Cerebral small vessel disease (CSVD) is one of the primary etiological factors underlying vascular cognitive impairment and dementia, characterized by a stealthy onset and progressive pathological course. While structural neuroimaging markers of CSVD play an instrumental role in clinical diagnosis and prognostic prediction, they still exhibit limitations in capturing early microstructural alterations in cognitive impairment and elucidating underlying pathophysiological mechanisms. With advancements in neuroimaging technology, the assessment paradigm for CSVD is undergoing a critical transition from “morphological analysis” to “functional and metabolic quantification”. This article demonstrates the application value of neuroimaging assessment in CSVD-related cognitive impairment across multiple dimensions, including structural neuroimaging evaluation, cerebral perfusion and oxygen metabolism assessment, blood-brain barrier function assessment, and functional brain network analysis.

Objective  To investigate the application value of the disease propensity score (DPS) based on brain structural norms in early risk assessment of cerebral small vessel disease (CSVD), and to analyze the correlations of DPS with imaging scores, vascular risk factors, and cognitive function.
Methods  This was a prospective cross-sectional study. Participants meeting the inclusion and exclusion criteria were consecutively recruited from June 2025 to January 2026 at Beijing Tiantan Hospital, Capital Medical University. Data collected included age, sex, BMI, cognitive function scores, and vascular risk factors. The following imaging markers of CSVD were used in this study: white matter hyperintensity (WMH), further classified into periventricular WMH (PVWMH) and deep WMH (DWMH); enlarged perivascular space (EPVS), further classified into basal ganglia EPVS (BG‑EPVS) and centrum semiovale EPVS (CSO‑EPVS); cerebral microbleed (CMB); lacunes; total CSVD burden score. CSVD was diagnosed according to the standards for reporting vascular changes on neuroimaging (STRIVE), and the total CSVD burden score was assessed. Based on this, participants were divided into the CSVD group (score≥1) and the non-CSVD group (score 0). The DPS based on brain structural norms was collected for all participants. The optimal cutoff value of DPS for identifying CSVD was determined to be 0.55, and participants were accordingly divided into the DPS high-risk group (DPS≥0.55) and the DPS low-risk group (DPS<0.55). Clinical data and imaging scores were compared between the CSVD and non‑CSVD groups, as well as between the DPS high‑risk and low‑risk groups. Correlations of DPS with vascular risk factors, imaging scores, and cognitive function scores were analyzed.
Results  A total of 147 participants were included, including 46 (31.29%) in the CSVD group and 101 (68.71%) in the non‑CSVD group. Compared with the non‑CSVD group, the CSVD group had an older age (P<0.001), higher BMI (P=0.006), a higher proportion of males (P=0.009), and lower MoCA scores (P=0.002). Regarding vascular risk factors, the CSVD group had higher systolic blood pressure (P<0.001), diastolic blood pressure (P<0.001), and proportions of hypertension (P<0.001), hyperlipidemia (P=0.010), and smoking history (P=0.021). All imaging scores were higher in the CSVD group than in the non‑CSVD group (all P<0.001). There were 33 participants (22.45%) in the DPS high‑risk group and 114 (77.55%) in the DPS low‑risk group. No statistically significant difference was found in CSVD positivity rate between the two groups (33.3% vs. 30.7%, P=0.742), and DPS showed no correlation with total CSVD burden score (r=0.105, P=0.205). The DPS high‑risk group had a lower proportion of females (P=0.020), higher BMI(P=0.042) and diastolic blood pressure (P=0.009), and higher proportions of diabetes mellitus (P=0.010) and coronary heart disease (P=0.001). Regarding imaging scores, the DPS high‑risk group had higher PVWMH (P=0.001) and WMH (P=0.013) scores than the DPS low‑risk group, whereas lacunes, DWMH, BG‑EPVS, CSO‑EPVS, CMB, and total CSVD burden scores showed no statistically significant differences. Correlation analysis showed that DPS was significantly correlated with coronary heart disease (r=0.534, P<0.001), diabetes mellitus (r=0.392, P<0.001), hypertension (r=0.190, P=0.021), hyperlipidemia (r=0.164, P=0.047), and PVWMH (r=0.267, P<0.001), but not with other vascular risk factors, imaging scores, total MoCA score or its subitems, smoking history, or drinking history.
Conclusions  DPS is correlated with some vascular risk factors and PVWMH, but its role in assessing overall CSVD imaging burden is limited. Its value as an early risk assessment tool for CSVD requires further investigation.

Objective  To investigate the differences in perfusion and cerebral oxygen metabolism among different subtypes of white matter hyperintensity (WMH) and their surrounding normal-appearing white matter (NAWM) in patients with cerebral small vessel disease (CSVD), and to explore the spatial variation characteristics of these parameters within NAWM.
Methods  Patients with CSVD who visited the First Affiliated Hospital of Chongqing Medical University from October 2023 to June 2025 were consecutively enrolled, and their total CSVD burden scores were calculated. Cranial MRI data of all participants were acquired using a 3.0 T MRI scanner. Cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) were quantitatively measured in periventricular WMH (PWMH), deep WMH (DWMH), periventricular NAWM (PNAWM), and deep NAWM (DNAWM). Matched samples t-tests were used to compare the differences in CBF, OEF, and CMRO2 between different WMH subtypes and their surrounding NAWM. Linear mixed-effects models were applied to analyze the spatial variation characteristics of CBF, OEF, and CMRO2 within NAWM. Partial correlation analyses were performed to evaluate the associations of CBF, OEF, and CMRO2 in different WMH subtypes with the mini-mental state examination (MMSE) and MoCA scores, with adjustment for age, sex, years of education, and total CSVD burden score.
Results A total of 97 patients with CSVD were enrolled, including 54 males (55.7%), with a mean age of (61.6±6.2) years and a mean education duration of (11.2±3.6) years. Compared with PWMH, DWMH exhibited higher CBF, OEF, and CMRO2 (all P<0.001). Compared with PNAWM, DNAWM also exhibited higher CBF, OEF, and CMRO2 (all P<0.001). Linear mixed-effects models demonstrated linear increasing trends in CBF and CMRO2 with increasing distance from WMH in both PNAWM and DNAWM (all P<0.001), with a steeper increasing trend in PNAWM than in DNAWM (all P<0.001). OEF showed an inverted U-shaped nonlinear curve (initially increasing and then decreasing) with increasing distance from WMH in both PNAWM and DNAWM (all P<0.001), and the nonlinear trend was significantly more pronounced in PNAWM than in DNAWM (P<0.001). Additionally, partial correlation analysis showed that OEF in DWMH was positively correlated with both MMSE scores (r=0.215, P=0.045) and MoCA scores (r=0.227, P=0.033).
Conclusions  DWMH, PWMH, and their surrounding NAWM exhibited spatial heterogeneity in perfusion and cerebral oxygen metabolism in patients with CSVD. Different WMH subtypes and their surrounding NAWM exhibited distinct spatial gradient characteristics. The changes were more pronounced in the periventricular region, suggesting that this region is more sensitive to hemodynamic alterations. Notably, OEF in DWMH was significantly correlated with global cognitive function. This finding suggests that the oxygen metabolic status in DWMH may be involved in the pathological processes of cognitive impairment and holds promise as a potential imaging biomarker for predicting cognitive deterioration in patients with CSVD.

Objective  To quantitatively analyze the correlation between white matter hyperintensities (WMH) and postoperative delirium in elderly patients undergoing non-cardiac surgery using an intelligent imaging system.
Methods  Elderly patients scheduled for elective major non-cardiac surgery including thoracic, gastrointestinal, and urological procedures at Renji Hospital, Shanghai Jiao Tong University School of Medicine between September 2020 and September 2024 were enrolled. All patients underwent brain MRI within one week before surgery. Quantitative measurements and analyses of imaging markers of cerebral small vessel disease, including WMH, perivascular spaces, cerebral microbleeds, and lacunes, as well as WMH volumes in different brain regions, were performed using the intelligent imaging system. Patients were divided into a delirium group and a non-delirium group according to the occurrence of postoperative delirium. First, differences in clinical and imaging baseline data between the two groups were compared. Univariate analysis was employed to screen for potential risk factors associated with postoperative delirium, followed by model feature optimization and selection using the least absolute shrinkage and selection operator (LASSO) regression. Subsequently, multivariate logistic regression analysis was conducted to identify independent influencing factors of postoperative delirium and further evaluate their predictive value. 
Results  A total of 175 patients were included in this study, including 19 in the delirium group and 156 in the non-delirium group. The delirium group was older, had greater total and regional WMH volumes, whereas the incidence of drinking history was lower in the delirium group. All the above differences were statistically significant (all P<0.05). At the same time, there were also statistically significant differences in the score distribution of periventricular WMH and deep WMH between the two groups (both P<0.05). Five predictive variables were identified using LASSO regression: history of alcohol consumption, age, lateral ventricular rim WMH volume, juxtacortical WMH volume, and periventricular WMH score. Multivariate logistic regression analysis showed that advanced age (OR 1.288, 95%CI 1.107-1.499, P=0.001) and increased lateral ventricular rim WMH volume (OR 1.440, 95%CI 1.021-2.031, P=0.038) were independent influencing factors for postoperative delirium in elderly patients undergoing non-cardiac surgery. The AUC values of age and lateral ventricular rim WMH volume for predicting postoperative delirium were 0.762 and 0.804, respectively, with optimal cut-off values of 76.5 years and 4.402 cm3.
Conclusions  Advanced age and increased lateral ventricular rim WMH volume are independently associated with postoperative delirium in elderly patients undergoing non-cardiac surgery, and these factors can serve as reference indicators for early prediction of postoperative delirium in elderly patients.

Objective  To investigate the predictive value of white matter hyperintensity (WMH) distribution characteristics, WMH volume, and total cerebral small vessel disease (CSVD) burden score for cognitive impairment in patients with CSVD.
Methods  Patients hospitalized at the Second Affiliated Hospital of Kunming Medical University from January 2020 to December 2024 were enrolled. All patients met the CSVD diagnostic criteria outlined in the Neuroimaging Diagnostic Criteria and Standardized Definition of Terms for Small Vessel Disease in China—Expert Consensus from the Chinese Stroke Association. Based on clinical diagnosis, patients were divided into a cognitive impairment group and a non-cognitive impairment group (control group). All patients with cognitive impairment completed the mini-mental state examination (MMSE). The Dr.Wise® CSVD artificial intelligence assisted assessment system was used to automatically quantify the volumes of periventricular WMH (PWMH) and deep WMH (DWMH), and to calculate the total CSVD burden score. Multivariate binary logistic regression analysis was used to identify independent risk factors for cognitive impairment. The predictive performance of the models was evaluated using ROC curves. Spearman correlation analysis was applied to examine the relationship between each risk factor and MMSE score.
Results  A total of 2691 CSVD patients were enrolled, including 1625 males and 1066 females, with a mean age of (72.7±10.5) years. The control group consisted of 2531 patients, and the cognitive impairment group consisted of 160 patients. Intergroup comparisons showed statistically significant differences in PWMH volume, DWMH volume, modified Fazekas score, and total CSVD burden score between the two groups (all P<0.001). Multivariate binary logistic regression analysis identified that PWMH volume (OR 1.090, 95%CI 1.062-1.118, P<0.001) and total CSVD burden score (OR 1.732, 95%CI 1.340-2.239, P<0.001) were independent risk factors for cognitive impairment. ROC curve analysis showed that the combined model of PWMH volume and total CSVD burden score had the highest predictive performance (AUC 0.745, 95%CI 0.728-0.761, P<0.001), followed by PWMH volume alone (AUC 0.737, 95%CI 0.720-0.754, P<0.001) and total CSVD burden score alone (AUC 0.671, 95%CI 0.653-0.689, P<0.001). Spearman correlation analysis showed that PWMH volume was negatively correlated with MMSE score (rs=−0.408, P=0.009), whereas total CSVD burden score showed no correlation with MMSE score.
Conclusions  The effect of WMH distribution characteristics on cognitive impairment varies in CSVD patients. PWMH volume is an independent risk factor for cognitive impairment, while DWMH volume does not have this characteristic, suggesting that the association between WMH and cognitive function differs across brain regions. Moreover, although the modified Fazekas score, which is widely used in clinical practice, demonstrates statistically significant differences between groups, its predictive efficacy for cognitive impairment in CSVD patients is limited. Conversely, a prediction model constructed by combining PWMH volume with the total CSVD burden score exhibits higher predictive performance, facilitating the early identification of individuals at high risk for cognitive impairment and thereby providing a basis for clinical decision-making regarding early intervention strategies.

Cerebral small vessel disease (CSVD) is a major cause of cognitive impairment in the elderly, and its associated cognitive deficits exhibit marked heterogeneity, which cannot be fully explained by any single neuroimaging marker. The integrity of structural connectivity (SC) and functional connectivity (FC), as well as their coupling, is essential for normal brain function. An increasing body of studies indicates that CSVD-related cognitive impairment is not only associated with structural brain damage but also accompanied by abnormal interactions between SC and FC. With advances in multimodal MRI techniques, multiscale brain SC-FC coupling analyses at the voxel, brain network, and neurovascular levels have progressively revealed alterations in brain network connectivity patterns in patients with CSVD. This review describes the analytical methods of SC, FC, and SC-FC coupling, and summarizes the research progress in multimodal MRI-based brain SC-FC coupling analyses in CSVD-related cognitive impairment.

Objective  To investigate the influences of diabetes duration and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity on the clinical outcomes in patients with acute ischemic stroke or TIA. 
Methods  Patients with acute ischemic stroke or TIA who were consecutively enrolled in the third China national stroke registry (CNSR-Ⅲ) were selected as study subjects. Baseline data including demographic data, medical history, clinical characteristics, laboratory indicators, and imaging data were collected. Diabetes duration at baseline was determined through face-to-face interviews. Patients were divided into three groups: no diabetes, diabetes duration<8 years, and diabetes duration≥8 years, and their baseline blood samples were collected to detect Lp-PLA2 activity. Cox proportional hazards regression and multivariate logistic regression models were used to analyze the effects of diabetes duration and Lp-PLA2 activity on stroke recurrence, all-cause mortality, and poor functional outcome (mRS score of 3-6 points) during the 1-year follow-up period, and to determine whether there was an interaction between the two factors. The survival curves of clinical outcomes were plotted using the Kaplan-Meier method, and the differences between groups were compared using the log-rank test.
Results  A total of 10 398 patients with acute ischemic stroke or TIA from the CNSR-Ⅲ study were included in this study. During the 1-year follow-up period, 1021 (9.82%) patients had recurrent stroke, 348 (3.35%) died from any cause, and 1369 (13.17%) had poor functional outcome. After adjusting for potential confounders, compared with patients with Lp-PLA2 activity≤21.6 nmol·mL-1·min-1, patients with diabetes duration≥8 years and Lp-PLA2 activity≥194.8 nmol·mL-1·min-1 showed a higher risk of 1-year stroke recurrence (HR 1.85, 95%CI 1.17-2.91, P=0.008); patients with Lp-PLA2 activity≥194.8 nmol·mL-1·min-1 showed a higher risk of 1-year all-cause mortality, no matter whether the diabetes duration＜8 years (HR 3.22, 95%CI 1.45-7.18, P=0.004) or≥8 years (HR 2.61, 95%CI 1.16-5.89, P=0.021). Interaction analysis showed no significant interaction between Lp-PLA2 activity and diabetes duration on stroke recurrence, all-cause mortality, or poor functional outcome (P values for interaction were 0.545, 0.132, and 0.769, respectively).
Conclusions   In patients with acute ischemic stroke/TIA, although no significant interaction was observed between diabetes duration and Lp-PLA2 activity, long-standing (≥8 years) diabetes combined with high Lp-PLA2 activity independently increased the risks of stroke recurrence and all-cause mortality.

Objective  To explore predictors of outcomes after intravenous thrombolysis with tenecteplase for acute ischemic stroke based on data from the prospective, multicenter registry study of intravenous TNK for acute ischemic stroke in China (INTACT-China).
Methods  A post-hoc analysis was conducted on patients from the INTACT-China study who had 90-day outcome data and complete baseline clinical information. According to the 90-day mRS score, patients were divided into the good outcome group (mRS score 0-1) and the poor outcome group (mRS score 2-6). Intergroup comparisons and multivariate logistic regression analysis were performed.
Results  A total of 873 patients with acute ischemic stroke were included in this study, with 544 (62.3%) in the good outcome group and 329 (37.7%) in the poor outcome group. Univariate analysis indicated that age, smoking history, drinking history, history of hypertension, history of diabetes mellitus, history of atrial fibrillation, history of stroke, NIHSS score at admission, pre-onset mRS score, time from onset to admission, time from admission to treatment, receipt of endovascular therapy, and TOAST classification were associated with 90-day functional outcomes. Multivariate logistic regression analysis suggested that the NIHSS score at admission (OR 0.858, 95%CI 0.825-0.893, P<0.001), pre-onset mRS score (OR 0.427, 95%CI 0.258-0.705, P<0.001), and small artery occlusion stroke (OR 3.339, 95%CI 1.593-7.000, P<0.001) were independent predictors of outcomes after intravenous thrombolysis with tenecteplase in acute ischemic stroke.
Conclusions   Lower NIHSS score at admission, lower pre-onset mRS score, and small artery occlusion stroke are independent predictors of the 90-day good functional outcome after intravenous thrombolysis with tenecteplase in patients with acute ischemic stroke. The proportion of patients achieving good functional outcome decreases with increasing stroke severity.

Objective  To investigate the causal association between gut microbiota (GM) and ischemic stroke (IS) using a bidirectional two-sample Mendelian randomization (MR) analysis.
Methods  Summary data from the MiBioGen international consortium on genome-wide association studies (GWAS) of the association between GM relative abundance and human autosomal genetic variants (18 340 individuals) were used as the exposure. Two independent GWAS datasets, the FinnGen biobank and a large-scale meta-analysis from European Bioinformatics Institute (EBI), were used as the outcomes. Weighted mode, simple mode, weighted median, inverse variance weighted and MR-Egger regression methods were applied to assess causal associations between GM and IS. Leave-one-out analysis, heterogeneity test, and horizontal pleiotropy test were used to verify the robustness and reliability of the results. Reverse MR analysis was conducted for GM that showed a causal association with IS in the forward MR analysis.
Results  In the two independent cohorts of FinnGen and EBI, the forward MR analysis initially screened 20 GM showing potential causal associations with IS. Among them, Clostridiaceae 1 exhibited a significant protective effect in the EBI cohort (OR 0.84, 95%CI 0.77-0.92, P<0.01), and this association remained significant after false discovery rate correction (P=0.02). Besides, although the results showed no statistically significance after false discovery rate test, Peptococcaceae exhibited a preliminary protective effect in both FinnGen and EBI cohorts. Reverse MR analysis revealed a unidirectional causal association between IS and GM, with no evidence of a reverse causal effect of IS on the GM. Sensitivity analyses, including leave-one-out tests, heterogeneity tests, and horizontal pleiotropy tests, confirmed the robustness of the above results.
Conclusions   This study identified 20 GM taxa associated with IS, and Clostridiaceae 1 was regarded as a protective factor for IS. This association existed only when GM served as the exposure and IS as the outcome.

Objective  This study aimed to explore the predictive value of the neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI) for early neurological deterioration (END) in minor ischemic stroke due to large vessel occlusion (LVO-MIS) patients, evaluate the efficacy and safety of rescue endovascular therapy (REVT), and analyze the predictive performance of perioperative dynamic changes in SIRI (ΔSIRI) for 90-day functional prognosis after REVT.
Methods  A retrospective analysis was conducted on patients diagnosed with LVO-MIS admitted to Hanzhong Central Hospital from January 2020 to January 2025. END was defined as an increase of≥2 points in the total NIHSS score or an increase of≥1 point in the motor subscore within 72 hours after onset compared with baseline. Patients were divided into the END group and the non-END group according to this criterion. All LVO-MIS patients with END were assigned to treatment groups based on the therapy they received: those who underwent REVT were classified into the REVT group, and those who received medical therapy alone were classified into the best medical therapy group. Multivariate logistic regression analysis was used to identify independent risk factors for END in LVO-MIS patients. The 90-day functional prognosis (favorable prognosis defined as 90-day mRS score of 0-2) was compared between END patients in the REVT group and the best medical management group. Routine blood indexes before operation and at 24 hours after REVT were detected to calculate NLR (NLR1 was defined as the preoperative NLR level), SIRI (SIRI1 was defined as the preoperative SIRI level) and their dynamic changes (ΔNLR, ΔSIRI). ROC curve and decision curve analysis were adopted to evaluate the predictive performance and clinical net benefit of the above indicators.
Results  A total of 291 LVO-MIS patients were enrolled, including 148 cases (50.9%) in the END group and 143 cases (49.1%) in the non-END group. Multivariate logistic regression analysis showed that diabetes mellitus (OR 2.086, 95%CI 1.184-3.675, P=0.011), elevated NLR1 (OR 1.046, 95%CI 1.010-1.084, P=0.032), and elevated SIRI1 (OR 1.531, 95%CI 1.137-2.062, P=0.018) were independent risk factors for END in LVO-MIS patients. ROC curve analysis indicated that the AUC of SIRI1 for predicting END was 0.731 (95%CI 0.630-0.833, P=0.028), with superior predictive performance to NLR1 (AUC 0.615, 95%CI 0.508-0.722, P=0.039). The optimal cut-off value of SIRI1 was 1.655, yielding the sensitivity of 63.4% and the specificity of 80.6%. Decision curve analysis demonstrated that the combined model integrating clinical indicators and inflammatory biomarkers presented a higher clinical net benefit. Among END patients, the 90-day favorable functional prognosis rate in the REVT group was significantly higher than that in the best medical management group (55.7% vs. 36.7%, P=0.023). There were no significant differences in the incidence of symptomatic intracranial hemorrhage and mortality between the two groups. Multivariate logistic regression analysis revealed that poor collateral circulation (OR 1.458, 95%CI 1.121-1.896, P=0.042) and increased ΔSIRI (OR 2.442, 95%CI 1.302-4.582, P=0.015) were independent risk factors for poor 90-day functional prognosis after REVT in END patients. ROC curve analysis showed that the AUC of ΔSIRI for predicting poor 90-day functional prognosis was 0.828 (95%CI 0.742-0.914, P=0.008); with ΔSIRI=0.750 as the cut-off value, the sensitivity was 75.0% and the specificity was 89.9%.
Conclusions  The incidence of END is relatively high in LVO-MIS patients. SIRI1 serves as an independent predictor of END and exhibits better predictive performance than NLR1. For LVO-MIS patients complicated with END, REVT can improve 90-day neurological functional prognosis without increasing the risks of symptomatic intracranial hemorrhage and mortality. Perioperative ΔSIRI is an effective indicator for evaluating poor functional prognosis after REVT. These easily accessible inflammatory biomarkers can provide evidence for early warning and the formulation of individualized intervention strategies for high-risk LVO-MIS patients.

Objective  To investigate the risk factors of 6-month prognosis in elderly patients with anterior circulation minor acute ischemic stroke (AIS).  
Methods  Clinical data were prospectively and continuously collected from elderly patients (aged≥60 years) with anterior circulation minor AIS (defined as an admission NIHSS score≤5) hospitalized in the Department of Neurology, Tangshan Gongren Hospital from October 2023 to June 2024. Data included demographic information, medical history, personal history, laboratory test results at admission, admission NIHSS score, time from onset to admission, maximum carotid plaque length, carotid intima-media thickness (cIMT), maximum carotid plaque area, plaque echogenicity, and the mRS score at the 6-month follow-up. Patients were divided into a favorable prognosis group (mRS score 0-2) and an unfavorable prognosis group (mRS score≥3) based on the mRS score at the 6-month follow-up. Clinical data were compared between the two groups. Multivariate logistic regression analysis was performed to identify factors influencing the outcome, and ROC curves were used to evaluate the predictive efficacy of independent risk factors for the 6-month outcome.
Results  A total of 140 patients were included, with 100 in the favorable prognosis group and 40 in the unfavorable prognosis group. Univariate analysis showed that the maximum carotid plaque length [(15.79±8.43) mm vs. (12.02±6.17) mm, P=0.004], cIMT [2.85 (2.33-3.55) mm vs. 2.50 (2.10-3.00) mm, P=0.014], and the maximum carotid plaque area [41.90 (28.77-66.92) mm2 vs. 27.29 (17.46-42.57) mm2, P=0.003] were significantly greater in the unfavorable prognosis group than in the favorable prognosis group. In addition, the admission NIHSS score [5.0 (4.0-5.0) points vs. 3.0 (2.0-4.0) points, P＜0.001] and the incidence of hypoechoic plaque [36/40 (90.0%) vs. 58/100 (58.0%), P＜0.001] were higher in the unfavorable prognosis group than in the favorable prognosis group. Multivariate logistic regression analysis showed that a high admission NIHSS score (OR 3.071, 95%CI 1.947-4.845, P＜0.001), increased cIMT (OR 1.681, 95%CI 1.042-2.711, P=0.033), and the presence of hypoechoic plaque (OR 4.105, 95%CI 1.117-15.088, P=0.033) were independent risk factors for unfavorable prognosis.  
Conclusions  A high admission NIHSS score, hypoechoic plaque on admission carotid color Doppler ultrasonography, and increased cIMT are independent risk factors for unfavorable prognosis at 6 months in elderly patients with anterior circulation minor AIS.

Objective  To screen for risk factors for poor prognosis in patients with ruptured intracranial aneurysms by analyzing their clinical characteristics, and to construct a nomogram prediction model for poor prognosis based on the screening results.
Methods  Patients with ruptured intracranial aneurysms admitted to the Department of Neurosurgery, Chengdu Pidu District People’s Hospital from June 2019 to June 2024 were enrolled into the training set. They were divided into the good prognosis group (mRS score 0-2) and the poor prognosis group (mRS score 3-6) according to clinical outcomes. Simultaneously, patients with ruptured intracranial aneurysms admitted to the Department of Neurosurgery, the First Affiliated Hospital of Chengdu Medical College were enrolled into the validation set. Univariate and multivariate logistic regression analyses were used to screen for risk factors for poor prognosis, and a nomogram prediction model for poor prognosis in ruptured intracranial aneurysms was constructed based on independent risk factors. The discrimination, calibration, and clinical utility of the model were evaluated using ROC curves, calibration curves, and decision curve analysis (DCA). 
Results  A total of 151 patients with ruptured intracranial aneurysms were included in the training set, consisting of 60 patients with poor prognosis and 91 patients with good prognosis. The validation set included 103 patients, including 41 patients with poor prognosis and 62 patients with good prognosis. Multivariate logistic regression analysis showed that Hunt-Hess grade (OR 3.369, 95%CI 1.687-6.727, P<0.001), intracerebral hematoma volume (OR 1.078, 95%CI 1.035-1.123, P<0.001), fasting blood glucose (OR 1.189, 95%CI 1.019-1.387, P=0.028), and cerebral infarction (OR 7.475, 95%CI 1.438-38.861, P=0.017) were independent risk factors for poor prognosis of ruptured intracranial aneurysms in the training set. The ROC curve of the nomogram prediction model for poor prognosis of ruptured intracranial aneurysms yielded an AUC of 0.867, with a sensitivity of 0.805 and a specificity of 0.855 in the validation set. The calibration curve results showed an average absolute error of 0.019. Decision curve analysis indicated that the net benefit ranged from 0 to 0.27 when the high-risk threshold exceeded 0.17. 
Conclusions  Hunt-Hess grade, intracerebral hematoma volume, fasting blood glucose, and cerebral infarction are independent risk factors for poor prognosis of ruptured intracranial aneurysms. The nomogram prediction model constructed based on the above variables has good predictive performance and clinical application value.

Objective  To explore the effect of the remote intervention program on recurrence risk perception in patients with high-risk non-disabling ischemic cerebrovascular events (HR-NICE).
Methods  Patients with HR-NICE who were hospitalized at the Department of Vascular Neurology, Beijing Tiantan Hospital, Capital Medical University from May to September 2025 were prospectively and consecutively enrolled. They were randomly divided into a control group and an intervention group using the random envelope method. The control group received routine health education, while the intervention group received a remote intervention program on recurrence risk perception in addition to the routine health education. The stroke patient recurrence risk assessment scale scores, social support rating scale scores, and patient communication pattern scale scores at 1 month and 3 months after discharge, as well as the stroke recurrence rate, rate of favorable functional outcome (mRS score 0-1), BMI, glycated hemoglobin, and LDL-C levels at 3 months after discharge were compared between the two groups.
Results  A total of 80 patients with HR-NICE were included, with 40 patients in each group. Ultimately, 76 patients were included in the analysis (37 in the control group and 39 in the intervention group). No statistically significant differences were observed between the intervention group and the control group in the recurrence rate or rate of favorable functional outcome at 3 months after discharge. The scores on the stroke patient recurrence risk assessment scale in the intervention group were higher than those in the control group at 1 month [(47.7±9.9) points vs. (43.1±9.6) points, P＝0.043] and 3 months [(49.0±9.8) points vs. (44.4±9.2) points, P＝0.042] after discharge. The social support rating scale scores in the intervention group were also higher than those in the control group at 1 month [(44.4±10.5) points vs. (38.0±7.9) points, P＝0.004] and 3 months [(48.2±8.8) points vs. (39.0 ± 8.0) points, P<0.001] after discharge. The patient communication pattern scale scores in the intervention group were higher than those in the control group at 3 months after discharge [(58.2±5.6) points vs. (54.4±7.8) points, P＝0.016]. In addition, no statistically significant differences were found in BMI or glycosylated hemoglobin levels between the two groups at 3 months after discharge. However, the LDL-C level in the intervention group at 3 months after discharge was significantly lower than that in the control group [(1.6±0.7) mmol/L vs. (1.9±0.6) mmol/L, P＝0.028].
Conclusions  The remote intervention program on recurrence risk perception can improve the recurrence risk perception, social support, and positivity of doctor-patient communication among patients with HR-NICE. It is beneficial for controlling the blood lipid levels.

Objective  To investigate the correlations of matrix metalloproteinase (MMP) expression profiles and human kallistatin (Kal) levels with the risk of short-term mortality in elderly patients with hypertensive intracerebral hemorrhage (HICH).
Methods  This was a prospective study that consecutively enrolled elderly patients with HICH admitted to Pingdingshan Hospital of Traditional Chinese Medicine and Pingdingshan Second People’s Hospital from January 2023 to December 2024. Patients were divided into a death group and a survival group based on their vital status within 30 days after onset. Clinical characteristics, as well as MMP1, MMP2, MMP3, MMP9, and Kal levels within 24 hours after admission, were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors associated with 30-day mortality in elderly HICH patients, and a logistic regression prediction model was constructed. The predictive efficacy of individual influencing factors and the combined model for 30-day mortality was assessed using ROC curves.
Results  A total of 224 elderly patients with HICH aged 60-78 years were initially enrolled, of whom 11 were lost to follow-up. The final analysis included 213 patients with an average age of (71.9±5.7) years, comprising 136 males and 77 females. Forty-five patients (21.1%) died within 30 days after onset. Compared with the survival group, the death group exhibited older age, higher proportion of diabetes mellitus, higher admission NIHSS score, larger hematoma volume, elevated levels of MMP1, MMP2, MMP3, and MMP9, and longer time from onset to surgery. Meanwhile, the death group presented lower admission GCS and Kal levels, with all intergroup differences statistically significant. Multivariate logistic regression analysis indicated that higher admission NIHSS score (OR 1.127, 95%CI 1.010-1.257, P=0.033), larger hematoma volume (OR 1.060, 95%CI 1.005-1.118, P=0.032), and higher MMP9 level (OR 1.009, 95%CI 1.001-1.017, P=0.029) were independent risk factors for 30-day mortality in elderly HICH patients, whereas higher Kal level (OR 0.973, 95%CI 0.946-0.989, P=0.006) was an independent protective factor. ROC curve analysis showed that the combination of these four factors predicted 30-day mortality with an AUC of 0.827 (95%CI 0.734-0.880, P<0.001), corresponding to a sensitivity of 0.786 and a specificity of 0.805.
Conclusions  Admission NIHSS score, hematoma volume, MMP9 level, and Kal level are independent influencing factors for 30-day mortality in elderly patients with HICH. The combination of these four indicators demonstrates high predictive efficacy for the risk of 30-day mortality.

Acute ischemic stroke due to large vessel occlusion (LVO) is a severe subtype of stroke, and endovascular therapy can significantly improve patient outcomes. Reducing the time from symptom onset to reperfusion is critical for the management of LVO-related ischemic stroke. However, in the conventional in-hospital reperfusion workflow, patients first present to the emergency department and undergo CT or MRI, which may lead to delays in reperfusion therapy. Direct transfer to angiography suite (DTAS) is a novel reperfusion strategy for ischemic stroke that bypasses the emergency department and conventional imaging workflow, enabling patients with suspected LVO to be transferred directly to the angiography suite. There, flat-panel CT or sliding-gantry CT in combination with DSA is used for rapid diagnosis, and eligible patients receive reperfusion therapy, thereby shortening the door-to-reperfusion time. Based on current domestic and international evidence, the Chinese Stroke Association convened an expert panel to develop this guideline, which systematically addresses the definition, infrastructure requirements, clinical workflow, and quality control indicators of DTAS.

Inflammation and coagulation-related blood indicators play an important role in the occurrence and development of cervicocranial artery dissection (CcAD). This article reviews the research progress on the correlation between CcAD and various inflammatory markers, including white blood cells, C-reactive protein, α1-antitrypsin, combined inflammatory indices, cytokines, and chemokines. It also covers coagulation markers such as fibrillin-1 and D-dimer. The interplay between inflammation and coagulation cascade reaction in the pathogenesis of CcAD is elaborated. The potential value of these indicators in acute-phase identification, severity stratification, and prognosis evaluation of CcAD is further explored, aiming to provide a reference for clinical practice.

This article reports the diagnosis and treatment process of a 39-year-old male patient who presented with acute ischemic stroke secondary to hypertrophic cardiomyopathy (HCM) caused by a p.Arg145Gln mutation in the troponin I3, cardiac type (TNNI3) gene. The patient initially manifested with left-sided limb weakness. Vascular recanalization was achieved through intravenous thrombolysis combined with mechanical thrombectomy. Subsequent evaluations confirmed HCM accompanied by atrial flutter and third-degree atrioventricular block. Anticoagulation therapy with rivaroxaban was adopted. During a 10-month follow-up period, no recurrence of stroke was observed. The patient’s younger sister also carries a homozygous mutation at the same locus in the TNNI3 gene, but only mild left atrial enlargement is observed. This case suggests that TNNI3 mutation-related HCM represents a rare etiology of ischemic stroke in young adults. Additionally, sex may be an important factor influencing its clinical phenotype, providing clinical evidence for etiological exploration and individualized management of ischemic stroke in this population.