Table of Content

20 March 2025, Volume 20 Issue 3

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Prevention and Treatment of Stroke in Chinese Communities: Analysis of Current Status, Challenges, and Strategies of Stroke Prevention and Treatment from the Perspective of Integration of Medical Care and Prevention

FAN Yanqin, CAO Liming, REN Lijie

2025, 20(3):  261-268.  DOI: 10.3969/j.issn.1673-5765.2025.03.001

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Stroke has become the leading cause of death and disability among residents in China, characterized by high incidence, disability, mortality, and recurrence rates, placing a heavy burden on families and society. In response to this challenge, the community stroke prevention and treatment model centered on the integration of medical care and prevention has gained increasing attention in recent years. This model emphasizes and promotes the shift of stroke diagnosis and treatment in China from “focusing mainly on treatment” to “equal emphasis on prevention and treatment”. While some progress has been made, the existing prevention and treatment system still has shortcomings in professional training, resource utilization, information construction, and policy support. This paper systematically reviews the current status of community stroke prevention and treatment, refining key issues and optimization strategies from the aspects of human resources, financial investment, material resources, and policies and management, thereby providing a theoretical framework and practical path for advancing the integration of medical care and prevention model.



Community Stroke Prevention and Treatment

REN Lijie

2025, 20(3):  269-269. 

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Optimization and System Construction of Prevention and Treatment Strategies for High-Risk Populations of Stroke under the Background of Integration of Medical Care and Prevention

LIU Zhao, CHEN Minxia, SHEN Dou, CHI Feng, YU Monica, LIU Yuehua, YANG Yansui

2025, 20(3):  270-276.  DOI: 10.3969/j.issn.1673-5765.2025.03.002

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Stroke, as a high-incidence disease, is characterized by its high frequency of occurrence, severe disabling consequences, high risk of death, and heavy economic burden. It has become the “number one killer” threatening the health of residents in China. There is an urgent need to implement prevention and treatment management under the integration of medical care and prevention to address the challenges of the disease, alleviate the burden on patients and society, and improve the health status of the entire population. This paper reviews the strategies and system construction of stroke prevention and treatment in China in recent years. Based on the concept and policy development of the integration of medical care and prevention, it identifies the current issues stroke prevention and treatment such as insufficient coordination, misalignment in financing incentives, and inadequate information sharing. Furthermore, it proposes suggestions for reconstructing organizational management relationships, optimizing financing mechanisms, innovating incentive mechanisms, and strengthening information sharing, aiming to provide references for relevant work.

The Current Status, Challenges, and Strategies for Non-Specialist Doctors in China Regarding the Recognition of Stroke

XIA Runyu, CAO Liming, REN Lijie

2025, 20(3):  277-282.  DOI: 10.3969/j.issn.1673-5765.2025.03.003

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Stroke has become a leading cause of death and disability among Chinese residents, imposing a significant burden on families and society. Therefore, the prevention and treatment of stroke is not only an important medical issue but also has great societal implications. Doctors are the key frontline workers in stroke prevention and treatment, among whom non-specialist doctors play an important role in pre-hospital emergency care, grassroots prevention, and long-term management. The level of understanding of non-specialist doctors directly affects the early identification, standardized referral, and preventive effects of stroke patients, and then plays an important role in the overall treatment quality and prognosis. Currently, the understanding of stroke among non-specialist doctors in China is unclear, and the standardized diagnosis and treatment of stroke face severe challenges. These issues not only affect the decision-making of government and healthcare management authorities but also relate to the policy formulation of stroke prevention and treatment programs. This article reviews the current status, challenges, and strategies of non-specialist doctors in China regarding the recognition of stroke, aiming to provide a basis for subsequent clinical practice and management decisions.

Current Status and Influencing Factors of Emergency Medical Service Utilization Among Patients with Acute Ischemic Stroke in China

HUANG Xuming, CAO Liming, LEI Youzhen, REN Lijie

2025, 20(3):  283-290.  DOI: 10.3969/j.issn.1673-5765.2025.03.004

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Stroke emergency is not only an important medical issue but also a significant social issue. Timely utilization of emergency medical service (EMS) is crucial for improving the prognosis of stroke patients. Although the accessibility of EMS has been improved in China, the utilization rate of EMS is still significantly lower than that in developed countries, and there are deficiencies in the public’s awareness and use of EMS. The factors affecting patients’ adoption of EMS are complex and diverse, including patients’ economic status, awareness of EMS, accessibility and efficiency of EMS, etc. In the future, efforts should be made to enhance public awareness of the importance and advantages of using EMS for transportation to hospitals after the onset of stroke, and to provide corresponding policy support to promote the effective use of EMS. This review aims to explore the current situation and influencing factors of EMS utilization in acute stroke patients in China, providing a basis for formulating and improving medical policies.

Construction and Prospects of Community Stroke Prevention and Treatment Maps

GAN Qingyue, CAO Liming, CHI Feng, REN Lijie

2025, 20(3):  291-297.  DOI: 10.3969/j.issn.1673-5765.2025.03.005

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As the leading cause of adult death and disability in China, stroke has caused a heavy economic burden to society and families. Although the past medical model based on in-hospital treatment has been continuously improved, the incidence of stroke is still on the rise. Therefore, China is actively promoting the transformation of stroke prevention and treatment strategies, constructing a comprehensive prevention and treatment system that attaches equal importance to prevention and intervention and clinical treatment. By strengthening the national health education network, optimizing the screening and management mechanism for high-risk groups centered on community health service centers, and innovating the community stroke prevention and treatment map system, a three-level closed-loop prevention management system has been formed for the stages before the onset, early stage, and middle-late stage. This system has become a key path to reduce the incidence, disability rate, and mortality of stroke and improve the quality of life of patients. This paper focuses on the systematic construction strategy of the community stroke prevention and treatment map system, and deeply analyzes its practical significance, implementation difficulties, and countermeasures, providing a theoretical basis and practical reference for improving the level of community stroke prevention and treatment.

Research Progress on a Community-Based Full Life-Cycle Health Management Model for Stroke

CHANG Danfeng, SHEN Dou, CAO Xin, MA Kefei, YANG Yansui, ZHANG Yuzhe, CHI Feng, LIU Yuehua, GAO Yuexia

2025, 20(3):  298-304.  DOI: 10.3969/j.issn.1673-5765.2025.03.006

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The Stroke Prevention and Control “Million Reduction Disability Project” in China proposes the concept of full life-cycle health management services for stroke, aiming to transform stroke prevention and treatment from the traditional “disease treatment” model to the “health management” model. This paper, based on the unique advantages of communities in stroke prevention and treatment, systematically reviews the service practices, implementation models, and intervention strategies of stroke prevention and treatment in primary communities at home and abroad, aiming to provide scientific evidence and practical references for constructing a full life-cycle health management model for stroke. The community-based full life-cycle health management model for stroke can integrate resources and techniques to form an innovative model in mobilizing community participation, creating a healthy environment, early prevention and screening, rapid response during the acute phase, integrated management during the rehabilitation, dynamic follow-up, and providing psychological and social support. This model not only improves the quality of life for stroke patients but also effectively reduces the burden on families and society.



Study on the Construction of Evaluation Index System for Stroke Prevention and Screening Capacity of Primary Medical and Health Institutions

LIU Chao, CHI Feng, QIN Lifen, LI Yanlei, REN Lijie

2025, 20(3):  305-312.  DOI: 10.3969/j.issn.1673-5765.2025.03.007

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Objective  To construct a scientific and effective evaluation index system for stroke prevention and screening capacity of primary medical and health institutions, serving as guidance and reference for related research.
Methods  Through literature search, group discussion, and literature research, and combined with the expert opinions of the Shenzhen Neurological Disease Medical Prevention Integration Project Group, a preliminary evaluation index system for stroke prevention and screening capacity of primary medical and health institutions was developed. On this basis, experts who have participated in the construction of the Stroke Emergency Map of China or Stroke Prevention Map were invited to be the subjects of the Delphi consultation. Based on the results of the consultation, the coefficients of expert positivity, expert authority, and expert coordination were calculated. After two rounds of consultation and group discussions, the final index system was established.
Results  A total of 22 experts who have participated in the construction of the Stroke Emergency Map of China or Stroke Prevention Map were invited. All questionnaires for the two rounds of expert consultation were returned and valid, with an expert participation rate of 100% for both rounds. The expert authority coefficients were 0.795 and 0.790, respectively. The Kendall’s concordance coefficients of the importance of expert questionnaires were 0.233 (χ2=240.752, P<0.001) and 0.338 (χ2=349.240, P<0.001), respectively. The final index system consisted of 9 primary and 47 secondary indicators.
Conclusions  This study constructed an evaluation index system for stroke prevention and screening capacity of primary medical and health institutions based on stroke prevention and treatment practices and the Delphi method. It has high reliability, comprehensiveness and scientificity. The application effects of the index system in different regions and the weight of the indicators still need to be further validated and studied.


Risk Factors and Prediction Model Construction for Delirium in Patients with Subarachnoid Hemorrhage in the Neurology Intensive Care Unit

WANG Yanxin, YI Xiaoping, LI Man, YUAN Yuan

2025, 20(3):  313-319.  DOI: 10.3969/j.issn.1673-5765.2025.03.008

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Objective  To analyze the risk factors for delirium in patients with subarachnoid hemorrhage (SAH) in the neurology intensive care unit and to construct a risk prediction model. 
Methods  A prospective cohort study design was used to include SAH patients continuously admitted to the neurology intensive care unit of Beijing Tiantan Hospital, Capital Medical University from January 1, 2017, to January 1, 2020. After admission, a unified standard protocol was used to collect demographic information, disease-related data, surgical treatment information, and other data. According to the results of the confusion assessment method for the intensive care unit (CAM-ICU), patients were divided into the delirium group and the non-delirium group. Differences in data between the two groups were compared. The independent risk factors were screened using multivariate logistic regression. A prediction model was constructed based on risk factors, and the diagnostic efficacy of the model was evaluated using the AUC and the Hosmer-Lemeshow (H-L) goodness of fit test. 
Results  A total of 252 SAH patients were included, and 42 (16.7%) experienced delirium. The results of multivariate logistic regression analysis showed that drinking history (OR 4.005, 95%CI 1.538-10.432, P<0.001), coronary artery heart disease history (OR 6.758, 95%CI 2.048-22.301, P<0.001), mechanical ventilation (OR 7.816, 95%CI 2.305-26.500, P<0.001), use of analgesics (OR 2.832, 95%CI 1.093-7.334, P=0.032), use of sedatives (OR 21.896, 95%CI 8.397-57.092, P<0.001), and hypoalbuminemia (OR 3.047, 95%CI 1.121-8.282, P=0.029) were independent risk factors for delirium in patients with SAH in the neurology intensive care unit. The prediction model was Logit (P)=-4.553+1.388×drinking history+1.911×coronary artery heart disease history+2.056×mechanical ventilation+1.041×use of analgesics+3.086×use of sedatives+1.114×hypoalbuminemia. The AUC value of the model was 0.890 (95%CI 0.829-0.951, P<0.001). The Hosmer-Lemeshow test χ2=3.579, P=0.733. The maximum Youden index was 0.695, corresponding to a sensitivity of 76.2%, a specificity of 93.3%, and a prediction accuracy of 89.7%. 
Conclusions  Drinking history, coronary artery heart disease history, mechanical ventilation, use of analgesics, use of sedatives, and hypoalbuminemia are independent risk factors for delirium in patients with SAH in the neurology intensive care unit. The constructed prediction model based on the factors above has good performance.


The Construction of a Predictive Scale for Emergency Conversion to General Anesthesia during Mechanical Thrombectomy for Acute Ischemic Stroke

LI Chuanyou, SHENG Lei, GUO Xueyan, LIU Yuanyue

2025, 20(3):  320-327.  DOI: 10.3969/j.issn.1673-5765.2025.03.009

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Objective  To construct a predictive scale for emergency conversion to general anesthesia during mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS).
Methods  Patients with AIS who received MT at the First Affiliated Hospital with Nanjing Medical University from January 2020 to December 2023 were retrospectively included. They were categorized into two groups based on the anesthesia approach: the local anesthesia/monitored anesthesia care (LA/MAC) group and the emergency conversion to general anesthesia group. Multivariate logistic regression analysis was performed to determine the risk factors for emergency conversion to general anesthesia during MT. The scores were assigned to each risk factor based on the results of multivariate logistic regression analysis, and the predictive scale was subsequently developed. 
Results  A total of 864 patients with AIS were included, including 803 patients (92.9%) in the LA/MAC group and 61 patients (7.1%) in the emergency conversion to general anesthesia group. Multivariate logistic regression analysis showed that NIHSS score≥15 points (OR 1.53, 95%CI 1.27-1.78), ASPECTS<6 points (OR 1.40, 95%CI 1.21-1.70), aphasia (OR 1.62, 95%CI 1.30-1.91), and vertebrobasilar artery occlusion (OR 2.21, 95%CI 1.82-2.96) were independently associated with emergency conversion to general anesthesia during MT. Based on the above four independent risk factors, an emergency conversion to general anesthesia predictive scale was developed [NIHSS score≥15 points (1 point), ASPECTS<6 points (1 point), aphasia (1 point), and vertebrobasilar artery occlusion (2 points)]. The optimal cutoff value of the scale for predicting emergency conversion to general anesthesia in AIS patients receiving MT was 3 points. When the scale score was≥3 points, the AUC was 0.853, and the sensitivity, the specificity, and the negative predictive value for predicting emergency conversion to general anesthesia were 0.892, 0.813, and 0.982, respectively. 
Conclusions  The emergency conversion to general anesthesia predictive scale constructed in this study has good predictive value for emergency conversion to general anesthesia during MT in patients with AIS.


Correlation Analysis of Serum IL-6, CysC, T₃ Levels, and Total Imaging Burden Score with Cognitive Impairment in Patients with Cerebral Small Vessel Disease

YU Shilin, HAO Chunbo

2025, 20(3):  328-332.  DOI: 10.3969/j.issn.1673-5765.2025.03.010

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Objective  To investigate the correlation between serum IL-6, cystatin C (CysC), triiodothyronine (T3) levels, and total imaging burden score with cognitive impairment in patients with cerebral small vessel disease (CSVD).
Methods  CSVD patients treated from January 2021 to January 2023 were retrospectively included and subsequently divided into the cognitive impairment group and the normal cognitive function group based on their MoCA scores during hospitalization. The demographic information, past medical history, and laboratory and imaging data of the patients were collected. The predictive value of serum IL-6, CysC, T3, and total imaging burden score for cognitive impairment in CSVD patients was analyzed. 
Results  A total of 142 patients with CSVD were included, with 61 cases (43.0%) in the cognitive impairment group and 81 cases (57.0%) in the normal cognitive function group. The levels of IL-6, Hcy, and CysC were higher, the level of T3 was lower, and the proportion of moderate to severe total imaging burden was higher in the cognitive impairment group, with statistically significant differences. Multivariate logistic regression analysis showed that elevated serum IL-6 levels (OR 1.070, 95%CI 1.039-1.103, P＜0.001), elevated CysC levels (OR 2.117, 95%CI 1.027-5.500, P=0.004), decreased T3 levels (OR 2.314, 95%CI 1.361-3.935, P=0.003), and moderate (OR 1.017, 95%CI 1.002-1.032, P=0.029) and severe (OR 9.032, 95%CI 6.076-18.012, P＜0.001) total imaging burden were risk factors for cognitive impairment in patients with CSVD. The AUC values for predicting cognitive impairment of serum IL-6, CysC, T3, and severe total imaging burden were 0.888, 0.812, 0.918, and 0.889, respectively, with the optimal cutoff values of 2.010 pg/mL, 0.982 ng/L, 1.302 nmol/L, and 3.6 points.
Conclusions  Elevated serum IL-6 and CysC levels, decreased T3 levels, and severe total imaging burden are correlated with cognitive impairment in patients with CSVD and can serve as a basis for identifying cognitive impairment in CSVD patients.


HR-VWI Analysis of Vertebrobasilar Artery Geometric Shapes and Basilar Artery Plaques in Patients with Symptomatic Acute Ischemic Stroke in the Posterior Circulation

ZHONG Liling, XU Dihao, SONG Jianxun, LIN Guohui, FU Nianxia

2025, 20(3):  333-340.  DOI: 10.3969/j.issn.1673-5765.2025.03.011

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Objective  To investigate the relationship between the geometric shapes of the vertebrobasilar artery (VBA) and the occurrence, distribution, and characteristics of the basilar artery (BA) plaques in patients with symptomatic acute ischemic stroke (AIS) in the posterior circulation using high resolution vessel wall imaging (HR-VWI). 
Methods  Patients with symptomatic AIS in the posterior circulation who were hospitalized in the Department of Neurology of Shenzhen Baoan People’s Hospital from June 2017 to December 2021 were retrospectively and consecutively included. According to the presence or absence of atherosclerotic plaque in the BA on HR-VWI, the patients were divided into the plaque group and the nonplaque group. The baseline characteristics, BA-vertebral artery (VA) angle, BA-middle angle, and BA tortuosity rate of the two groups were compared. According to 3D-TOF-MRA, the VBA geometric shapes of patients were divided into walking type, tuning fork type, λ type, and unilateral VA non-merging type. The incidence of BA plaques in the four VBA geometric shapes was statistically analyzed. The BA-VA angle, BA-middle angle, BA tortuosity rate, plaque distribution, external lumen diameter, plaque volume, external vessel wall area, vessel wall area, plaque thickness, plaque burden (PB), and enhancement rate (ER) of the four VBA geometric shapes were compared.
Results  A total of 71 patients were included, of which 54 (76.1%) had plaques and 17 (23.9%) did not. There was no statistically significant difference in the baseline characteristics and VBA morphological features between the plaque group and the nonplaque group (all P>0.05). Among the four VBA geometric shapes, the incidence of BA plaques in the walking type was higher than that in the tuning fork type (92.3% vs. 55.6%, P=0.033). The BA-middle angle in the tuning fork type [(166.83±13.27)° vs. (150.77±19.65)°, P=0.008)] and the λ type [(163.82±12.36)° vs. (150.77±19.65)°, P=0.028)] was greater than that in the walking type. The tortuosity rate of the BA in the walking type among the four VBA geometric shapes was the highest (P=0.005). However, there was no statistically significant difference in the distribution of BA plaques among the four geometric shapes (P=0.109), and there was no statistically significant difference in plaque characteristics, PB, and ER (all P>0.05). 
Conclusions  The geometric shapes of the VBA in patients with symptomatic AIS in the posterior circulation is closely related to the occurrence of BA plaques. Compared with the tuning fork type, the walking type is more likely to have BA plaques, and the BA in the walking type among the four geometric shapes is more likely to bend.




Analysis of Vascular Risk Factors and Neuropsychological Factors in Transient Global Amnesia with Hippocampal Lesions

WANG Weisen, DU Bingying, LI Binghan, ZHANG Xinyuan, PENG Wenjia, BI Xiaoying

2025, 20(3):  341-348.  DOI: 10.3969/j.issn.1673-5765.2025.03.012

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Objective  To investigate the clinical characteristics, vascular risk factors, and neuropsychological factors in patients with transient global amnesia (TGA) associated with hippocampal lesions.
Methods  A retrospective study was conducted on patients with TGA admitted to the First Affiliated Hospital of Naval Medical University from January 2015 to January 2024. The locations of TGA with hippocampal lesions and the time from onset to completion of brain MRI were recorded. TGA patients were divided into two groups based on whether they were accompanied by hippocampal lesions: the TGA with hippocampal lesions group and the TGA without hippocampal lesions group. The differences in vascular risk factors, small vessel markers, degree of large vessel stenosis, and neuropsychological assessment results were compared between the two groups. 
Results  A total of 72 patients were included, with an average age of (63.7±11.7) years, and 27 males (37.5%). Twenty-one patients (29.2%) had hippocampal lesions. TGA with hippocampal lesions mainly involved the body of the hippocampus (57.1%), and the detection rate of hippocampal lesions in brain MRI completed 3-＜5 days after onset was relatively high (42.9%). Compared with the TGA without hippocampal lesions group, the proportion of hypertension (76.2% vs. 49.0%, P=0.034), completion of brain MRI within one week from onset (95.2% vs. 66.7%, P=0.025), moderate to severe cerebral white matter hyperintensity (38.1% vs. 11.8%, P=0.025), and periventricular white matter hyperintensity score of 3 points (33.3% vs. 9.8%, P=0.037) were significantly higher in the TGA with hippocampal lesions group, while the HAMA score (3.0 points vs. 7.0 points, P=0.008) and the proportion of anxiety state (4.8% vs. 29.4%, P=0.048) were significantly lower.
Conclusions  Hippocampal lesions are the characteristic imaging marker of part of TGA patients and may be associated with hypertension and small vessel lesions. TGA without hippocampal lesions may be related to neuropsychological factors.




Research Progress of Noninvasive Intracranial Pressure Monitoring

CHEN Yunna, HUO Farong, ZHAO Long, TAN Yafang, ZHANG Xiaoyan

2025, 20(3):  349-356.  DOI: 10.3969/j.issn.1673-5765.2025.03.013

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Intracranial pressure refers to the pressure exerted by the intracranial contents on the cranial cavity walls, and its changes can reflect the physiological and pathological changes within the skull. In adults lying flat, the intracranial pressure consistently maintains above 15 mmHg (1 mmHg=0.133 kPa), which is considered intracranial hypertension. Currently, the monitoring methods for intracranial pressure, such as invasive external ventricular drainage and parenchymal probe, are considered the “gold standard”. However, these methods have disadvantages such as a high risk of infection, potential for brain injury and bleeding, and high costs. Given this, exploring a safe and accurate noninvasive intracranial pressure monitoring method is particularly critical. This article reviewed the latest research progress in noninvasive intracranial pressure monitoring, and compared the advantages and disadvantages of various techniques. Brain imaging, TCD, electroencephalogram, near-infrared spectroscopy, and monitoring methods based on the eyes and ears all play a certain role in intracranial pressure assessment. In particular, the optic nerve sheath diameter has become an effective indicator for identifying patients at risk of intracranial hypertension, and TCD shows potential to replace traditional invasive monitoring methods.

Impaired Dynamic Cerebral Autoregulation in Patients with Cerebral Venous Sinus Thrombosis: Evaluation Using Transcranial Doppler and Silent Reading Stimulation

CHEN Songwei, CHEN Hongxiu, DUAN Jiangang, CUI Liuping, LIU Ran, XING Yingqi

2025, 20(3):  357-364.  DOI: 10.3969/j.issn.1673-5765.2025.03.014

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Objective  Cerebral venous sinus thrombosis (CVST) may impair dynamic cerebral autoregulation (dCA) of the middle cerebral artery (MCA). This study explored the effects of CVST on dCA of the MCA and the posterior cerebral artery (PCA) during silent reading and neurovascular coupling (NVC).
Methods  From January 2021 to August 2022, 60 CVST patients (the CVST group) and 30 healthy controls (the control group) were enrolled in this study. Non-invasive continuous beat-to-beat blood pressure, cerebral blood flow velocity, and other associated information of the MCA and PCA during silent reading were collected using TCD. Based on the MRI staging, CVST was divided into chronic phase and non-chronic phase. Based on the distribution of CVST on MRI, CVST patients were divided into the large range group and the small range group. The subjects were assessed for NVC by opening and closing the eyes in response to voice prompts, with eye-open visual stimulation achieved by silent reading of Chinese tourism materials. When silent reading with eyes open, the visual stimulation signals can selectively activate Brodmann areas 17, 18, and 19 in the occipital lobe, prompting them to release neurotransmitters and dilate the PCA. The dCA parameters were determined by transfer function analysis.
Results  In dCA of the PCA during silent reading, the CVST group’s very low frequency phase difference was lower than that of the control group [52.91 (29.56-75.12)° vs. 66.43 (48.68-79.55)°, P=0.047]. In NVC, the index of the cerebrovascular conductance (CVCi) changes (ΔCVCi) [0.09 (0.08-0.12) cm·s-1·mmHg-1 vs. 0.12 (0.09-0.15) cm·s-1·mmHg-1, P=0.017] (1 mmHg=0.133 kPa) and visually evoked flow response (VEFR) [25.36 (18.28-32.43) % vs. 30.73 (23.67-38.18) % , P=0.019] in the CVST group were lower than those in the control group. There were no statistically significant differences in the very low frequency phase difference, ΔCVCi, and VEFR of the PCA between patients with chronic CVST and non-chronic CVST. For the distribution range of CVST, the VEFR in the large range group was lower than that in the small range group, and the difference was statistically significant (P=0.018).
Conclusions  Compared with healthy controls, the dCA and NVC of the PCA during silent reading were impaired in CVST patients. In addition, NVC reactivity was related to the involvement range of CVST. Patients with larger involvement range had lower NVC reactivity to visual stimulation than those with smaller involvement range.




The Predictive Value of Dynamic Cerebral Autoregulation for Poor Prognosis in Acute Ischemic Stroke Patients with Complete Recanalization after Endovascular Thrombectomy

LIU Ran, WANG Pingping, CHEN Hongxiu, LI Na, ZHOU Fubo, ZHAO Wenbo, MA Qingfeng, XING Yingqi

2025, 20(3):  365-372.  DOI: 10.3969/j.issn.1673-5765.2025.03.015

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Objective  To explore the changes in dynamic cerebral autoregulation (dCA) function after complete recanalization of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS), and to investigate the relationship between dCA and clinical prognosis of patients.
Methods  This study included patients with AIS caused by the occlusion of the middle cerebral artery or internal carotid artery from March to September 2022, all of whom underwent EVT. The control group consisted of individuals without neurological diseases who underwent dCA examination at Xuanwu Hospital, Capital Medical University, and were matched 1∶1 based on age and gender. Through transfer function analysis, parameters such as the phase difference, gain, and consistency of very low frequency (VLF) and low frequency at 12 hours and 5 days after EVT, as well as the difference in VLF phase difference between the two examinations, were obtained. The mRS at 3 months after EVT was used to assess the clinical prognosis. The good prognosis group was defined with mRS score≤2 points and the poor prognosis group was defined with mRS score of 3-6 points. Logistic regression analysis was used to analyze the risk factors affecting clinical prognosis.
Results  A total of 43 AIS patients who underwent EVT and 43 healthy controls were ultimately included, with 27 patients in the good prognosis group and 16 in the poor prognosis group. Compared with the healthy controls, the VLF phase difference on the affected side of AIS patients who underwent EVT was significantly impaired 12 hours after EVT [(39.31±24.11)° vs. (65.26±19.87)°]. The VLF phase difference on the affected side in the good prognosis group at 5 days after EVT was significantly improved compared to 12 hours after EVT [(54.95±21.78)° vs. (38.74±22.33)°, P=0.004], while the VLF phase difference on the affected side in the poor prognosis group did not recover at 5 days after EVT compared to 12 hours after EVT [(24.54±16.35)° vs. (40.27±27.60)°, P=0.063]. Logistic regression analysis showed that the phase difference on the affected side of AIS patients was significantly related to bad clinical prognosis (adjusted OR 0.911, 95%CI 0.854-0.972, P=0.005). The Δphase difference (phase difference5 days-phase difference12 hours) was an independent risk factor for the bad clinical prognosis at 3 months after surgery in AIS patients receiving EVT (adjusted OR 1.061, 95%CI 1.016-1.109, P=0.008). ROC curve analysis showed that VLF phase difference of 35° at 5 days after EVT was optimal cutoff value for predicting good prognosis at 3 months after AIS surgery (AUC 0.878, 95%CI 0.756-1.000, P<0.001).
Conclusions  The dCA function was impaired in patients with AIS after EVT. The Δphase difference were independent predictors of the clinical prognosis. The dCA may provide a new means of predicting clinical prognosis for AIS patients treated with EVT.


Pre-Stroke Dementia and In-Hospital Outcomes in Patients with Intracerebral Hemorrhage: An Analysis Based on the China Stroke Center Alliance Registry Database

LI Qiuju, YIN Jinfeng, WANG Chunjuan, YANG Xin, REN Tianhua, LI Zixiao, GU Hongqiu, JIANG Yong

2025, 20(3):  373-379.  DOI: 10.3969/j.issn.1673-5765.2025.03.016

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Objective  To investigate the prevalence of pre-stroke dementia in patients with intracerebral hemorrhage and its relationship with in-hospital outcomes.
Methods  The data for this study were derived from patients with intracerebral hemorrhage enrolled in the China Stroke Center Alliance registry database from August 2015 to December 2022. The determination of pre-stroke dementia was based on self-reports in the patient’s medical history. In-hospital outcomes included walking within 2 days of admission, stroke recurrence, in-hospital death, in-hospital complications (pulmonary embolism, pneumonia, etc.), and discharge to home. Multivariate logistic regression was used to analyze the correlation between pre-stroke dementia and in-hospital outcomes in patients with intracerebral hemorrhage.
Results  A total of 109 366 patients with intracerebral hemorrhage were enrolled in this study, including 68 386 (62.5%) males, aged 63.0 (53.0-72.0) years. The NIHSS score at admission was 6.0 (2.0-13.0) points, and the length of hospitalization was 15.0 (10.0-21.0) days. A total of 293 (0.3%) patients had a history of pre-stroke dementia. Compared with patients without pre-stroke dementia, patients with pre-stroke dementia were older, had a higher proportion of females, and had lower levels of education. Multivariate logistic regression analysis showed that pre-stroke dementia may be associated with a higher risk of in-hospital complications (OR 2.35, 95%CI 1.46-3.83), particularly pneumonia (OR 2.52, 95%CI 1.57-4.08). However, there were no significant differences in outcomes such as stroke recurrence (OR 1.45, 95%CI 0.63-2.88), in-hospital death (OR 1.43, 95%CI 0.80-2.50), and discharge to home (OR 0.83, 95%CI 0.46-1.60) between the two groups.
Conclusions  In this study, the prevalence of pre-stroke dementia in patients with intracerebral hemorrhage was 0.3%, and pre-stroke dementia may increase the risk of in-hospital complications, particularly pneumonia, in patients with intracerebral hemorrhage.


The Application and Challenges of Artificial Intelligence in Enhancing the Diagnosis and Treatment Capabilities of Neurology Residents in Cerebrovascular Diseases

ZHANG Linyuan, SHEN Xiang, LYU Haiyan, WANG Guodong, WU Yuncheng

2025, 20(3):  380-383.  DOI: 10.3969/j.issn.1673-5765.2025.03.017

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In recent years, the development of artificial intelligence (AI) has provided new technological support for the training of neurology residents. Cerebrovascular disease is one of the earliest and most mature fields of AI application in neuroscience. Integrating AI organically into traditional neurology resident training can help consolidate neurology basic skills, optimize neuroimaging analysis, and assist in individualized diagnosis and treatment of disease, thereby accelerating the growth of young physicians and greatly benefiting the construction of the prevention and treatment system for cerebrovascular disease in China. However, the application of AI in medical training also presents challenges, including physicians’ over-reliance on AI, “AI hallucinations”, limitations of AI technology, and ethical concerns. This article systematically summarizes the comprehensive application and value of AI in the training of residents in cerebrovascular disease, explores potential risks and challenges, and proposes strategies to optimize AI applications, aiming to provide valuable references for the deep integration of AI in medical education in the future.