Cerebrovascular Disease | Improving Stroke Care Through Personalized and Novel Therapeutics*
Date: October 19, 2026
Time: 3:45 pm to 5:15 pm
Room: Sandpiper Salons A&B
Track: Traditional Special Interest Group (SIG)
Session Description
Cerebrovascular disease remains a rapidly evolving field, with ongoing advances shaping prevention, treatment, and outcomes. This session will highlight late-breaking developments in secondary stroke prevention, intracerebral hemorrhage (ICH), and sex-specific risk factors in stroke.
Presentations will examine factors unique to women that influence stroke risk, treatment, and participation in research, with particular emphasis on pregnancy and menopause. The session will also review recent progress in ICH management, including emerging evidence supporting minimally invasive surgical approaches, rapid triage strategies, and comprehensive care bundles aimed at improving outcomes in this high-mortality condition.
In addition, the evolving role of Factor XI inhibitors will be discussed as a promising strategy for targeted stroke prevention, with the potential to reduce recurrence while minimizing bleeding risk.
The session will also feature presentations from authors of two top-scoring ANA2026 abstracts, along with a third presentation highlighting an early-career investigator (e.g., trainee, Instructor, Assistant Professor, or participant from a low- and middle-income country) to support emerging researchers and foster continued engagement with the ANA.
Learning Objectives
At the conclusion of this session, attendees will be able to:
- Describe the impact of sex-specific factors on stroke risk, treatment, and research participation in women.
- Explain how ultra-early assessment and management of intracerebral hemorrhage can improve patient outcomes.
- Evaluate the role of Factor XI inhibitors as emerging therapies for stroke prevention.
Speakers
- (Chair) Christoph Stretz, MD, FANA
- (Co-Chair) Michelle Johansen, MD, PhD, FAHA, FANA
- (Speaker) Cheryl Bushnell, MD, MHS
- (Speaker) Stephan A. Mayer, MD, FCCM, FNCS
- (Speaker) James Siegler, MD, FAHA
- (Speaker) Chaitali Dagli, BHMS, MPH (2026 SIG Oral Presenter)
- (Speaker) Mina Ghayour, BS (2026 SIG Oral Presenter)
- (Speaker) Jiajing Shan, PhD (2026 SIG Oral Presenter)
Bridging the Gap: Navigating Sex-specific Factors Affecting Stroke Risk, Treatment and Research
Description
Sex-specific biological and reproductive factors play an important role in stroke risk, prevention, and clinical management but are often underrecognized in neurological practice. Greater awareness of these factors is essential to improving risk assessment, patient counseling, and individualized care for women across the lifespan.
This presentation will examine the influence of sex-specific factors on stroke risk, treatment, and research. Participants will review the relationship between menopausal symptoms, including vasomotor symptoms such as hot flashes and night sweats, and the risk of cardiovascular disease and stroke. Topics will include the use of menopausal hormone therapy, recent trends in the prescribing of compounded hormonal therapies, and ongoing controversies surrounding FDA labeling and safety considerations. Participants will also discuss the long-term cerebrovascular implications of pregnancy complications, including preeclampsia and other hypertensive disorders of pregnancy, and learn practical approaches to incorporating reproductive history into stroke risk assessment. An illustrative clinical case will demonstrate how these factors can inform diagnosis, management, and patient counseling.
Attendees will leave with a greater understanding of the impact of sex-specific and reproductive health factors on stroke risk and practical strategies for integrating these considerations into clinical evaluation, treatment planning, and research aimed at improving cerebrovascular outcomes for women.
Advancing Care for Intracerebral Hemorrhage
Description
Acute intracerebral hemorrhage (ICH) remains one of the most devastating forms of stroke, with high rates of mortality and long-term disability. Despite advances in neurocritical care, improving outcomes continues to depend on timely diagnosis, rapid intervention, and the development of innovative therapeutic strategies.
This presentation will provide an overview of the most promising current and emerging advances in the emergency management of acute intracerebral hemorrhage. Participants will review recent developments in acute medical and procedural interventions, examine evolving evidence supporting strategies to limit hematoma expansion and secondary brain injury, and discuss emerging therapies that have the potential to improve neurological outcomes. Topics will also include ongoing clinical research and future directions that are shaping the next generation of ICH care.
Attendees will leave with a greater understanding of the evolving landscape of acute intracerebral hemorrhage management and practical insights into the latest evidence-based interventions and emerging therapies designed to improve patient outcomes.
Factor XI Inhibitors - Novel Therapeutics in Stroke Prevention
Description
While conventional antiplatelets, antihypertensives, and lipid-lowering therapies have established benefit for reducing the risk of recurrent stroke, there is considerable residual risk that is unmitigated by present day pharmacotherapies. As stroke is a clinical consequence of a heterogeneous constellation of prothrombotic and atheroembolic factors, effective secondary prevention must target numerous causal mechanisms.
This presentation will summarize the role of factor XI in the coagulation cascade, in particular as it relates to endothelial function, and further provide evidence to supports its role as a target for novel antithrombotics to prevent thrombogenesis. The natural history of patients who are deficient in factor XI will be described and will support the safety of pharmacologic inhibition of factor XI. Finally, the results and implications of randomized trials testing novel factor XIa inhibitors in stroke will be summarized.
Attendees will leave with a greater familiarity with residual stroke risk, a broader awareness of the intrinsic and extrinsic clotting pathways, and greater knowledge of the future treatments of stroke as they pertain to factor XIa inhibition.
Gut Microbiome - Related Metabolites as Mediators of Environmental Risk of Ischemic Stroke: Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Description
Environmental factors such as perceived stress and neighborhood social vulnerability contribute substantially to ischemic stroke risk, yet the biological mechanisms linking these exposures to cerebrovascular disease remain incompletely understood. Emerging evidence suggests that gut microbiome–related metabolites may serve as important intermediates connecting environmental stressors with inflammation, endothelial dysfunction, and vascular injury. Elucidating these pathways may provide new insights into ischemic stroke pathogenesis and identify potential targets for prevention.
This presentation will review the role of gut microbiome–related metabolites in mediating the associations between perceived stress, neighborhood social vulnerability, and incident ischemic stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Participants will explore how integrating metabolomic and epidemiologic data can clarify the biological pathways through which environmental exposures contribute to stroke risk. The presentation will also discuss the broader implications of identifying metabolic pathways that link adverse environmental conditions to ischemic stroke and highlight opportunities for future research into prevention and precision medicine.
Attendees will leave with a greater understanding of the interplay between environmental exposures, gut microbiome–related metabolites, and ischemic stroke risk in the REGARDS study, as well as how integrating social and biological data can advance understanding of disease mechanisms and inform future research on stroke prevention.
Long-Term Neuropsychiatric Outcomes After Subarachnoid Hemorrhage: The Amplifying Role of Delayed Cerebral Ischemia in Dementia, Epilepsy, and Mood Disorders : A 5-Year Cohort Study
Description
Subarachnoid hemorrhage (SAH) is traditionally viewed as an acute neurologic emergency, but growing evidence suggests that its consequences extend well beyond the initial hospitalization. Long term neuropsychiatric complications including dementia, epilepsy, and depression can substantially affect survivors, yet population level data characterizing these outcomes over time remain limited. Delayed cerebral ischemia (DCI), a major complication of SAH, may further contribute to long term cognitive and psychiatric morbidity.
This presentation will examine the long-term neuropsychiatric consequences of nontraumatic SAH using data from the TriNetX Research Network, with a focus on the relationship between DCI and subsequent development of dementia, epilepsy, and depression. Participants will explore the magnitude of these risks compared with matched controls, the additional risk associated with DCI among SAH patients, and the progression of neuropsychiatric events over a five year follow up period. The presentation will also discuss differences in outcomes between patients undergoing surgical clipping versus endovascular coiling.
Attendees will gain a greater understanding of the long term cognitive and psychiatric burden following SAH and the role of DCI in shaping these outcomes. These findings highlight the importance of viewing SAH as a chronic neurologic condition requiring continued follow up beyond the acute phase and underscore the need for ongoing attention to cognitive, seizure, and mood related complications in SAH survivors.
Single-cell RNA Sequencing Analyses Revealed Integrated Vascular Reactions in Promoting Angiogenesis After Chronic Cerebral Hypoperfusion
Description
Chronic cerebral hypoperfusion is associated with vascular dysfunction and progressive changes in the brain’s microvascular environment. Understanding the cellular mechanisms that drive vascular remodeling and angiogenesis following reduced cerebral blood flow may provide important insights into the brain’s adaptive responses and identify potential therapeutic targets.
This presentation will use single-cell RNA sequencing to examine the cellular and molecular responses underlying vascular remodeling and angiogenesis after chronic cerebral hypoperfusion. Participants will explore how distinct vascular and nonvascular cell populations interact and contribute to angiogenic responses, with a focus on the coordinated cellular mechanisms that promote vascular adaptation following prolonged reductions in cerebral blood flow. The session will also highlight how single-cell approaches can provide new insights into complex vascular responses at cellular resolution.
Attendees will leave with a greater understanding of the cellular and molecular mechanisms underlying vascular remodeling and angiogenesis after chronic cerebral hypoperfusion and the potential of single-cell RNA sequencing to advance our understanding of cerebrovascular disease.
