mounting evidence that challenges the traditional compartmentalization of the ischemic core, penumbra, and oligemia, calling for more nuanced pathophysiological tissue concepts. For example, clinical benefits and the harmful hemorrhagic transformation associated with reperfusion therapies are observed across a spectrum of core volumes, challenging the deterministic assumptions of the core-penumbra hypothesis. Automated image processing systems reinforce this simplification of stroke pathophysiology, leading to misinterpretation of the range of truth in human imaging. We propose a modified definition of the core-penumbra-oligemia continuum that includes 6 levels of ischemic progression and their corresponding clinical implications: (1) benign oligemia, (2) vulnerable oligemia, (3) durable penumbra, (4) critical penumbra, (5) nonleaky core, and (6) leaky core. This more granular classification could better reflect the continuum of pathological ischemic changes and vulnerability. The proposed 6 levels can provide a framework for future neuroimaging efforts to better understand tissue fate and infarct evolution in ischemic stroke, ultimately informing treatment decision-making and refining targeting for new therapeutic approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.055331","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T09:00:41Z","timestamp":1778230841000},"page":"2237-2247","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Redefining the Cerebral Ischemic Core-Penumbra-Oligemia Continuum"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4042-4735","authenticated-orcid":true,"given":"Umberto","family":"Pensato","sequence":"first","affiliation":[{"name":"Neuro Center, IRCCS Humanitas Research Hospital, Milan, Italy (U.P.)."},{"name":"Department of Biomedical Sciences, Humanitas University, Milan, Italy (U.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0029-6764","authenticated-orcid":true,"given":"Johanna M.","family":"Ospel","sequence":"additional","affiliation":[{"name":"Department of Radiology (J.M.O.), University of Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-2070","authenticated-orcid":true,"given":"Aravind","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3647-0904","authenticated-orcid":true,"given":"Nishita","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Canada (N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9550-8197","authenticated-orcid":true,"given":"Mohammed","family":"Almekhlafi","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7575-9850","authenticated-orcid":true,"given":"Gabriel","family":"Broocks","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (G. Broocks)."},{"name":"Department of Neuroradiology, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany (G. Broocks)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7007-6030","authenticated-orcid":true,"given":"Giorgio","family":"Busto","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy (G. Busto, E.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0477-724X","authenticated-orcid":true,"given":"Enrico","family":"Fainardi","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy (G. Busto, E.F.)."},{"name":"Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (E.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7007-5995","authenticated-orcid":true,"given":"Diego","family":"Gutierrez Vasquez","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, Pontifical Catholic University of Chile, Santiago (D.G.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dalhousie University, Halifax, Nova Scotia, Canada (T.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3545-6927","authenticated-orcid":true,"given":"Maarten G.","family":"Lansberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stanford University School of Medicine, CA (M.G.L., G.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6973-8677","authenticated-orcid":true,"given":"Felix","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (F.N., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2027-2276","authenticated-orcid":true,"given":"Jean-Marc","family":"Olivot","sequence":"additional","affiliation":[{"name":"Acute Stroke Unit, H\u00f4pital Pierre-Paul Riquet, CHU Toulousepital Pierre-Paul Riquet, CHU Toulouse, France (J.-M.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8874-2487","authenticated-orcid":true,"given":"Mark W.","family":"Parsons","sequence":"additional","affiliation":[{"name":"Neurology Department, John Hunter and Liverpool Hospitals, Ingham Institute of Applied Medical Science, University of New South Wales, Sydney, Australia (M.W.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8814-6853","authenticated-orcid":true,"given":"Vignan","family":"Yogendrakumar","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (V. Yogendrakumar)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1486-4507","authenticated-orcid":true,"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Italy (A.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2719-3012","authenticated-orcid":true,"given":"Beom Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cerebrovascular Disease Center Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2450-4014","authenticated-orcid":true,"given":"Vivek","family":"Yedavalli","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD (V. Yedavalli)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0263-4632","authenticated-orcid":true,"given":"Gregory W.","family":"Albers","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stanford University School of Medicine, CA (M.G.L., G.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-9433","authenticated-orcid":true,"given":"Bruce C.V.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (F.N., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-1543","authenticated-orcid":true,"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-496X","authenticated-orcid":true,"given":"Bijoy K.","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4930-7789","authenticated-orcid":true,"given":"Andrew M.","family":"Demchuk","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (A.G., M.A., M.D.H., B.K.M., A.M.D.), University of Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0118-8"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2003.025825"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1981.54.6.0773"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.049013"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.8.1.51"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493020975229"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030620"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.050897"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.016616"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.562116"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001751"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.903263"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.006745"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.053226"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.12.6.723"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.16.3.361"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000041048.33908.18"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209939"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-67448-x"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/CON.0000000000000376"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X261417186"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.035132"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000209238.61459.39"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.011873"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70055-8"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.250708"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231166306"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.52236"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002862"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.050171"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23837"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.008171"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000158913.91058.93"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.20.5.598"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010049"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nic.2018.06.013"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1148\/rg.315105014"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000200775"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.4557"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-008-0403-9"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.33549\/physiolres.933303"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/159101991201800304"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873241251718"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.663716"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25109"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.009250"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.026281"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X19855885"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.042491"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012484"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.048899"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.718046"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2006.00063.x"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.023392"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.049641"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106208"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003857"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X15621704"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.002396"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm-22-2255"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25785"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.594613"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.07.004"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000119751.92640.7F"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.035049"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(66)92199-4"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X231155222"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.047441"},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2012.00728.x"},{"key":"e_1_3_2_72_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-020-00885-y"},{"key":"e_1_3_2_73_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-022-01120-6"},{"key":"e_1_3_2_74_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-017-8490-3"},{"key":"e_1_3_2_75_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.027011"},{"key":"e_1_3_2_76_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X211029165"},{"key":"e_1_3_2_77_2","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2020.01466"},{"key":"e_1_3_2_78_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.06.012"},{"key":"e_1_3_2_79_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.021106"},{"key":"e_1_3_2_80_2","doi-asserted-by":"publisher","DOI":"10.3892\/br.2017.1033"},{"key":"e_1_3_2_81_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.020840"},{"key":"e_1_3_2_82_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008520"},{"key":"e_1_3_2_83_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1610"},{"key":"e_1_3_2_84_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.482810"},{"key":"e_1_3_2_85_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000214261"},{"key":"e_1_3_2_86_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2023-020443"},{"key":"e_1_3_2_87_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033806"},{"key":"e_1_3_2_88_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-021-00605-6"},{"key":"e_1_3_2_89_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.045755"},{"key":"e_1_3_2_90_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.051270"},{"key":"e_1_3_2_91_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.Str.0000251792.76080.45"},{"key":"e_1_3_2_92_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00425-3"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.126.055331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T19:36:32Z","timestamp":1785958592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.126.055331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":91,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1161\/STROKEAHA.126.055331"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.126.055331","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-05-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}