About

Wuwei Feng is a Professor of Neurology at Duke University School of Medicine, specializing in Stroke and Vascular Neurology. He is also the Chief of the Division of Stroke & Vascular Neurology and the Medical Director of the Duke Comprehensive Stroke Center. Dr. Feng is a board-certified vascular neurologist and a physician-scientist with a research portfolio focused on developing imaging biomarkers for post-stroke motor outcomes prediction and utilizing non-invasive brain stimulation tools, such as transcranial direct current stimulation (tDCS), vagus nerve stimulation, low intensity focused ultrasound, and transcranial light stimulation, to enhance post-stroke recovery. His research has been actively funded by the NIH, the American Heart Association/American Stroke Association, and other sources. He leads significant clinical trials, including the NIH-funded TRANSPORT 2 phase II study on post-stroke motor recovery. Dr. Feng has published extensively, with over 150 peer-reviewed manuscripts, and has received numerous awards recognizing his contributions to stroke research and rehabilitation. He also serves as an adjunct professor of Biomedical Engineering at North Carolina State University and is involved in mentoring programs for the World Federation of Neurorehabilitation.

Research topics

• Medicine
• Internal medicine
• Physical therapy
• Surgery
• Physical medicine and rehabilitation
• Environmental health
• Immunology
• Neuroscience
• Psychology
• Nursing
• Economic growth

Selected publications

• Flexible ultrasound array for subcortical brain stimulation in humans: a simulation study

  npj Acoustics · 2026-03-30

  articleOpen access

  Transcranial focused ultrasound (tFUS) is a non-invasive neuromodulatory tool that holds promise for various neuropsychiatric disorders. While it offers several distinct advantages, it also faces notable technical challenges. The irregular shape and inhomogeneous acoustic properties of the human skull impede efficient acoustic energy transmission through the skull. So far, clinical semi-spherical (hemispherical) arrays still suffer from strong wave reflection and refraction at the skull interface, especially with steering. We propose a flexible ultrasound array that conforms to individual skull shapes and can be optimized to target vertex-accessible subcortical regions. The impact of flexible array configuration was investigated by comparing the flexible array with a semi-spherical array commonly used in the clinical setting. Numerical results show that the random-patterned flexible array reduces the z-axis −6 dB full width at half maximum (FWHM) by 29.4% and enhances the focal peak pressure by 44.4% when compared to the semi-spherical array without steering. In addition, it achieves a wide steering range over a 30 × 20 mm2 region while maintaining the focusing performance. We expect that our proposed tFUS stimulation with a flexible array may provide a theoretical framework for improving the therapeutic efficiency for various neuropsychiatric conditions.

  PublisherOA PDFDOI

• Stroke Risk After Bioprosthetic Aortic Valve Replacement in Aortic Stenosis: Systematic Review and Meta-Analysis

  Stroke · 2026-03-20

  article

  BACKGROUND: Stroke is a possible complication after bioprosthetic aortic valve replacement (AVR) for severe aortic stenosis (AS), impacting morbidity and mortality. Accurate estimates of the proportion of individuals who experience stroke within and beyond the periprocedural period after transcatheter AVR (TAVR), surgical AVR, and valve-in-valve (ViV) replacement are essential for management and prognostication. The objective was to determine the proportion of adults aged >18 who experienced an ischemic stroke after bioprosthetic AVR for AS. METHODS: A systematic search of MEDLINE, Embase, and Web of Science was conducted from database inception through March 2024. Studies reporting on stroke rates at least 90 days after bioprosthetic AVR for severe AS, including ViV procedures, and meeting predefined eligibility criteria were included. The pooled proportion of individuals experiencing a stroke was estimated for TAVR and ViV procedures, whereas comparative analyses between TAVR and surgical AVR were performed using mixed-effects models in studies directly comparing both procedures. RESULTS: Twenty-seven studies were included in the native AS treatment cohort, and 5 in the ViV subanalysis. In native AS, the pooled 30-day proportion of individuals who had a stroke after TAVR was 3.0% (95% CI, 2.5-3.9), with different studies reporting major and minor stroke proportions of 1.7% each. At 1 year, all stroke proportion was 5.0% (95% CI, 4.0-6.0), major stroke was 3.0%, and minor stroke was 2.0%. Comparative analysis demonstrated that TAVR was associated with significantly lower odds of all stroke at 30 days compared with surgical AVR (odds ratio, 0.73 [95% CI, 0.57-0.93]). No significant difference in the proportions of individuals who had a stroke was observed in TAVR versus surgical AVR at 1, 2, or 5 years. In the ViV cohort, the pooled 30-day and 1-year all stroke proportion after ViV was 2.0% (95% CI, 1.0-3.0) and 3.0% (95% CI, 2.0-6.0), respectively. CONCLUSIONS: This meta-analysis provides updated estimates of stroke after bioprosthetic AVR for AS, capturing risk beyond the early periprocedural period. Future studies should investigate the causes of long-term stroke post-AVR, the effects of different antithrombotic therapies on the risk of stroke, as well as the potential impact of these procedures on short and long-term cognitive function.

  PublisherDOI

• Transcranial Direct Current Stimulation for Stroke Motor Recovery What the TRANSPORT2 Trial Taught Us

  Stroke · 2026-05-08

  articleOpen accessSenior author

  Over the past 2 decades, transcranial direct current stimulation has attracted substantial interest as an adjunctive strategy to enhance poststroke motor recovery. In addition to its potential neuromodulatory effects on motor cortical networks, transcranial direct current stimulation devices are low-cost, easy to use, and compatible with concurrent rehabilitation. Yet, despite its promise, several barriers hinder translation into routine clinical practice, including neutral results from several recently completed multicenter trials, such as TRANSPORT2 (Transcranial Direct Current Stimulation for Post-Stroke Motor Recovery). Moving forward, progress will depend on addressing issues in 3 broad domains: device-related (stimulation parameters and montage), disease-related (patient characteristics and timing), and trial design (outcomes, analytical approaches, adjunctive therapy, and trial infrastructure). In this topical review, we critically examine these challenges and outline strategies to refine transcranial direct current stimulation application, with the goal of more effectively leveraging its neuromodulation properties to promote neuroplasticity and enhance motor recovery after stroke.

  PublisherOA PDFDOI

• Associations between contralesional neuroplasticity and motor impairment through deep learning-derived MRI regional brain age in chronic stroke (ENIGMA): a multicohort, retrospective, observational study

  The Lancet Digital Health · 2026-01-01

  articleOpen access

  BACKGROUND: Stroke leads to complex chronic structural and functional brain changes that specifically affect motor outcomes. The brain predicted age difference (PAD) has emerged as a sensitive biomarker of both sensorimotor and cognitive function after stroke. Our previous study showed a higher global brain PAD associated with poorer motor function after stroke. However, the association between local stroke lesion load, regional brain age, and motor impairment is unclear. This study aimed to investigate the associations between focal lesion damage, regional brain PAD in both hemispheres, and motor outcomes in chronic stroke, and to identify key predictors of motor impairment. METHODS: In this multicohort, retrospective, observational study, we included individuals with chronic unilateral stroke (>180 days post stroke) from the ENIGMA Stroke Recovery Working Group dataset and used individuals from the UK Biobank cohort to train the regional brain age prediction model. Structural T1-weighted MRI scans were used to estimate regional brain PAD in 18 predefined functional subregions via a graph convolutional network algorithm. Lesion load for each region was calculated on the basis of lesion overlap. Linear mixed-effects models assessed associations between lesion size, local lesion load, and regional brain PAD. Machine learning classifiers predicted motor outcomes using lesion loads and regional brain PADs. Structural equation modelling examined directional relationships among corticospinal tract lesion load, ipsilesional brain PAD, motor outcomes, and contralesional brain PAD. FINDINGS: We included 501 individuals from the ENIGMA Stroke Recovery Working Group dataset (34 cohorts in eight countries) and 17 791 individuals from the UK Biobank dataset. Larger total lesion size was positively associated with higher ipsilesional regional brain PADs (older brain age) across most regions (β=0·5420 to 0·9458 across significantly correlated regions, false discovery rate [FDR]-corrected p<0·05), and with lower brain PAD in the contralesional ventral attention and language network region (β=-0·3747, 95% CI -0·6961 to -0·0534, FDR-corrected p<0·05). Higher local lesion loads showed similar patterns. Specifically, lesion load in the salience network significantly influenced regional brain PADs across both hemispheres. Machine learning models identified corticospinal tract lesion load (adjusted mean difference -0·0905, 95% CI -0·1221 to -0·0589, p<0·0001), salience network lesion load (-0·0632, -0·0906 to -0·0358, p<0·0001), and regional brain PAD in the contralesional frontoparietal network (0·9939, 0·4929 to 1·4950, p=0·0001) as the top three predictors of motor outcomes. Structural equation modelling revealed that higher corticospinal tract lesion load was associated with poorer motor outcomes (β=-0·355, 95% CI -0·446 to -0·267, p<0·0001), which were further linked to younger contralesional brain age (0·204, 0·111 to 0·295, p<0·0001), suggesting that severe motor impairment is linked to compensatory decreases in contralesional brain age. INTERPRETATION: Our findings reveal that larger stroke lesions are associated with accelerated ageing in the ipsilesional hemisphere and paradoxically decelerated brain ageing in the contralesional hemisphere, suggesting compensatory neural mechanisms. Assessing regional brain age might serve as a biomarker for neuroplasticity and inform targeted interventions to enhance motor recovery after stroke. FUNDING: US National Institutes of Health.

  PublisherOA PDFDOI

• Statin use is associated with reduced stroke risk after cranial radiation in glioma patients with hyperlipidemia

  Journal of Neuro-Oncology · 2026-04-22

  article
  PublisherDOI

• External validation of the predictive swallow score for dysphagia in stroke patients

  Journal of Stroke and Cerebrovascular Diseases · 2026-02-12

  articleOpen accessSenior author

  INTRODUCTION: Post-stroke dysphagia (PSD) is a common complication following acute ischemic stroke (AIS). Predicting the recovery of swallow function remains challenging. The Predictive Swallow Score (PRESS) model, derived and validated in a Swiss cohort, sought to predict the recovery of PSD after AIS. We aimed to validate the PRESS model in a US-cohort, conducting a two-center retrospective review of 149 patients with AIS and functional oral intake scale (FOIS) ≤ 4. METHODS: We collected the predictors of recovery of PSD according to PRESS (age, NIH Stroke Scale (NIHSS), any2 score, stroke location, FOIS score), with a primary outcome of impaired swallow at day 7 (FOIS ≤ 4). Model validation was completed using the Hosmer-Lemeshow (HL) test, calibration plots, and AUC analysis. RESULTS: =48.343, df=5), and the calibration curve analysis (intercept = -0.80 (95% CI: -1.21 to -0.38), slope = 0.60 (95% CI: 0.37 to 0.82)) also demonstrated a poor calibration of the model. Area under the curve analyses demonstrated a C statistic of 0.75 (95% CI 0.67-0.82), indicating suboptimal model discrimination in predicting the recovery of swallow 7 days following AIS. In particular, the model overpredicted dysphagia severity at day-7 in patients with higher PRESS scores and more severe strokes. CONCLUSION: Further validation of the PRESS score in prospective cohorts is warranted. The suboptimal model performance could be attributed to temporal advances in stroke care, as the original PRESS cohort was derived between 2011 and 2014. Geographic variability in acute stroke care practice could also be a factor, as the PRESS score was derived solely from a European cohort. This study, however, is limited by its retrospective design and a lack of generalizability.

  PublisherDOI

• Rethinking neuromodulation in stroke: lessons from TRANSPORT2 – Authors' reply

  The Lancet Neurology · 2025-07-16 · 1 citations

  letterOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Low intensity focused ultrasound stimulation in stroke: A phase I safety &amp; feasibility trial

  Brain stimulation · 2025-01-01 · 11 citations

  articleOpen accessSenior author

  <h2>Abstract</h2><h3>Objective</h3> We aimed to determine the maximum safe spatial-peak pulse-average intensity (I_SPPA) of low-intensity focused ultrasound stimulation (LIFUS) in stroke patients and explore its effect on motor learning and corticospinal excitability. <h3>Methods</h3> We adopted the classic 3 + 3 design to escalate I_SPPA (estimated in-vivo transcranial value) from 0, 1, 2, 4, 6, to 8 W/cm². Stopping rules were pre-defined: 2^nd-degree scalp burn, clinical seizure, new lesion on diffusion-weighted imaging or major reduction in apparent diffusion coefficient, and participant discontinuation due to any reason. We applied 12-min LIFUS over the ipsilesional motor cortex while participants were concurrently practicing 3 blocks of a motor sequence learning (MSL) task using the affected hand. We measured MSL (response time) and corticospinal excitability (motor evoked potential) pre- and post-stimulation and compared MSL and corticospinal excitability between the LOW (0, 1, and 2 W/cm²) and HIGH (4, 6, and 8 W/cm²) groups. <h3>Results</h3> I_SPPA was escalated to 8 W/cm² with 18 stroke participants without meeting the stopping rules. Compared to the LOW, more participants in the HIGH performed better on MSL (6/9 vs. 0/9, <i>p</i> = 0.009) and showed a sign of greater corticospinal excitability (7/9 vs. 5/9, <i>p</i> = 0.62). <h3>Interpretation</h3> Our phase-I safety study suggests that one session of LIFUS up to 8 W/cm² I_SPPA is safe and feasible in stroke patients, and LIFUS at high intensity induces positive changes in both MSL and corticospinal excitability. The next logical step is to conduct a phase-II trial testing the efficacy of LIFUS and continuously monitoring its safety profiles.

  PublisherOA PDFDOI

• A Methodological Protocol and Considerations for Transcranial Ultrasonic Stimulation in Exploratory Clinical Human Studies

  Journal of Visualized Experiments · 2025-12-12

  articleSenior author

  Transcranial ultrasonic stimulation (TUS) is emerging as a non-invasive neuromodulatory technique capable of delivering millimeter-precision stimulation at whole-brain depths. Research efforts have increasingly focused on its translational potential. Promising data have been reported across several disease populations, including Parkinson's disease and stroke, paving the way for clinical applications of TUS. Clinical studies to date, however, show substantial variability in transducer fixation, targeting approaches, and acoustic parameters. This limits the interpretability and comparability of results. Existing methodological guides address human TUS in general but do not focus on applications in neurological populations. This experimental protocol presents a standardized yet adaptable framework for applying TUS to neurological cohorts such as stroke. It offers detailed guidance on: (1) essential and optional hardware components in the context of therapy-oriented TUS; (2) hardware settings and parameter selection, including strategies to minimize auditory confounds; (3) calibration and quality assurance procedures to ensure the transducer delivers waveforms as specified; (4) targeting approaches based on simulation or non-simulation methods for accurate localization of TUS focus/foci to the intended anatomical region(s); (5) methodology adaption for clinical populations; and (6) outcome measures for clinical TUS, encompassing safety assessments and surrogate outcome measures such as corticospinal excitability and motor sequence learning. This protocol is designed as a replicable, modular resource. It accommodates both novice users (seeking a practical entry point into patient-based TUS) and experienced researchers (aiming to align with emerging scientific and methodological standards). The goal is to support the growing clinical interest in TUS and to facilitate clinically translatable, reproducible, and comparable results across research groups and patient populations.

  PublisherDOI

• Ischemic Stroke in Immune-Mediated Thrombotic Thrombocytopenia Purpura: Diagnostic and Management Challenges

  Stroke · 2025-03-07 · 1 citations

  articleOpen access

  Division of Hematology Department of Medicine Duke University School of Medicine

  PublisherOA PDFDOI

Recent grants

• Supplement to TRANScranial direct current stimulation for POst-stroke motor Recover - a phase II sTudy (TRANSPORT 2)

  NIH · $8.5M · 2019–2025

• COBRE in Stroke Recovery Administrative Supplement: Equipment

  NIH · $46.5M · 2014–2025

Frequent coauthors

• Steven A. Kautz

  Medical University of South Carolina

  88 shared

• Xunming Ji

  Chinese Institute for Brain Research

  83 shared

• Bruce Ovbiagele

  University of California, San Francisco

  75 shared

• Jeffrey L. Saver

  University of California, Los Angeles

  66 shared

• Jing‐Er Lee

  Taipei Medical University

  64 shared

• Meng Lee

  64 shared

• Keun‐Sik Hong

  Inje University Ilsan Paik Hospital

  64 shared

• Yi‐Ling Wu

  National Health Research Institutes

  64 shared

Labs

• Neuromodulation and Stroke Recovery LabPI

Education

• MS, biostatistics

  University of Alabama School of Medicine

  2002

• MD

  Central South University Xiangya School of Medicine

  1996

Awards & honors

• Scientific Investigation Award. The Society of Chinese Ameri…
• Franz Gerstenbrand Award. World Federation of Neurorehabilit…
• Arthur Guyton New Investigator Award. Consortium for Southea…
• Stroke Rehabilitation Award. American Heart Association. 201…
• Rehabilitation Award. American Heart Association/American St…