Table of Content

20 January 2025, Volume 20 Issue 1

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Highlights in Stroke in 2024

XIONG Yunyun, LI Guangshuo, MA Yujie, LI Zhixin, SHEN Kejia, MA Ying, SUN Dapeng, SUN Yiyang, WANG Yongjun

2025, 20(1):  1-19.  DOI: 10.3969/j.issn.1673-5765.2025.01.001

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In 2024, significant advancements were made in clinical research on cerebrovascular diseases. Stroke researchers worldwide have actively contributed their expertise, and further refined the diagnosis, treatment, and management strategies for cerebrovascular diseases. Exciting breakthroughs have been made in the field of hemorrhagic stroke, including the treatment of subdural hematoma and primary intracerebral hemorrhage. At the same time, as a research hotspot in recent years, ischemic stroke has seen a continuous emergence of high-quality research results in various aspects such as intravenous thrombolysis, arterial thrombectomy, and secondary prevention, providing more robust evidence for clinical diagnosis and treatment. This article aims to summarize and interpret the key clinical research findings in the field of cerebrovascular diseases in 2024, providing readers with a better understanding of the current research hotspots and deeply understand their significance.

Research Progress and Prospect of Tenecteplase in the Treatment of Acute Ischemic Stroke

XU Lu, DONG Yi, DONG Qiang

2025, 20(1):  20-25.  DOI: 10.3969/j.issn.1673-5765.2025.01.002

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This paper summarizes the clinical research results of tenecteplase in the treatment of acute ischemic stroke and looks forward to the broader clinical application and demand of tenecteplase. The current study has confirmed the strength of tenecteplase as a replacement for alteplase in intravenous thrombolysis within 4.5 hours of the onset of ischemic stroke. Although there is insufficient evidence-based medical evidence on the efficacy and safety of tenecteplase in the special population of acute ischemic stroke and treatment beyond the reperfusion time window, many related studies have been conducted to date. Some ongoing research will provide more evidence for the treatment of these patients.

Possibility of Early Use of Aspirin after Spontaneous Intracerebral Hemorrhage Surgery: The First High-Level Evidence-Based Evidence for Perioperative Management of Intracerebral Hemorrhage from Chinese Scholars

ZHOU Hang, CHEN Gao

2025, 20(1):  26-28.  DOI: 10.3969/j.issn.1673-5765.2025.01.003

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Spontaneous intracerebral hemorrhage is one of the important diseases causing death and disability worldwide. Although surgical treatment has become increasingly mature, the corresponding postoperative management strategies remain poorly defined. In this context, patients who survive after intracerebral hemorrhage surgery have a significantly increased risk of major cardiovascular, cerebrovascular, and peripheral vascular events. However, current guidelines have not yet established clear recommendations on whether or when to initiate antiplatelet therapy. The recently published early-start antiplatelet treatment after neurosurgery in patients with spontaneous intracerebral hemorrhage (E-start) study indicates that for intracerebral hemorrhage patients with a high risk of ischemic events, early initiation of postoperative antiplatelet therapy can bring significant benefits without increasing the risk of bleeding. As the first high-level evidence-based evidence on perioperative management of intracerebral hemorrhage in China, the E-start study is instrumental in improving the treatment and management standards for intracerebral hemorrhage and enhancing patient outcomes.

Implementing the Concept of Digital Intelligent Health Management to Enhance the Quality and Efficiency of Stroke Patient Management in China

LI Xingming, SONG Xifang, WU Jian, QIU Yue, YANG Yutong, GUO Junjun, GAO Yurun, ZHOU Lihan

2025, 20(1):  29-39.  DOI: 10.3969/j.issn.1673-5765.2025.01.004

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The prevalence and mortality of stroke continue to rise and have become the primary cause of death and disability among residents in China. Despite advances in emergency care and monitoring technology have improved patient survival rates, the long-term management outcomes and quality of life for stroke patients still need improvement. Currently, with the rapid development of information technology and mobile internet, digital intelligent health technology has begun to play a significant role in stroke management, providing patients with more efficient and real-time medical services and showing good cost-effectiveness. This paper analyzes the application progress and existing problems of digital intelligent health management for stroke patients from dimensions such as digital intelligent early diagnosis system, digital intelligent health intervention system, digital intelligent rehabilitation training assistance system, and digital intelligent follow-up management system. Suggestions for improvement and future development directions are proposed, hoping to optimize the stroke health management system through informatization construction to enhance service quality and management outcomes.



Digital Intelligent Monitoring and Diagnosis of Cerebrovascular Diseases

WU Jian

2025, 20(1):  40-40. 

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Digital Intelligence Empowering the Monitoring and Prevention of Cardio-Cerebrovascular Disease Risk Factors: Current Status and Prospect

LIU Liqiang, LI Guangyao, JI Xunming

2025, 20(1):  41-47.  DOI: 10.3969/j.issn.1673-5765.2025.01.005

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With the rise of wearable devices, artificial intelligence, big data, and other techniques, the management of chronic diseases has been continuously evolving towards digital intelligence. In the field of monitoring and preventing of cardio-cerebrovascular diseases risk factors, the role of digital intelligent technology is particularly prominent and important. This paper reviews the application status of digital intelligent technology in monitoring and preventing the risk factors of cardio-cerebrovascular diseases, such as hypertension, diabetes, and unhealthy lifestyles. It also proposes the possible problems and challenges that digital intelligent technology may face in future development, aiming to provide references for the coming application and research of digital intelligent technology in the prevention and treatment of cardio-cerebrovascular diseases.

The Application and Challenges of Digital Health Technology in Primary Prevention of Stroke

XIONG Weiqing, ZHAO Yilin, QIU Yue

2025, 20(1):  48-54.  DOI: 10.3969/j.issn.1673-5765.2025.01.006

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Primary prevention is the most direct and effective means to reduce the incidence of stroke. In recent years, digital health technology has shown great potential in the field of primary prevention for stroke. This paper reviews the current application of digital health technology in stroke risk factor identification, risk assessment and screening, health education, as well as health management and intervention. It also points out the challenges faced by the technology in practical application, including data quality, model generalization ability, integration into clinical practice, and privacy protection. The aim is to provide a reference for effectively utilizing digital health technology to strengthen primary prevention of stroke and optimizing stroke prevention and treatment strategies of stroke in China in the future.

Research Progress on the Application of Wearable Devices in Stroke Risk Prediction and Post-Stroke Management

WU Yating, WEI Chenming, SANG Zhenhua, CHEN Le, LIANG Yifan, WU Jian

2025, 20(1):  55-62.  DOI: 10.3969/j.issn.1673-5765.2025.01.007

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Stroke is one of the leading causes of death and disability worldwide. Traditional monitoring and management approaches can no longer meet the growing health management needs of high-risk groups and patients with stroke. Wearable devices, with their real-time capabilities and portability features, present new solutions for stroke risk prediction and post-stroke management. By integrating with health management platforms and artificial intelligence algorithms, wearable devices can significantly enhance the accuracy of risk assessment, optimize rehabilitation treatment plans, and thus improve the patients’ outcomes. This paper reviews the research progress of wearable devices in stroke risk factor monitoring, risk prediction, personalized rehabilitation, and self-management. In the future, with further technological advancements, wearable devices are expected to provide more precise and efficient support for optimizing stroke prevention and management strategies.



Research Progress of Limb Motor Function Rehabilitation after Cerebrovascular Diseases Based on Brain-Computer Interface

SANG Zhenhua, XUE Siyang, WEI Chenming, WU Jian

2025, 20(1):  63-69.  DOI: 10.3969/j.issn.1673-5765.2025.01.008

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Recently, brain-computer interface (BCI) has attracted significant attention in the field of neurorehabilitation. Commonly used experimental paradigms include motor imagery and steady state visual evoked potential, which have been widely applied in the research of motor disorders rehabilitation. This paper reviews the mechanisms of BCI technology in treating motor disorders after cerebrovascular diseases and the progress of electroencephalography-based BCI application in the rehabilitation of upper and lower limb motor disorders. The results show that BCI technology can help patients actively control external devices and stimulate the remodeling of motor cortex neural pathways, and realize the reconstruction of motor functions. It has great potential in the rehabilitation of cerebrovascular diseases. Despite significant advancements in BCI research, there are still many challenges in real-world applications, especially in signal processing, cross-subject research, and user experience. This paper aims to provide references for future research.



Identification and Diagnosis of Large Vessel Occlusion in Acute Ischemic Stroke Based on ChatGLM

SONG Xiaowei, YIN Wei, LI Jiaqi, WEI Chenming, WANG Yueming, PI Jingtao, CHEN Le, GAO Ceshu, MA Weizhi, WU Jian

2025, 20(1):  70-77.  DOI: 10.3969/j.issn.1673-5765.2025.01.009

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Objective  To explore the feasibility and accuracy of using the large language model ChatGLM for the identification and diagnosis of large vessel occlusion in patients with acute ischemic stroke based on emergency electronic medical record information.
Methods  This study selected patients with acute ischemic stroke that occurred within 24 hours and were consecutively treated at the Emergency Neurology Department of Beijing Tsinghua Changgung Hospital, Tsinghua University, from January 2016 to January 2024. Large vessel occlusion and non-large vessel occlusion were distinguished according to head and neck vascular examinations (CTA/MRA/DSA). Based on the ChatGLM model, the inference processes and diagnosis results were given by using techniques such as prompt function, instruction fine-tuning, and retrieval-augmented generation, and the accuracy, sensitivity, and specificity of different inference processes for determining large vessel occlusion were explored. This was uniformly implemented in Python to represent the model’s inference performance.
Results  A total of 935 patients with acute ischemic stroke were included, including 230 patients with large vessel occlusion. The diagnostic accuracy rates for large vessel occlusion using zero-shot learning, zero-shot learning + chain-of-thought, generative pre-trained transformer+chain-of-thought, few-shot learning, and few-shot learning + chain-of-thought were 36.1%, 52.1%, 73.0%, 72.6%, and 75.1%, respectively.
Conclusions  The large language model ChatGLM demonstrates a certain feasibility in case diagnosis and inference. It can identify and diagnose emergency large vessel occlusion strokes based on electronic medical record texts. The diagnostic accuracy using few-shot learning is significantly higher than zero-shot learning.




A Survey on the Cognition, Attitude, and Functional Requirements of Digital Intelligent Diagnosis and Treatment Among Neurologists of Different Seniority

PI Jingtao, YIN Wei, SONG Xiaowei, WU Haiyan, LIANG Yifan, GAO Ceshu, WEI Chenming, SANG Zhenhua, AN Zhiming, JIANG Yanmin, WU Yating, MU Jingyu, ZHAO Xinyi, CHEN Le, WU Jian

2025, 20(1):  78-86.  DOI: 10.3969/j.issn.1673-5765.2025.01.010

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Objective  To explore the cognition, attitude, and functional requirements of neurologists with different seniority on artificial intelligence (AI) assisted diagnosis and treatment, analyze their main concerns and worries, and provide a basis for the application and promotion of AI technology in neurology.
Methods  A nationwide online questionnaire survey was used to collect the relevant data from 174 neurologists, covering multi-dimensional factors such as professional titles, seniority, and hospital levels. Through quantitative and qualitative analyses, the cognitive level of neurologists on AI technology, the current usage status, functional requirements, and their views on future medical changes were analyzed.
Results  The survey showed that neurologists’ overall cognition of AI technology was limited. 58.62% (102/174) of the neurologists had varying degrees of knowledge in the field of AI, while among the neurologists with senior professional titles, this proportion was only 41.67% (5/12). 40.23% (70/174) of the neurologists had tried to use AI tools, while the proportion of undetermined-level medical students who had tried AI tools was 71.43% (15/21). Neurologists generally hold a positive attitude towards the clinical application prospects of AI, with 89.08% (155/174) of the neurologists recognizing that AI technology would lead to medical reform. Neurologists had the most urgent requirements for the functions of intelligent image interpretation, clinical guideline matching, and medical record generation, with weighted scores of 5.21 points, 4.41 points, and 4.36 points, respectively. The subjects believed that the main barrier for the application of AI tools in medical treatment was the lack of easily accessible and practical AI tools (62.07%, 108/174), while the main risk was the inaccurate judgment of diseases by AI technology (76.44%, 133/174).
Conclusions  To promote the clinical application of AI technology in neurology, efforts should be made in education and training, technology optimization, and policy support, providing customized solutions based on the actual needs of neurologists. The future development of AI should focus on the transparency and practicality of the technology to facilitate the intelligent transformation of the medical model.


Feasibility, Safety, and Efficacy of Cardiopulmonary Fitness Assessment and Moderate to High Intensity Aerobic Training for Patients Recovering from Stroke

XIE Li’na, ZHU Jie, LI Qinying, LIU Chenghong, DEN Panmo, JIA Jie

2025, 20(1):  87-94.  DOI: 10.3969/j.issn.1673-5765.2025.01.011

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Objective  To investigate the feasibility, safety, and efficacy of cardiopulmonary fitness assessment and moderate to high intensity aerobic training for patients recovering from stroke.
Methods  Patients in the recovery phase of stroke (1 month≤duration≤12 months) who were admitted to the Department of Rehabilitation Medicine, Jing’an Branch of Huashan Hospital, Fudan University from December 2022 to September 2023, were consecutively included for cardiopulmonary exercise testing. Patients who completed the cardiopulmonary exercise testing were randomly divided into the control group and the intervention group. Both groups received conventional rehabilitation therapy (3 hours/day, 5 days/week for 4 weeks). At the same time, the intervention group was added with the moderate to high intensity aerobic training (40 minutes/time, 5 times/week) according to the cardiopulmonary fitness results in accordance with the exercise prescription, and the control group was added with the rehabilitation guidance (rehabilitation education, flexibility training, etc.) for the same duration. The daily living ability indicators [modified Barthel index (mBI)], motor function indicators [Fugl-Meyer assessment scale (FMA)], and balance function indicators[Berg balance scale (BBS)] between the two groups of patients before the experiment and four weeks after the experiment were compared. The peak oxygen uptake (VO2peak) and peak work rate of the two groups were evaluated separately through cardiopulmonary exercise testing. At the same time, the incidence of adverse reactions and compliance of the two groups were compared.
Results  In this study, 68 patients recovering from stroke were included. Among them, 13 cases (19.12%) did not complete the cardiopulmonary exercise testing, 5 cases (7.35%) experienced adverse reactions such as lower extremity pain, myocardial ischemia, hypertension, and arrhythmia during the evaluation, and 6 cases (8.82%) refused the follow-up trial. Finally, 44 cases (64.7%) who completed the cardiopulmonary exercise testing were randomly divided into the intervention group and the control group, with 22 cases in each group. Among them, 3 cases (13.64%) in the intervention group and 2 cases (9.09%) in the control group withdrew from the training due to adverse reactions such as lower extremity pain, palpitation, and dizziness during the treatment. No recurrence of cardiovascular and cerebrovascular events, sudden death and other serious adverse events related to this study occurred in both groups. The attendance rate for all patients was 86.25% (759/880), with the intervention group at 88.41% (389/440) and the control group at 84.09% (370/440). Before the rehabilitation treatment, there were no statistical differences between the two groups in FMA (upper limb/lower limb), BBS, mBI, VO2peak, and peak work rate. After the rehabilitation treatment, the intervention group showed a significant improvement in ΔFMAlower limb[3.86 (2.00-5.25) points vs. 2.27 (1.00-3.25) points, P=0.016], ΔmBI[15.23 (5.00-25.00) points vs. 9.36 (5.00-11.25) points, P=0.025], ΔVO2peak[(3.78±3.49)mL/(kg·min) vs. (1.15±2.10) mL/(kg·min), P=0.004], and Δpeak work rate [(15.68±10.50) W vs. (7.05±10.20) W, P=0.008] compared to the control group. In addition, indicators for both groups like FMAupper limb (P<0.001), FMAlower limb (P<0.001), BBS (P<0.001), mBI (P<0.001), VO2peak (P<0.001), and peak work rate (P=0.006) were significantly improved compared with those before treatment.
Conclusions  Conducting cardiopulmonary exercise testing and aerobic training for patients recovering from stroke is safe and feasible. Compared to conventional rehabilitation treatment, engaging in moderate to high intensity aerobic training can achieve greater benefits in terms of motor function and cardiopulmonary function of patients.




Analysis of the Trend in the Burden of Ischemic Stroke Attributable to High BMI in China and Globally from 1990 to 2021

LIU Qiankun, LI Pengyao, MA Li, DAI Jingjiao, XU Yang, PANG Jiaxue, HUANG Juju, XIE Hui

2025, 20(1):  95-103.  DOI: 10.3969/j.issn.1673-5765.2025.01.012

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Objective  To analyze the current status and trend of the burden of ischemic stroke attributable to high BMI in China and globally from 1990 to 2021.
Methods  Based on the 2021 global burden of disease database, data on disability-adjusted life years (DALYs) and deaths related to ischemic stroke attributable to high BMI were extracted. This paper described the total number of DALYs and deaths due to strokes caused by high BMI in China in 2021, and the age-standardized mortality rate, as well as the trend changes from 1990 to 2021. The Joinpoint regression model was used to calculate the average annual percent change in standardized DALY rate and mortality in China and globally from 1990 to 2021. 
Results  From 1990 to 2021, the number of deaths due to ischemic stroke attributable to high BMI in China increased from 7171 to 44 263, and the DALYs increased from 211 600 person-years to 1 188 200 person-years, which increased by 5.17 times and 4.61 times, respectively. Globally, the corresponding increases were 0.95 times and 1.08 times. The annual percent change for China’s age-standardized mortality rate and age-standardized disability-adjusted life years was 2.67% and 2.69%, respectively, showing a significant upward trend.
Conclusions  Since 1990, the burden of ischemic stroke attributable to high BMI in China has significantly increased, indicating the growing public health pressure caused by high BMI. In contrast, global indicators have remained relatively stable.




Effects of Methyltransferase 3 on Gene Expression, Proliferation, and Migration Functions of Human Brain Vascular Smooth Muscle Cells

MENG Chenxi, SUN Hongying, ZHANG Jia, MAO Jian, YANG Yang, Celemuge

2025, 20(1):  104-111.  DOI: 10.3969/j.issn.1673-5765.2025.01.013

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Objective  To investigate the effects of methyltransferase 3 (METTL3) on gene expression, proliferation, and migration functions of human brain vascular smooth muscle cells (HBVSMC). 
Methods  The transfected HBVSMC were divided into three groups: the blank group (virus-free), the control group (empty vector), and the interference group (METTL3-shRNA) by using small interfering RNA (shRNA) interference technology and adenovirus packaging method. The mRNA expression levels of cerebral small vessel disease-related genes including zinc finger protein 395 (ZNF395), zinc finger protein 548 (ZNF548), DIS3-like exosome 3’-5’ exonuclease (DIS3L), interleukin enhancer binding factor 3 (ILF3) and G protein-coupled receptor 107 (GPR107) were detected by real-time reverse transcriptional PCR (RT-qPCR). Methylated RNA immunoprecipitation (MeRIP) was used to detect the N6-methyladenosine (m6A) modification levels of the mRNA for the genes above. The proliferation and migration abilities of HBVSMC were detected by cell counting kit 8 (CCK8) and Transwell chamber assay. 
Results  Compared with the blank group, there was no significant change in the relative mRNA expression levels of each gene in the control group. Compared with the control group, the relative mRNA expression levels of ZNF395 (P=0.02), ZNF548 (P=0.03), DIS3L (P=0.02) and GPR107 (P＜0.01) as well as the m6A modification levels of ZNF395 (P＜0.01) and ZNF548 (P＜0.01) were decreased in the interference group. Compared with the control group, the proliferation and migration abilities of HBVSMC in the interference group were significantly enhanced. 
Conclusions  Interfering with METTL3 expression may promote the proliferation and migration abilities of HBVSMC by down-regulating the m6A modification levels of ZNF395 and ZNF548 mRNA.


Interpretation of the Association Standard of Nursing Practice for Dysphagia in Stroke Patients

CAI Weixin, ZHANG Ran, SUN Weige, SUN Xue

2025, 20(1):  112-118.  DOI: 10.3969/j.issn.1673-5765.2025.01.014

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In December 2023, the Chinese Research Hospital Association officially released the association standard of Nursing Practice for Dysphagia in Stroke Patients (T/CRHA 027-2023), setting forth the fundamental requirements of nursing care for dysphagia in stroke patients. The operation of feeding nursing, oral nursing, airway nursing, medication nursing, rehabilitation nursing, psychological nursing, health education, continuous nursing, and complication prevention and treatment were standardized. This paper interprets the core points of the standard to facilitate users to understand, in order to promote the standardized practice of nursing care for dysphagia in stroke patients.

Prevention of Recurrence after Mechanical Thrombectomy for Cardiogenic Embolism Induced by Nonvalvular Atrial Fibrillation: A Report of Three Cases and Literature Review

ZHANG Haibing, XIA Weidong, WANG Fengmiao, LI Wenshuai, LI Qingmin, ZHANG Xinfang, ZHANG Quanzhong

2025, 20(1):  119-125.  DOI: 10.3969/j.issn.1673-5765.2025.01.015

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Ischemic strokes secondary to nonvalvular atrial fibrillation account for 20%-30% of all acute ischemic strokes, and these strokes often have high-load thrombosis, larger cerebrovascular blockages, and poor collateral compensation. Therefore, compared with other types of ischemic strokes, they are characterized by more severe symptoms, worse prognosis, and higher mortality. Patients with such strokes, even if successful revascularization is achieved through thrombectomy, have a high risk of recurrence in the short term after surgery. This article takes three stroke patients with nonvalvular atrial fibrillation as examples to describe the process of stroke recurrence and re-thrombectomy after mechanical thrombectomy. By combining with relevant literature, it analyzes the characteristics of cardiogenic embolism caused by nonvalvular atrial fibrillation and summarizes the preventive measures for the recurrence of patients with such strokes after mechanical thrombectomy.

Research Progress on the Development Status and Countermeasures of Scientific Communication in Stroke Prevention and Treatment

ZHANG Xi, LI Yang, ZHANG Pengqian

2025, 20(1):  126-130.  DOI: 10.3969/j.issn.1673-5765.2025.01.016

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Stroke has become the first cause of death in our country, and it is one of the major diseases threatening our national health. It is necessary and urgent to carry out scientific communication in stroke prevention and treatment. At present, there are some problems such as low public awareness, limited time and energy of medical workers, and the the need for enhancement in the capabilities of scientific communication and the quality of communication content. Enhancing the capabilities of scientific communication personnel for stroke prevention and treatment, innovating communication methods, improving the quality of communication content, implementing strategies based on local conditions, conducting targeted stroke prevention and treatment for different groups, and strengthening information construction are effective countermeasures and suggestions. These research contents and findings contribute to further elevating the level of scientific communication in stroke prevention and treatment, providing a reference for the government, medical workers, and relevant departments in carrying out scientific communication in stroke prevention and treatment.