Shifts in Clinical Practice-Changing Acute Ischemic Stroke Research Over the Last Decade

Area of Science:

• Neurology
• Clinical Trials
• Public Health

Background:

• Randomized clinical trials (RCTs) are crucial for practice-defining results in stroke care.
• Recent years show rapid growth in clinical trial programs in Europe and Asia.
• The relative influence of U.S. versus international trials on clinical practice is not well quantified.

Purpose of the Study:

• To evaluate shifts in geographic origin, funding, and clinical impact of practice-changing randomized clinical trials (RCTs) in acute ischemic stroke (AIS).
• To analyze trends in U.S. versus European and Asian contributions to AIS guidelines.
• To assess the changing role of National Institutes of Health (NIH) funding in stroke research.

Main Methods:

• Analysis of RCTs supporting American Heart Association/American Stroke Association (AHA/ASA) AIS Guidelines from 2018 and 2026.
• Extraction of geographic origin, funding source (government, academic, non-profit, industry, NIH), and research topic.
• Application of unweighted, reference-density-weighted, and clinical-impact-weighted analyses to assess temporal trends.

Main Results:

• The share of U.S. trials in AIS guidelines decreased from 31.9% in 2018 to 14.6% in 2026.
• China's contribution rose significantly, becoming the second-largest source of trials by 2026.
• NIH-funded trials' share dropped from over 20% in 2018 to under 5% in 2026 across all weighting strategies.

Conclusions:

• There is a notable shift away from U.S.-based clinical trials in acute ischemic stroke (AIS) research.
• Increasing reliance on non-U.S. studies raises questions about current U.S. research paradigms.
• China's growing influence and the decline in NIH funding necessitate a re-evaluation of stroke research strategies.