Research Progress on Ultra-Early Blood Pressure Management in Acute Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2025.07.005

Chinese Journal of Stroke ›› 2025, Vol. 20 ›› Issue (7): 829-839.DOI: 10.3969/j.issn.1673-5765.2025.07.005

Previous Articles Next Articles

Research Progress on Ultra-Early Blood Pressure Management in Acute Ischemic Stroke

YANG Zhijin¹, TAN Quandan^2,3, MAO Fengkai^2,3, LI Zhaohui¹, CHEN Chen⁴, LI Gang^4,5, YANG Jie⁶, LIN Yapeng^2,3,7

1 Department of Neurology, Dazhu County People’s Hospital, Dazhou 635100, China
2 School of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China
3 Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China
4 Neurology Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200123, China
5 Institute of Cerebrovascular Disease, Tongji University, Shanghai 200123, China
6 Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
7 Graduate School, Dalian Medical University, Dalian 116044, China

Received:2025-03-30 Revised:2025-06-05 Accepted:2025-06-12 Online:2025-07-20 Published:2025-07-20
Contact: YANG Jie, E-mail: yangjie1126@163.com LIN Yapeng, E-mail: linyapengsjnk@163.com

急性缺血性卒中超早期血压管理研究进展

杨志进¹，谭荃丹^2，3，毛凤凯^2，3，李朝晖¹，陈晨⁴，李刚^4，5，杨杰⁶，林亚鹏^2，3，7

1 达州 635100 大竹县人民医院神经内科
2 成都医学院临床医学院
3 成都医学院第一附属医院神经内科
4 同济大学附属东方医院神经内科
5 同济大学脑血管病研究中心
6 四川省医学科学院·四川省人民医院（电子科技大学附属医院）神经内科
7 大连医科大学研究生院

通讯作者: 杨杰 yangjie1126@163.com 林亚鹏 linyapengsjnk@163.com
基金资助:
国家自然科学基金面上项目（82171295）
四川省科技计划项目重点研发计划（2023YFS0042）

Abstract

Abstract: Stroke is one of the leading causes of disability and death worldwide, with ischemic stroke accounting for over 70% of all stroke cases, making it a major global public health issue. Patients with acute ischemic stroke (AIS) often exhibit elevated blood pressure in the early phase after onset, and numerous observational studies suggest that elevated blood pressure is associated with poor prognosis. The core challenge in ultra-early blood pressure management for AIS lies in the dual-directional impact of blood pressure fluctuations on the ischemic penumbra against the backdrop of impaired cerebral autoregulation. A rational blood pressure management strategy is one of the key factors to improve patient outcomes. Currently, significant controversies persist regarding the timing of blood pressure lowering, individualized blood pressure target setting, and the effects of different antihypertensive strategies on cerebral perfusion and reperfusion injury in the ultra-early phase of AIS. Given this, this article reviews and discusses the latest research progress in ultra-early blood pressure management for AIS, aiming to provide more valuable references for clinical practice.

Key words: Acute ischemic stroke; Ultra-early phase; Blood pressure management; Ischemia reperfusion injury

摘要： 卒中是全球范围内致残和致死的主要病因之一，其中缺血性卒中占卒中的70%以上，是全球重大公共卫生问题之一。急性缺血性卒中（acute ischemic stroke，AIS）患者发病早期常出现血压升高，大量观察性研究提示血压升高与AIS患者预后不良相关。AIS超早期血压管理的核心挑战在于脑血流自动调节受损背景下血压波动对缺血半暗带的双重影响，合理的血压管理策略是改善患者预后的关键因素之一。当前，在AIS超早期血压管理领域，在降压时机的抉择、目标血压值的个体化设定，以及不同降压策略对脑灌注和再灌注损伤的影响等方面仍存在广泛争议。鉴于此，本文对AIS超早期血压管理的最新研究进展进行梳理与探讨，以期为临床实践提供更具价值的参考。

关键词: 急性缺血性卒中; 超早期; 血压管理; 缺血再灌注损伤

CLC Number:

R74
R459.7

YANG Zhijin, TAN Quandan, MAO Fengkai, LI Zhaohui, CHEN Chen, LI Gang, YANG Jie, LIN Yapeng. Research Progress on Ultra-Early Blood Pressure Management in Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(7): 829-839.

杨志进, 谭荃丹, 毛凤凯, 李朝晖, 陈晨, 李刚, 杨杰, 林亚鹏. 急性缺血性卒中超早期血压管理研究进展[J]. 中国卒中杂志, 2025, 20(7): 829-839.

References

[1] TSAO C W，ADAY A W，ALMARZOOQ Z I，et al. Heart disease and stroke statistics—2023 update：a report from the American Heart Association[J/OL]. Circulation，2023，147（8）：e93-e621[2025-02-23]. https://doi.org/10.1161/CIR.0000000000001123.
[2] GBD 2021 Stroke Risk Factor Collaborators. Global，regional，and national burden of stroke and its risk factors，1990—2021：a systematic analysis for the global burden of disease study 2021[J]. Lancet Neurol，2024，23（10）：973-1003.
[3] LI X Y，KONG X M，YANG C H，et al. Global，regional，and national burden of ischemic stroke，1990—2021：an analysis of data from the global burden of disease study 2021[J/OL]. eClinicalMedicine，2024，75：102758[2025-02-23]. https://doi.org/10.1016/j.eclinm.2024.102758.
[4] HACKE W，KASTE M，BLUHMKI E，et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke[J]. N Engl J Med，2008，359（13）：1317-1329.
[5] BERKHEMER O A，FRANSEN P S S，BEUMER D，et al. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med，2015，372（1）：11-20.
[6] 《中国卒中中心报告2022》编写组. 《中国卒中中心报告2022》概要[J]. 中国脑血管病杂志，2024，21（8）：565-576.
Report on Stroke Center in China Writing Group. Brief report on stroke center in China，2022[J]. Chin J Cerebrovasc Dis，2024，21（8）：565-576.
[7] The OPTIMAL-BP Randomized Clinical Trial. Intensive vs. conventional blood pressure lowering after endovascular thrombectomy in acute ischemic stroke[J]. JAMA，2023，330（9）：832-842.
[8] KUMAR SAINI S，SINGH D. Mitochondrial mechanisms in cerebral ischemia-reperfusion injury：unravelling the intricacies[J/OL]. Mitochondrion，2024，77：101883[2025-02-23]. https://doi.org/10.1016/j.mito.2024.101883.
[9] SONG H Y，JIN S，LEE S，et al. The therapeutic effects of SP-8356，a verbenone derivative，with multimodal cytoprotective mechanisms in an ischemic stroke rat model[J/OL]. Int J Mol Sci，2024，25（23）：12769[2025-02-23]. https://doi.org/10.3390/ijms252312769.
[10] YANG G Y，BETZ A L. Reperfusion-induced injury to the blood-brain barrier after middle cerebral artery occlusion in rats[J]. Stroke，1994，25（8）：1658-1664.
[11] MALHOTRA K，AHMED N，FILIPPATOU A，et al. Association of elevated blood pressure levels with outcomes in acute ischemic stroke patients treated with intravenous thrombolysis：a systematic review and meta-analysis[J]. J Stroke，2019，21（1）：78-90.
[12] LI G，LIN Y P，YANG J，et al. Intensive ambulance-delivered blood-pressure reduction in hyperacute stroke[J]. N Engl J Med，2024，390（20）：1862-1872.
[13] 张谦，冀瑞俊，赵萌，等. 中国脑血管病临床管理指南（第2版）（节选）——第5章脑出血临床管理[J]. 中国卒中杂志，2023，18（9）：1014-1023.
ZHANG Q，JI R J，ZHAO M，et al. Chinese stroke association guidelines for clinical management of cerebrovascular diseases（second edition）（excerpt）—chapter five clinical management of intracerebral hemorrhage[J]. Chin J Stroke，2023，18（9）：1014-1023.
[14] SANDSET E C，ANDERSON C S，BATH P M，et al. European Stroke Organisation（ESO）guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage[J]. Eur Stroke J，2021，6（2）：48-89.
[15] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e440-e441[2025-02-23]. https://doi.org/10.1161/STR.0000000000000215.
[16] SARWAL A，ROBBA C，VENEGAS C，et al. Are we ready for clinical therapy based on cerebral autoregulation？A pro-con debate[J]. Neurocrit Care，2023，39（2）：269-283.
[17] KOSTOGLOU K，BELLO-ROBLES F，BRASSARD P，et al. Time-domain methods for quantifying dynamic cerebral blood flow autoregulation：review and recommendations. A white paper from the cerebrovascular research network（CARNet）[J]. J Cereb Blood Flow Metab，2024，44（9）：1480-1514.
[18] KUMARI S，DHAPOLA R，SHARMA P，et al. The impact of cytokines in neuroinflammation-mediated stroke[J/OL]. Cytokine Growth Factor Rev，2024，78：105-119[2025-02-23]. https://doi.org/10.1016/j.cytogfr.2024.06.002.
[19] HOLME N L A，ZILAKOS I，ELSTAD M，et al. Cerebral blood flow response to cardiorespiratory oscillations in healthy humans[J/OL]. Auton Neurosci，2023，245：103069[2025-02-23]. https://doi.org/10.1016/j.autneu.2022.103069.
[20] MANKOO A，ROY S，DAVIES A，et al. The role of the autonomic nervous system in cerebral blood flow regulation in stroke：a review[J/OL]. Auton Neurosci，2023，246：103082[2025-02-23]. https://doi.org/10.1016/j.autneu.2023.103082.
[21] VAN DEN DOOL R E C，SPERNA WEILAND N H，SCHENK J，et al. Dynamic cerebral autoregulation during step-wise increases in blood pressure during anaesthesia[J]. Eur J Anaesthesiol，2023，40（6）：407-417.
[22] XIONG L，CHEN X Y，LIU J，et al. Cerebral augmentation effect induced by external counterpulsation is not related to impaired dynamic cerebral autoregulation in ischemic stroke[J/OL]. Front Neurol，2022，13：784836[2025-02-23]. https://doi.org/10.3389/fneur.2022.784836.
[23] SHEN Y X，ZHOU Y X，XIONG J，et al. Association between cerebral autoregulation and long-term outcome in patients with acute ischemic stroke[J]. Neurologist，2022，27（6）：319-323.
[24] RAN L，WANG P P，CHEN H X，et al. Compromised dynamic cerebral autoregulation is a hemodynamic marker for predicting poor prognosis even with good recanalization after endovascular thrombectomy[J]. Brain Circ，2024，10（1）：77-84.
[25] GUO Z N，QU Y，SHEN Z D，et al. Cerebral autoregulation：a reliable predictor of prognosis in patients receiving intravenous thrombolysis[J/OL]. CNS Neurosci Ther，2024，30（5）：e14748[2025-02-23]. https://doi.org/10.1111/cns.14748.
[26] SHERIFF F G，AHMAD A，INAM M E，et al. A systematic review on the assessment of cerebral autoregulation in patients with large vessel occlusion[J/OL]. Front Neurol，2023，14：1287873[2025-02-23]. https://doi.org/10.3389/fneur.2023.1287873.
[27] SAVER J L，STARKMAN S，ECKSTEIN M，et al. Prehospital use of magnesium sulfate as neuroprotection in acute stroke[J]. N Engl J Med，2015，372（6）：528-536.
[28] The ENOS Trial Investigators. Efficacy of nitric oxide，with or without continuing antihypertensive treatment，for management of high blood pressure in acute stroke（ENOS）：a partial-factorial randomised controlled trial[J]. Lancet，2015，385（9968）：617-628.
[29] WOODHOUSE L J，APPLETON J P，ANKOLEKAR S，et al. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke（RIGHT-2）：effects on outcomes at day 365 in a randomised，sham-controlled，blinded，phase Ⅲ，superiority ambulance-based trial[J/OL]. BMJ Neurol Open，2023，5（1）：e000424[2025-02-23]. https://doi.org/10.1136/bmjno-2023-000424.
[30] VAN DEN BERG S A，UNIKEN VENEMA S M，REININK H，et al. Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke（MR ASAP）：an ambulance-based，multicentre，randomised，open-label，blinded endpoint，phase 3 trial[J]. Lancet Neurol，2022，21（11）：971-981.
[31] JORDAN J D，POWERS W J. Cerebral autoregulation and acute ischemic stroke[J]. Am J Hypertens，2012，25（9）：946-950.
[32] WAHLGREN N，AHMED N，DÁVALOS A，et al. Thrombolysis with alteplase 3-4.5 h after acute ischaemic stroke（SITS-ISTR）：an observational study[J]. Lancet，2008，372（9646）：1303-1309.
[33] The IST-3 Collaborative Group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke[the third international stroke trial（IST-3）]：a randomised controlled trial[J]. Lancet，2012，379（9834）：2352-2363.
[34] BERGE E，COHEN G，LINDLEY R I，et al. Effects of blood pressure and blood pressure-lowering treatment during the first 24 hours among patients in the third international stroke trial of thrombolytic treatment for acute ischemic stroke[J]. Stroke，2015，46（12）：3362-3369.
[35] ZHOU Z E，XIA C，MAIR G，et al. Thrombolysis outcomes according to arterial characteristics of acute ischemic stroke by alteplase dose and blood pressure target[J]. Int J Stroke，2022，17（5）：566-575.
[36] MULDER M J H L，ERGEZEN S，LINGSMA H F，et al. Baseline blood pressure effect on the benefit and safety of intra-arterial treatment in MR CLEAN（multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in the Netherlands）[J]. Stroke，2017，48（7）：1869-1876.
[37] XU H F，SUN D P，SONG L G，et al. Association of baseline blood pressure and outcomes in etiology subtypes of large vessel occlusion stroke：data from ANGEL-ACT registry[J/OL]. J Neuroradiol，2024，51（5）：101213[2025-02-23]. https://doi.org/10.1016/j.neurad.2024.101213.
[38] MISTRY E A，DAKAY K，PETERSEN N H，et al. Pre-endovascular therapy change in blood pressure is associated with outcomes in patients with stroke[J]. J Neurol Neurosurg Psychiatry，2020，91（4）：438-439.
[39] CHEN M，MEIS J，POTRECK A，et al. Effect of individualized versus standardized blood pressure management during endovascular stroke treatment on clinical outcome：a randomized clinical trial[J]. Stroke，2023，54（11）：2755-2765.
[40] MAZIGHI M，RICHARD S，LAPERGUE B，et al. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke（BP-TARGET）：a multicentre，open-label，randomised controlled trial[J]. Lancet Neurol，2021，20（4）：265-274.
[41] YANG P F，SONG L L，ZHANG Y W，et al. Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke（ENCHANTED2/MT）：a multicentre，open-label，blinded-endpoint，randomised controlled trial[J]. Lancet，2022，400（10363）：1585-1596.
[42] MISTRY E A，HART K W，DAVIS L T，et al. Blood pressure management after endovascular therapy for acute ischemic stroke[J]. JAMA，2023，330（9）：821-831.
[43] GHARAIBEH K，ALADAMAT N，MIERZWA A T，et al. Blood pressure after successful endovascular therapy：a systematic review and meta‐analysis of randomized control trials[J]. Ann Neurol，2024，95（5）：858-865.
[44] LEONARDI-BEE J，BATH P M W，PHILLIPS S J，et al. Blood pressure and clinical outcomes in the international stroke trial[J]. Stroke，2002，33（5）：1315-1320.
[45] WOHLFAHRT P，KRAJCOVIECHOVA A，JOZIFOVA M，et al. Low blood pressure during the acute period of ischemic stroke is associated with decreased survival[J]. J Hypertens，2015，33（2）：339-345.
[46] RORDORF G，CRAMER S C，EFIRD J T，et al. Pharmacological elevation of blood pressure in acute stroke：clinical effects and safety[J]. Stroke，1997，28（11）：2133-2138.
[47] RORDORF G，KOROSHETZ W J，EZZEDDINE M A，et al. A pilot study of drug-induced hypertension for treatment of acute stroke[J]. Neurology，2001，56（9）：1210-1213.
[48] HILLIS A E，ULATOWSKI J A，BARKER P B，et al. A pilot randomized trial of induced blood pressure elevation：effects on function and focal perfusion in acute and subacute stroke[J]. Cerebrovasc Dis，2003，16（3）：236-246.
[49] KANG M J，YANG J W，LEE Y B，et al. The role of phenylephrine in patients with small deep subcortical infarct and progressive weakness[J/OL]. J Neurol Sci，2017，377：107-111[2025-02-23]. https://doi.org/10.1016/j.jns.2017.04.008.
[50] BANG O Y，CHUNG J W，KIM S K，et al. Therapeutic-induced hypertension in patients with noncardioembolic acute stroke[J/OL]. Neurology，2019，93（21）：e1955-e1963[2025-02-23]. https://doi.org/10.1212/WNL.0000000000008520.
[51] KAMIENIARZ-MĘDRYGAŁ M，KAŹMIERSKI R. Ambiguities in blood pressure management in acute ischaemic stroke[J]. Neurol Neurochir Pol，2022，56（2）：131-140.
[52] SUNIL S，JIANG J，SHAH S，et al. Neurovascular coupling is preserved in chronic stroke recovery after targeted photothrombosis[J/OL]. Neuroimage Clin，2023，38：103377[2025-02-23]. https://doi.org/10.1016/j.nicl.2023.103377.
[53] CHRISTENSON J，HILL M D，SWARTZ R H，et al. Efficacy and safety of intravenous nerinetide initiated by paramedics in the field for acute cerebral ischaemia within 3 h of symptom onset（FRONTIER）：a phase 2，multicentre，randomised，double-blind，placebo-controlled study[J]. Lancet，2025，405（10478）：571-582.
[54] AKAY E M Z，HILBERT A，CARLISLE B G，et al. Artificial intelligence for clinical decision support in acute ischemic stroke：a systematic review[J]. Stroke，2023，54（6）：1505-1516.
[55] BONKHOFF A K，GREFKES C. Precision medicine in stroke：towards personalized outcome predictions using artificial intelligence[J]. Brain，2022，145（2）：457-475.
[56] WARDLAW J M，MAIR G，VON KUMMER R，et al. Accuracy of automated computer-aided diagnosis for stroke imaging：a critical evaluation of current evidence[J]. Stroke，2022，53（7）：2393-2403.
[57] AL-JANABI O M，EL REFAEI A，ELGAZZAR T，et al. Current stroke solutions using artificial intelligence：a review of the literature[J/OL]. Brain Sci，2024，14（12）：1182[2025-02-23]. https://doi.org/10.3390/brainsci14121182.

Research Progress on Ultra-Early Blood Pressure Management in Acute Ischemic Stroke

急性缺血性卒中超早期血压管理研究进展

PDF

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

[1]	CHEN Chen, LIU Feifeng, XIONG Xinli, TANG Yueyu, LI Gang. Challenges and Breakthroughs in Prehospital Emergency Care and Blood Pressure Management for Stroke: Current Status and Future Directions [J]. Chinese Journal of Stroke, 2025, 20(7): 797-801.
[2]	YANG Ruotong, CHEN Chen, LIU Feifeng, LI Gang. Research Advances in Blood Pressure Management during the Hyperacute Phase of Intracerebral Hemorrhage [J]. Chinese Journal of Stroke, 2025, 20(7): 819-828.
[3]	HU Yanqin, WANG Shuo, ZHAO Taoli, GUO Dongxing, LI Shen, JIN Zhenbo. Meta-Analysis of the Efficacy and Safety of Butylphthalide Sequential Treatment in Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(6): 753-761.
[4]	DONG Yi, DONG Qiang. Thrombolytic Therapy in Chinese Stroke Clinical Research: Achievements over the Past Two Decades and Future Directions [J]. Chinese Journal of Stroke, 2025, 20(5): 549-554.
[5]	JIANG Lan, FU Xinmin, SUN Mengfei, LI Yiping. Risk Factors Analysis and Prediction Model Development for Poor Prognosis after Endovascular Treatment of Middle Cerebral Artery Occlusive Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(4): 418-427.
[6]	NI Dianli, CHEN Xiaobing, ZHANG Guanghui, PENG Qingrong. Construction and Evaluation of Pre-Hospital Delay Risk Prediction Model for Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(4): 428-434.
[7]	ZHANG Xinyue, CHANG Hong, ZHAO Jie, LI Peipei, LIU Mengrao, LI Suai. Correlation between Cognitive Load and Physiological Indicators in Motor Imagery Training in Patients with Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(4): 435-446.
[8]	WANG Yan, HAO Huaiyu, LU Qiang, ZHANG Lei, SHEN Xueyan, WEI Guimei. Effects of the Ratio of Extracellular Water to Total Body Water on Discharge Outcomes in Patients with Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(4): 457-461.
[9]	HU Yanqin, ZHAO Taoli, LI Shen, GUO Dongxing, ZHAO Zhigang. Meta-Analysis of the Efficacy and Safety of Intravenous Ginkgo Biloba Leaf Preparation in the Treatment of Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(4): 462-469.
[10]	CHI Qi, ZHAO Ying, HAN Dongqian, ZHANG Siqi, DU Peijie, DONG Wanyue, XU Anding, YANG Zhenguo, MENG Heng. Research Progress in Assessing the Onset Time of Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(4): 493-499.
[11]	GUO Yuanli, GAO Renke, YANG Caixia, FAN Wenfeng, GUO Li’na, DONG Xiaofang, LYU Peihua, GAO Huanhuan, MA Keke. Development and Reliability and Validity Testing of the Intravenous Thrombolysis Intention Scale for Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(4): 511-518.
[12]	ZHONG Liling, XU Dihao, SONG Jianxun, LIN Guohui, FU Nianxia. HR-VWI Analysis of Vertebrobasilar Artery Geometric Shapes and Basilar Artery Plaques in Patients with Symptomatic Acute Ischemic Stroke in the Posterior Circulation [J]. Chinese Journal of Stroke, 2025, 20(3): 333-340.
[13]	XU Lu, DONG Yi, DONG Qiang. Research Progress and Prospect of Tenecteplase in the Treatment of Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2025, 20(1): 20-25.
[14]	WANG Xiaorui, LUO Song, ZOU Liangyu, QU Hongdang, CUI Xue, ZHAO Yujie. Value of Eosinophil-to-Monocyte Ratio in Predicting the Prognosis of Patients with Acute Ischemic Stroke Receiving Intravenous Thrombolysis [J]. Chinese Journal of Stroke, 2024, 19(9): 1025-1033.
[15]	ABULANIYAZI Anaguli, WU Xiaoxin, LI Jiaoxing, LI Zhuhao, SHENG Wenli. Research Progress on Factors Related to the Susceptibility Vessel Sign and its Clinical Application in Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2024, 19(9): 1077-1085.