Table of Content

20 July 2022, Volume 17 Issue 07

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China Stroke Statistics 2020 (3)

WANG Yongjun, LI Zixiao, GU Hongqiu, ZHAI Yi, JIANG Yong, ZHOU Qi, ZHAO Xingquan, WANG Yilong, YANG Xin, WANG Chunjuan, MENG Xia, LI Hao, LIU Liping, JING Jing, WU Jing, XU Anding, DONG Qiang, David Wang, WANG Wenzhi, MA Xudong, ZHAO Jizong, China Stroke Statistics Writing Committee

2022, 17(07):  675-682.  DOI: 10.3969/j.issn.1673-5765.2022.07.001

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Attach Importance to Prevention and Care of In-hospital Stroke

NI Jun

2022, 17(07):  683-685.  DOI: 10.3969/j.issn.1673-5765.2022.07.002

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In-hospital Stroke Care Quality Management

NI Jun

2022, 17(07):  686-686. 

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Interpretation for Identifying Best Practices to Improve Evaluation and Management of In-hospital Stroke: A Scientific Statement from the American Heart Association

ZHOU Lixin, NI Jun

2022, 17(07):  687-694.  DOI: 10.3969/j.issn.1673-5765.2022.07.003

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Progress of Reperfusion Therapy for In-hospital Stroke

LIU Ziyue, ZHU Yicheng

2022, 17(07):  695-705.  DOI: 10.3969/j.issn.1673-5765.2022.07.004

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Reperfusion therapy for in-hospital stroke is frequently absent or delayed, due to complex underlying disease, difficulties in recognition and contraindications, which are the major factors contributing to poor prognosis of in-hospital stroke. Some intervenes addressing delays in different sections of stroke fast tract have been proved to improve the in-hospital stroke reperfusion processes. The system of in-hospital stroke care in China have not yet been perfected. Thus, it is necessary refine the workflow of stroke fast tract according to China's national conditions, characteristics of in-hospital stroke and the experience of advanced centers, in order to improve the prognosis of patients with in-hospital stroke.



Impact of Optimized In-hospital Stroke Emergency System on Reperfusion Therapy and Outcome of In-hospital Ischemic Stroke: A Single Center Retrospective Study

HONG Yuehui, HAN Guangsong, WU Juanjuan, SHA Yuhui, FU Hanhui, ZHOU Lixin, ZHU Yicheng, NI Jun

2022, 17(07):  706-710.  DOI: 10.3969/j.issn.1673-5765.2022.07.005

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Objective  Based on the optimized in-hospital stroke emergency system of Peking Union Medical College Hospital established since 2021, this study analyzed the impact of optimized in-hospital stroke emergency system on the reperfusion therapy and outcome of patients with in-hospital ischemic stroke.

Methods  This retrospective study included the consecutive patients with in-hospital ischemic stroke during hospitalization for non-stroke disease in Peking Union Medical College Hospital from March 2013 to January 2022. Demographic data, vascular risk factors, clinical and imaging data of new-onset stroke, reperfusion therapy, reasons for not receiving reperfusion therapy, and neurological outcome at discharge were collected. NIHSS was used to assess neurological impairment in acute phase (mild stroke for NIHSS 0-5, moderate-severe stroke for NIHSS 6-42), and mRS for assessing functional outcome at discharge. Patients were classified into two groups according to whether the optimized in-hospital stroke emergency system were applied. The differences in proportion of reperfusion therapy and good functional outcome at discharge (mRS 0-2) were compared between the two groups. Binary logistic regression was used to analyze the independent risk factors of poor outcome for patients with in-hospital ischemic stroke.

Results  A total of 203 eligible patients were included. The median age was 64 (52-72) years and 126 patients (62.1%) were males. The median score of NIHSS at baseline was 5 (2-10), and there were 100 cases (49.3%) with moderate-severe stroke. Of the 23 patients (11.3%) who received reperfusion therapy, 2 patients (1.0%) received intravenous thrombolysis, 20 patients (9.9%) received endovascular therapy, and 1 patient (0.5%) received intravenous thrombolysis combined with endovascular therapy. The main reasons for not receiving reperfusion therapy included the following factors: contraindications in 104 patients (51.2%), beyond the time window of intravenous thrombolysis in 67 patients (33.0%), and other reasons in 9 ones (4.4%). The median mRS score at discharge was 3 (1-4), 103 patients (50.7%) had a poor outcome, and 14 patients (6.9%) died. The optimized in-hospital stroke emergency system was utilized in 58 cases (28.6%), and original emergency process in 145 cases (71.4%). The proportion of patients who received reperfusion therapy in optimized emergency process group was higher than that in original emergency process group (27.6% vs. 4.8%, P<0.001), especially receiving endovascular therapy (24.1% vs. 4.1%, P<0.001). Logistic regression analysis showed that older age (OR 1.036, 95%CI 1.014-1.059) and moderate-severe stroke (OR 10.951, 95%CI 5.338-22.467) were independent risk factors for poor outcome. Using the optimized in-hospital stroke emergency system can increase the proportion of patients with good function at discharge compared to the original emergency process, while the difference had no statistical significance.

Conclusions  This single-center study showed that in-hospital ischemic stroke was not uncommon, with higher percentage of moderate-severe stroke and poor prognosis. Optimizing in-hospital stroke emergency system can increase the proportion of patients receiving reperfusion therapy, and relatively improve the functional prognosis of patients at discharge.



Application of Standardized Stroke Care System in In-hospital Stroke Management: A Case of In-hospital Stroke Fast Tract Care in Beijing Union Medical College Hospital

FU Hanhui, HONG Yuehui, SHEN Dongchao, ZHANG Xiaobo, CAO Jian, WANG Jian, CHENG Sihang, XU Weifeng, DONG Jie, PAN Hui, ZHU Yicheng, NI Jun

2022, 17(07):  711-713.  DOI: 10.3969/j.issn.1673-5765.2022.07.006

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Survey on Awareness Rate of In-hospital Stroke Recognition and Treatment among Nurses

ZHOU Lixin, HOU Xiufeng, CHEN Ying, GA Duo, ZHAO Yuhua, CI Yang, NI Jun, PENG Bin

2022, 17(07):  714-719.  DOI: 10.3969/j.issn.1673-5765.2022.07.007

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Objective  To investigate the awareness rate of in-hospital stroke recognition and treatment among nurses, and provide reference for improving the quality of education training.

Methods  In April 2022, the clinical nurses in Tibet Autonomous Region People’s Hospital were surveyed using self-made electronic questionnaire. The contents of the questionnaire included demographic information (gender, age, education background, professional title, position, working years and department), awareness rate of stroke rapid recognition, in-hospital stroke fast tract and training needs. The differences in the awareness rate of stroke rapid recognition, in-hospital stroke fast tract were compared among the nurses of different age, education degree, position, professional title, working years and departments.

Results  A total of 270 valid questionnaires (85.7%) were collected from 315 nurses. In terms of early stroke identification, 202 nurses (74.8%) considered that stroke rapid recognition was very important, but only 89 nurses (33.0%) knew the BEFAST stroke identification scale, 177 nurses (65.6%) knew stroke intravenous thrombolysis, and only 54 nurses (20.0%) knew the 4.5-hour time window of intravenous thrombolysis. In terms of in-hospital stroke fast tract: 91 nurses (33.7%) reported in-hospital stroke in their department, while only 63 nurses (23.3%) had participated in in-hospital stroke rescue. There were statistical differences in the awareness rates of BEFAST rapid recognition scale (P<0.001) and intravenous thrombolysis (P=0.040), the incidence of in-hospital stroke in their departments (P<0.001) and proportion of participating in acute stroke rescue (P<0.001) among nurses in different departments.

Conclusions  It was insufficient for the nurses to identify in-hospital stroke and know in-hospital stroke fast tract. In the future, various forms of regular training should be strengthened for all nurses, especially nurses in departments with high incidence of in-hospital stroke and non-neurology departments.



Efficacy and Safety of Direct Thrombectomy versus Bridging Therapy for Acute Ischemic Stroke: A Meta-Analysis

ZHENG Wei, ZHAI Huazheng, CHEN Mengmeng, WANG Jingye

2022, 17(07):  720-729.  DOI: 10.3969/j.issn.1673-5765.2022.07.008

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Objective  To compare the efficacy and safety of direct endovascular thrombectomy (DEVT) and bridging therapy (BT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO).

Methods  The literature involving the DEVT and BT for AIS-LVO were retrieved in the PubMed, Embase database and Cochrane library database from January 1, 1990 to July 15, 2022. The studies included randomized controlled trials (RCTs) or prospective observational studies enrolling the patients with AIS-LVO who were eligible for intravenous thrombolysis (IVT) (time from stroke onset ≤4.5 h). The efficacy and safety of DEVT and BT were compared. The primary efficacy outcome was 90-day functional independence, defined as a mRS score of 0-2, the primary safety outcome was all-cause mortality, the other endpoints were symptomatic intracranial hemorrhage (sICH), and successful vascular recanalization (defined as TICI 2b/3). The non-inferiority cutoff for primary validity was defined as the lower limit of 95%CI for RD ≥-6.5%.

Results  Finally, six RCTs (n=2334) and five observational prospective trials (n=2947) were included in the meta-analysis. There were 2620 patients (49.6%) in DEVT group and 2661 (50.4%) in BT group. The primary efficacy endpoint in DEVT group was inferior to that in BT group (44.4% vs. 47.6%, RD -0.03, 95%CI -0.06--0.01). The incidence of sICH in DEVT group was lower than that in BT group (4.3% vs. 5.5%, RD -0.01, 95%CI -0.02--0.00); while there were no statistical differences in all-cause death (20.0% vs. 18.8%, RD 0.01, 95%CI -0.01-0.03), and the rate of successful recanalization (85.1% vs. 86.4%, RD -0.01, 95%CI -0.04-0.01) between the two groups.

Conclusions  For patients with AIS-LVO within 4.5 hours from stroke onset, DEVT was inferior to BT and more RCTs were needed in the future.



Prediction of Clinical Outcome of Acute Ischemic Stroke Patients with Hyperglycemia Based on Machine Learning Model

YANG Jialei, CHEN Siding, MENG Xia, JIANG Yong, WANG Yongjun

2022, 17(07):  730-736.  DOI: 10.3969/j.issn.1673-5765.2022.07.009

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Objective  To establish the prediction models of prognosis of acute ischemic stroke patients with hyperglycemia based on machine learning, and to compare the prediction performance of traditional logistic model and machine learning model.

Methods  This study included the patients from the China National Stroke Registration Ⅲ. The baseline information including patients' demographic characteristics, medical history, laboratory tests, head magnetic resonance imaging results and stroke etiology classification were collected case report forms. The cases were divided into the training set (3325 patients) and test set (369 patients) using stratified 10-fold cross-validation. Poor clinical outcome was defined as a modified Rankin score of 3-6 at 3-month follow-up. Machine learning methods such as random forest model, GBDT (Gradient Boosted Decision Trees) model, XGBoost (eXtreme Gradient Boosting) model, and traditional logistic model were used to construct the 3-month poor prognosis prediction models. The area under the receiver operating characteristic curve (AUC) was used to evaluate the degree of discrimination, and the Brier score was used to evaluate the degree of calibration.

Results  A total of 3694 acute ischemic stroke patients with hyperglycemia were included, with an average age of 62.4±10.4 years and 2408 males (65.2%). There were 585 patients (15.8%) with poor prognosis at 3 months. The AUCs of logistic model, random forest model, GBDT model and XGBoost model for predicting 3-month poor prognosis were 0.843 (0.814-0.872), 0.847 (0.823-0.871), 0.845 (0.819-0.871), 0.848 (0.820-0.876), respectively. The sensitivity of logistic model, random forest model, GBDT model and XGBoost model were 0.373 (0.340-0.405), 0.679 (0.629-0.728), 0.426 (0.383-0.468), 0.634 (0.583-0.686), respectively. Although the AUC of the machine learning model was higher than that of the logistic model, the difference was not statistically significant (P>0.05). The sensitivity of the machine learning model was better than that of the logistic model (all P<0.05), and the calibration of all models were good (0.094-0.138).

Conclusions  The traditional logistic model and machine learning model have high predictive value in predicting 3-month poor prognosis of acute ischemic stroke patients with hyperglycemia, and there is no significant difference in discrimination. The results of this study need to be validated in a larger sample size cohort.



Effect of Different Intracranial Venous Drainage Patterns on Stenting for Idiopathic Intracranial Hypertension with Venous Sinus Stenosis

YANG Hongchao, LIU Zhenqiang, MO Dapeng

2022, 17(07):  737-741.  DOI: 10.3969/j.issn.1673-5765.2022.07.010

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Objective  To evaluate the effect of different intracranial venous drainage patterns on stenting for idiopathic intracranial hypertension.

Methods  This retrospective study enrolled the consecutive patients with idiopathic intracranial hypertension who underwent venous sinus stent implantation in Beijing Tiantan Hospital from January 2014 to December 2019. According to intracranial venous drainage pattern, the patients were divided into the unilateral transverse sinus drainage (UTSD) group and bilateral transverse sinus drainage (BTSD) group. The clinical characteristics and 1-month prognosis of the two groups were compared, and the 1-month follow-up symptoms and signs after stenting were analyzed.

Results  A total of 115 patients received stenting, with a median age of 38 (31-46) years (range:18-62 years) and 90 females (78.3%), 87 cases in UTSD group and 28 cases in BTSD group. The percentage of hyperlipidemia in UTSD group was lower than that in BTSD group (8.0% vs. 21.4%, P=0.022). The stenosis rate in UTSD group was higher than that in BTSD group (79.2% vs. 73.9% P=0.018). The 1-month follow-up after stenting showed that symptoms and signs had improved in 101 patients (87.8%), headache, visual impairment and papilledema disappeared in 13 patients (11.3%), the original symptoms and signs had no improvement or deterioration in only one patient (0.9%). There were no statistical differences in improvement of headache (P=0.799) and visual impairment (P=0.104) and the overall improvement of symptoms (P=0.484) between the two groups. However, papilledema improved better in UTSD group than in BTSD group (P=0.031).

Conclusions  Venous sinus stenting can improve the symptoms of patients with idiopathic intracranial hypertension. The papilledema improved better in patients with unilateral transverse sinus drainage than in patients with bilateral transverse sinus drainage.



Incidence and Risk Factors of Non-infective Fever after Cerebral Revascularization in Moyamoya Disease

KANG Shuai, HAN Heze, LU Junlin, CHEN Xiaolin, CHEN Yu, YE Xun, WANG Rong, ZHAO Yuanli

2022, 17(07):  742-747.  DOI: 10.3969/j.issn.1673-5765.2022.07.011

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Objective  To investigate the incidence and risk factors of postoperative non-infective fever (POF) after cerebral revascularization in moyamoya disease (MMD).

Methods  This retrospective study enrolled the consecutive patients with MMD who received revascularization surgery at Beijing Neurosurgical Institute between November 2019 and February 2021. Clinical information were collected and analyzed. The poor prognosis at discharge was defined as a mRS score >2. POF was defined as postoperative temperature > 38℃ without systematic infection evidence within 14 days after surgery. A multivariate logistic regression analysis was conducted to determine the risk factors for POF.

Results  A total of 110 patients including143 hemispheres were included in the final analysis. POFs occurred in 91 patients (63.6%), 81 (89.0%) of whom had a fever within 2 days after surgery. Univariable analysis showed the proportion of adults (74.7% vs. 88.5%, P=0.049) and males (37.4% vs. 63.5%, P=0.003) and poor prognosis at discharge (4.4% vs. 15.4%, P=0.049), and postoperative hematocrit [(33.6±4.2)% vs. (35.8±4.3)%, P=0.004], red blood cell counts [(3.9±0.5)×10¹²/L vs. (4.1±0.5)×10¹²/L, P=0.004)], and white blood cell counts [(11.4±3.6)×10¹²/L vs. (12.8±3.5)×10¹²/L, P=0.031)] were lower in patients with POF than those in patients without POF, while the proportion of posterior circulation involvement (35.2% vs. 11.5%, P=0.002) was higher in patients with POF than that in ones without POF. Logistic regression analysis showed that the patients with posterior circulation involvement were more likely to have POF (OR 3.731, 95%CI 1.265-10.998, P=0.017).

Conclusions  POF was more common in MMD patients after cerebral revascularization, especially ones with posterior circulation involvement.



Correlation between Cerebral Microbleeds and Cognitive Impairment

ZHANG Yaqing, LIU Xiumei, YU Ping, WANG Penglian

2022, 17(07):  748-752.  DOI: 10.3969/j.issn.1673-5765.2022.07.012

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Objective  To investigate the clinical characteristics and related factors of cognitive impairment in patients with cerebral microbleeds (CMBs).

Methods  This prospective study enrolled the consecutive patients with CMBs (CMBs group) and healthy people with matched education level (control group) from January 2017 to January 2021. MMSE, MoCA and clinical dementia rating (CDR) were used to evaluate global cognitive function and functional status in different cognitive domains. The clinical characteristics and cognitive function of the two groups were compared. The correlation of the number and location of CMBs with the total score of MoCA and different cognitive domains score were analyzed in the CMBs group. Independent risk factors for cognitive decline were analyzed in the CMBs group.

Results  There were 110 subjects in CMBs group and control group respectively. The age (P=0.045), proportion of hypertension (P=0.003) and rate of taking antiplatelet drugs (P=0.015) were higher in CMBs group than those in control group. The scores of MMSE (P=0.019), MoCA (P=0.026) and CDR (P<0.001) in CMBs group were lower than those of control group. In patients with CMBs, the number of CMBs was negatively correlated with MoCA score (r_s=-0.930, P<0.001). Deep CMBs was negatively correlated with visual space and executive ability (F=-8.09, P=0.017), orientation (F=-1.33, P=0.041) and abstraction ability (F=-8.03, P=0.023). Cortical-subcortical CMBs were negatively correlated with delayed memory (F=-28.57, P=0.001), language ability (F=-2.88, P=0.038), and mixed CMBs were negatively correlated with attention score (F=-8.70, P=0.012). Multivariate logistic regression analysis showed that the number of CMBs was an independent risk factor for cognitive impairment (OR 7.106, 95%CI 3.026-15.309, P=0.001).

Conclusions  CMBs is associated with age, hypertension and the use of antiplatelet drugs. In CMBs population, CMBs is an independent risk factor for cognitive impairment, and associated with impairment of visual space and executive function, orientation and abstraction ability, delayed memory, language ability and attention.



Effect of Fasting Blood Glucose on Cognitive Function in Patients with Asymptomatic Carotid Atherosclerotic Plaque: A Survey of Rural Residents

ZHANG Qian, ZHANG Guanyi, ZHANG Jia, CHEN Shengyun, ZHAO Xingquan

2022, 17(07):  753-757.  DOI: 10.3969/j.issn.1673-5765.2022.07.013

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Objective  To explore the effect of fasting blood glucose on cognitive function in patients with asymptomatic carotid atherosclerotic plaque.

Methods  Participants aged ≥40 years who participated in the China National Stroke Screen Survey (CNSSS) program between September 2015 to September 2017, from two rural communities (Beiqijia community, Changping District, Beijing and Konggang community, Shunyi District, Beijing), were enrolled in this study. The included patients had carotid atherosclerotic plaques confirmed by carotid ultrasound, yet no cerebrovascular diseases and neurological deficits. Cognitive function was evaluated by the Montreal cognitive assessment (Beijing version). The multivariable logistic regression analysis was used to determine the association between fasting blood glucose and cognitive impairment (MoCA<26 points).

Results  Finally, a total of 1446 subjects were included in this study, with a mean age of 62.0±8.3 years and 809 males (55.9%). 1364 (94.3%) had an education level of no more than 12 years, and 936 (64.7%) had cognitive impairment. Univariate logistic regression analysis showed that fasting blood glucose was associated with cognitive impairment (P_trend=0.003). After adjusting for the confounding factors, fasting blood glucose was still an independent risk factor for cognitive impairment (P_trend=0.008). The patients with the highest quartile of fasting blood glucose had an  increased risk of cognitive impairment by 0.49 times, compared to patients with the lowest quartile (OR 1.49, 95%CI 1.10-2.02, P=0.010).

Conclusions  High fasting blood glucose was an independent risk factor for cognitive impairment in patients with asymptomatic carotid atherosclerotic plaque.



Correlation of Hypoprealbuminemia and Outcome after Endovascular Treatment for Acute Ischemic Stroke

CUI Xiaoyu, NIE Ximing, LIU Liping

2022, 17(07):  758-763.  DOI: 10.3969/j.issn.1673-5765.2022.07.014

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Objective  To explore the occurrence of serum hypoprealbuminemia and its correlation with prognosis after endovascular treatment of acute ischemic stroke.

Methods  This study prospectively collected the data of patients who underwent endovascular treatment for acute ischemic stroke in 18 sub-centers in China from July 2017 to October 2020. According to serum prealbumin level within 24 hours after surgery, the patients were divided into low prealbumin group and normal prealbumin group. Low prealbumin was defined as the serum prealbumin level is lower than 170 mg/L within 24 hours after endovascular therapy in one or more detections. Good prognosis was defined as a mRS score of 0-2. The logistic regression analysis was used to evaluate the correlation of low prealbumin level with short-term prognosis and long-term (90 days) prognosis. The short-term prognosis included early neurological deterioration, any intracranial hemorrhage within 72 hours after surgery. The mRS was used to evaluate 90-day prognosis.

Results  A total of 1254 patients was included in this study, including 289 patients (23.05%) in low prealbumin group and 965 (76.95%) in normal prealbumin group. Logistic regression analysis showed that the low prealbumin level was an independent influencing factor for 90-day good prognosis (aOR 0.48, 95%CI 0.35-0.66, P<0.01), and 90-day death (aOR 1.84, 95%CI 1.29-2.64, P<0.01), but had no effect on early neurological deterioration and any intracranial hemorrhage (P>0.05).

Conclusions  For acute ischemic stroke patients after endovascular therapy, the occurrence of hypoprealbuminemia was correlated with 90-day poor prognosis.



Incidence and Influencing Factors of Anxiety and Depression in Caregivers of Patients with Acute Ischemic Stroke during Hospitalization

ZHOU Juan, TAN Yunbin, WANG Tiejun, SHI Fuming, YU Ping

2022, 17(07):  764-768.  DOI: 10.3969/j.issn.1673-5765.2022.07.015

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Objective  To analyze the influencing factors of anxiety and depression in the caregivers of patients with acute ischemic stroke (AIS), and identify the psychological state of the caregivers early so as to provide reference for early intervention.

Methods  This study prospectively enrolled the caregivers of AIS patients during hospitalization. All the subjects completed the self-rating anxiety scale (SAS) and self-rating depression scale (SDS), and they were divided into anxiety group (SAS≥50) and non-anxiety group (SAS<50), depression group (SDS≥53) and non-depression group (SDS<53). Demographic data, history of chronic diseases, marriage, employment of the caregivers and baseline stroke severity (admission NIHSS), health insurance, anxiety and depression state of AIS patients were collected. Multivariate logistic regression analysis was used to determine the factors influencing the caregivers' anxiety or depression state.

Results  A total of 164 caregivers who completed anxiety and depression assessment were included in this study (corresponding to 164 AIS patients), with an average age of 54.2±6.2 years and 63 males (38.4%). There were 75 cases (45.7%) in anxiety group, 89 (54.3%) in non-anxiety group. The proportion of women (73.3% vs. 51.7%, P<0.01) and chronic disease history (77.3% vs. 59.6%, P=0.02) in anxiety group was higher than that in non-anxiety group. The neurological deficits at admission was more severe (66.7% vs. 48.3% for the proportion of NIHSS≥5 scores, P=0.02) and the proportion of having anxiety was higher (57.3% vs. 31.4%, P<0.01) in the patients who were cared for in anxiety group than those in non-anxiety group. There were 59 cases (36.0%) in depression group and 105 cases (64.0%) in non-depression group. Patients who were cared for in depression group had more severe neurological deficits at admission (88.1% vs. 39.0% for NIHSS≥5, P=0.01) than those in non-depression group. Logistic analysis showed that female caregivers (OR 1.041, 95%CI 1.020-1.062, P=0.01) and patients with anxiety (OR 1.062, 95%CI 1.041-1.083, P=0.03) were independent risk factors for anxiety in caregivers.

Conclusions  The incidence of anxiety and depression was higher in the caregivers of AIS patients. Female and chronic disease history for caregivers and stroke severity and having anxiety for AIS patients were independent risk factors for anxiety in caregivers.



Association of Admission Blood Pressure with Outcome in Cerebral Hemorrhage

SONG Xinjie, JIANG Ruixuan, ZHANG Yijun, WANG Anxin, LI Zixiao, ZHAO Xingquan

2022, 17(07):  769-773.  DOI: 10.3969/j.issn.1673-5765.2022.07.016

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Objective  To explore the relationship between admission blood pressure (BP) and outcomes in patients with cerebral hemorrhage.

Methods   This study collected the data of patients with spontaneous intracerebral hemorrhage from the China National Stroke Registry Ⅱ (CNSRⅡ) database. Logistic regression model was used to analyze the relationship between systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and the outcomes (including in-hospital death, 3-month death, 3-month poor prognosis and 1-year poor prognosis), after adjusting for the confounding factors.

Results  A total of 1048 patients were included in this study, with an average age of 62.1±12.5 years and 666 males (63.5%). At admission, the average SBP was 162.1±28.9 mmHg, the average DBP was 95.1±17.6 mmHg, and the average MAP was 117.4±20.1 mmHg. Compared with patients with SBP 120-139 mmHg at admission, the patients with SBP 180-199 mmHg (OR 17.53, 95%CI 2.25-136.66, P=0.0063) and SBP ≥200 mmHg (OR 21.74, 95%CI 2.74-172.55, P=0.0036) had a higher in-hospital mortality rate. The risk of in-hospital mortality (OR 1.25, 95%CI 1.14-1.37, P<0.0001), 3-month poor prognosis (OR 1.08, 95%CI 1.02-1.15, P=0.0066), and 3-month mortality (OR 1.13, 95%CI 1.04-1.22, P=0.0049) all increased per an increase of 10 mmHg in admission SBP. The risk of in-hospital mortality (OR 1.36, 95%CI 1.16-1.59, P=0.0001), 3-month poor prognosis (OR 1.16, 95%CI 1.05-1.29, P=0.0034), and 3-month mortality (OR 1.20, 95%CI 1.05-1.38, P=0.0093) all increased per an increase of 10 mmHg in admission DBP. The risk of in-hospital mortality (OR 1.37, 95%CI 1.20-1.57, P<0.0001), 3-month poor prognosis (OR 1.13, 95%CI 1.04-1.23, P=0.0044), and 3-month mortality (OR 1.20, 95%CI 1.06-1.35, P=0.0036) all increased per an increase of 10 mmHg in admission MAP.

Conclusions  Admission SBP, DBP and MAP levels were independent risk factors for in-hospital death and 3-month poor prognosis in patients with intracerebral hemorrhage, but were not associated with 1-year poor prognosis.



Efficacy of Superselective Intra-arterial Thrombolysis in Treatment of Acute Central Retinal Artery Occlusion

WANG Wei, ZHAO Shangfeng, ZHANG Baorui, LIANG Xihong, KANG Jun

2022, 17(07):  774-779.  DOI: 10.3969/j.issn.1673-5765.2022.07.017

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Objective  To investigate the efficacy of superselective intra-arterial thrombolysis (IAT) in treatment of acute central retinal artery occlusion (CRAO).

Methods  Consecutive patients diagnosed with CRAO and treated with superselective IAT at Department of Neurosurgery of Beijing Tongren Hospital Affiliated to Capital Medical University from April 2019 to May 2020 were included in this study, and the clinical data of all patients were collected. The best corrected visual acuity (BCVA) examination was routinely performed by ophthalmologists one week after treatment to evaluate vision improvement. The patients were divided into vision improvement group and no improvement group according to their vision improvement situation. The demographic information, clinical characteristics and culprit carotid stenosis were compared between the two groups. According to the degree of carotid artery stenosis, the patients were divided into carotid artery stenosis/occlusion (carotid artery stenosis ≥50%) subgroup and no stenosis (carotid artery stenosis <50%) subgroup, and the demographic information, clinical characteristics and postoperative vision improvement were compared between the two subgroups.

Results  A total of 18 patients with CRAO were included, with a median age of 52.5 (38.8-64.3) years and 12 males (66.7%). A small amount of cortical hemorrhage was found in 1 patient (5.6%) on the second day after treatment. There were 5 patients in vision improvement group and 13 patients in no improvement group. There were no statistical differences in demographic information and clinical characteristics between the two groups. The stenosis rate of carotid artery in vision improvement group was lower than that in no improvement group (20.0% vs. 53.8%), without statistical difference. There were 8 patients in carotid stenosis/occlusion subgroup and 10 patients in no-stenosis subgroup. There were no statistical differences in demographic information and clinical characteristics between the two subgroups. The rate of vision improvement in carotid stenosis/occlusion subgroup was lower than that in no-stenosis group (12.5% vs. 40.0%), without statistical difference.

Conclusions  IAT for CRAO has a good therapeutic effect, but the influencing factors of vision improvement after treatment are still uncertain.



Clinical Features and Risk Factors of Persistent Vestibular Symptoms Associated with Acute Mild Stroke

LI Jiashu, FANG Ruile, LIU Gaifen, ZHAO Xingquan, JU Yi

2022, 17(07):  780-785.  DOI: 10.3969/j.issn.1673-5765.2022.07.018

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Objective  To describe the clinical features, evolution and risk factors of persistent vestibular symptoms related with acute mild stroke.

Methods  This study prospectively enrolled the consecutive inpatients with acute mild stroke (NIHSS<6) -related vestibular symptoms in Department of Neurology of Beijing Tiantan Hospital from September 2020 to September 2021. Baseline information were collected. At admission, the Hamilton anxiety scale and Hamilton depression scale were used to assess the patients' anxiety and/or depression. These patients were followed up from the hospitalization to 3 months after stroke onset to evaluate the evolution of vestibular symptoms. Binary logistic regression analysis was used to analyze the risk factors of persistent vestibular symptoms.

Results  A total of 153 patients were included in the final analysis, with a mean age of 55.3±11.6 years old and 130 males (85.0%). During stroke occurring, dizziness (137/153, 89.5%) was the most common vestibular symptoms, followed by postural symptoms (107/153, 69.9%), vertigo (67/153, 43.8%) and vestibule-visual symptoms (15/153, 9.8%). 114 patients (74.5%) had two or more symptoms. The vestibular symptoms of 77 patients (50.3%) relieved 2 weeks after stroke onset. Only 43 patients (28.1%) still had vestibular symptoms at 3-month follow up, mainly manifested as dizziness (38/43, 88.4%) and postural symptoms (29/43, 67.4%); only 2 patients (4.6%) had dizziness, none of patients had vestibule-visual symptoms. Univariate analysis showed that the proportion of stroke in proximal posterior circulation was higher in the patients with vestibular symptoms 3 months after stroke than that in the patients without vestibular symptoms (58.1% vs. 32.7%, P=0.004). After adjusting for the confounders, logistic regression analysis showed that stroke in proximal posterior circulation (OR 3.75, 95%CI 1.71-8.25, P=0.001) and high baseline NIHSS score (OR 1.35, 95%CI 1.06-1.73, P=0.017) were independent risk factors for persistent vestibular symptoms 3 months after stroke onset.

Conclusions  The acute mild stroke-related vestibular symptoms were mainly dizziness and postural symptoms, often with multiple symptoms coexisting. The vestibular symptoms recovered well in a short time. Stroke in proximal posterior circulation and high baseline NIHSS score were independent risk factors for persistent vestibular symptoms 3 months after stroke onset.



Susceptibility-Weighted Imaging: Core Technologies and Clinical Application

MA Xiaodan, XIA Wanhong, ZHANG Yingkui

2022, 17(07):  786-790.  DOI: 10.3969/j.issn.1673-5765.2022.07.019

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The Anti-aging Mechanism of Melatonin and Its Relationship with Ischemic Stroke

ZHANG Jiali, CHEN Chuxin, ZHANG Xinyi, ZHANG Ning, WANG Chunxue

2022, 17(07):  791-796.  DOI: 10.3969/j.issn.1673-5765.2022.07.020

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Melatonin has significant anti-aging effect, and the main action mechanisms includes free radical scavenging and mitochondrial protection. The decline of melatonin level may be the manifestation of human aging. In addition, it has been confirmed that melatonin has the effect of lipid-lowering, antihypertension and weight-loss, which can prevent and delay the progression of atherosclerosis, and reduce ischemia-reperfusion injury, so melatonin has a good application prospect in the field of ischemic stroke. This article summarized the mechanism and application prospect of melatonin in anti-aging, preventing stroke related risk factors and improving stroke prognosis.