Table of Content

20 November 2025, Volume 20 Issue 11

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“Four-in-One” Management System for Comorbid Cerebrocardiovascular Diseases: from Organ-Centered to Systemic Integration

LUO Lingfu, FAN Yanqin, CAO Liming, REN Lijie

2025, 20(11):  1335-1343.  DOI: 10.3969/j.issn.1673-5765.2025.11.001

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As the leading cause of death and disability worldwide, cerebrocardiovascular diseases share the common pathological basis of atherosclerosis and vascular risk factors such as hypertension and diabetes mellitus. They often coexist in the form of comorbid cerebrocardiovascular diseases. The traditional department-based diagnosis and treatment model leads to fragmented prevention and treatment, low utilization efficiency of medical resources, ultimately limiting the improvement in patients’ overall prognosis. Based on the bidirectional regulation mechanism of the brain-heart axis, this paper systematically proposes a “Four-in-One” management system for comorbid cerebrocardiovascular diseases, which emphasizes co-prevention, co-screening, co-treatment, and co-rehabilitation. Co-prevention focuses on the whole-cycle prevention and control of common risk factors, and prevents diseases before they occur through lifestyle interventions and risk factor management; co-screening relies on cerebrocardiac combined multimodal examinations to achieve simultaneous assessment of the structure and function of the cerebrovascular and cardiovascular systems; co-treatment takes multi-disciplinary collaboration as the core, formulates coordinated plans, and resolves treatment conflicts and fragmented diagnosis and treatment; co-rehabilitation builds an integrated rehabilitation pathway that takes both cardiac and cerebral functions into account, realizing the mutual promotion and joint recovery of cardiac and cerebral functions. Combined with the latest evidence-based evidence and China’s medical practice, this paper demonstrates the scientificity and necessity of this system, analyzes the challenges in its implementation, and puts forward development directions. It aims to provide a theoretical basis and practical path for improving the prognosis of patients with comorbid cerebrocardiovascular diseases and reducing the disease burden.




“Four-in-One” Management System—Breaking the Dilemma of Diagnosis and Treatment for Comorbid Cerebrocardiovascular Diseases

REN Lijie, CAO Liming

2025, 20(11):  1344-1344. 

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Study on Collaborative Management and Implementation Pathways for Comorbid Cerebrocardiovascular Diseases under the Framework of Medical Consortium

LUO Zhiyi, BIAN Zihao, KONG Fanyi, YANG Yansui, SHEN Dou, LIU Yuehua

2025, 20(11):  1345-1354.  DOI: 10.3969/j.issn.1673-5765.2025.11.002

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The prevalence of comorbid cerebrocardiovascular diseases continues to rise, imposing a substantial disease and economic burden on healthcare systems in China and globally. The pathological mechanisms of comorbid cerebrocardiovascular diseases are complex. To meet the demand for full-cycle health services among patients, it is necessary to establish a collaborative management model for co-treatment of brain and heart. Based on this, this paper proposes leveraging the institutional advantages of the medical consortium to construct an internal-external coordination model for co-treatment of brain and heart. On the one hand, this model strengthens hierarchical coordination and resource integration within the medical consortium, optimizes the functional positioning of medical institutions at different levels, and improves mechanisms for two-way referral, information sharing, and multidisciplinary collaboration. On the other hand, it promotes collaborative cooperation between the medical consortium and external entities such as centers for disease control and prevention, public health institutions, and social organizations. Through the integration of medical treatment and prevention, social participation, and the development of information platforms, the model aims to establish a comprehensive network for prevention, control, and health support targeting comorbid cerebrocardiovascular diseases. In terms of implementation pathways, this paper puts forward a practical plan for co-treatment of brain and heart in medical consortium driven by the plan-do-study-act (PDSA) cycle, outlining processes including target anchoring, data-driven decision-making, strategy feedback, and experience promotion. It also suggests that future efforts should be systematically advanced from multiple dimensions, such as top-level policy design, grassroots network construction, information platform development, and social resources mobilization, to facilitate the transformation in addressing comorbid cerebrocardiovascular diseases from a “treatment-centered” to “integration of medical treatment and prevention” and “multi-stakeholder co-governance”. This paper aims to provide theoretical and practical references for improving the management level of comorbid cerebrocardiovascular diseases and enhancing the collaborative governance capacity of the medical consortium.



The Current Status, Dilemmas, and Breakthrough Strategies of “Co-Treatment of Brain and Heart” for Comorbid Cerebrocardiovascular Diseases

WU Jiarui, CAO Liming

2025, 20(11):  1355-1362.  DOI: 10.3969/j.issn.1673-5765.2025.11.003

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Cerebrocardiovascular diseases share common core pathophysiological mechanisms such as atherosclerosis and inflammatory responses, often presenting as comorbid cerebrocardiovascular diseases. This significantly increases the disability and mortality rates of patients and has become a major global public health challenge. The conventional organ-centered disciplinary diagnosis and treatment model has deficiencies such as fragmented risk assessment, insufficient treatment coordination, and neglect of the interactive effects of cerebrocardiovascular diseases, which makes it difficult to meet clinical needs. The concept of co-treatment of brain and heart integrates the holistic view of traditional Chinese medicine with modern neurocardiology, takes the brain-heart axis as the core mechanism, and emphasizes the holistic prevention and treatment of cerebrocardiovascular diseases through multidisciplinary collaboration. In recent years, domestic and foreign countries have achieved certain results in clinical practice by establishing joint diagnosis and treatment centers, interdisciplinary working groups, and providing guarantees through legislative forms. However, current practice still faces many challenges, such as insufficient comprehensive assessment of comorbid cerebrocardiovascular diseases, conflicts in treatment plans, and lack of overall prognosis evaluation. This article reviews the clinical practice, challenges, and prospects of co-treatment of brain and heart for comorbid cerebrocardiovascular diseases, aiming to provide reference for further clinical practice in this field.

Behavioral and Lifestyle Risk Factors for Cerebrocardiovascular Diseases and Intervention Strategies

SHEN Dou, ZHANG Yixi, KONG Xinru, GAO Yuexia, ZHANG Xu, YAN Ziheng, LIU Hong, CAO Xin

2025, 20(11):  1363-1370.  DOI: 10.3969/j.issn.1673-5765.2025.11.004

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Cerebrocardiovascular diseases pose a significant public health challenge threatening the health of Chinese residents. Common behavioral and lifestyle risk factors, including unhealthy dietary pattern, lack of physical activity, tobacco exposure, and sleep disorders, provide a theoretical and scientific basis for the co-prevention and co-treatment of cerebrocardiovascular diseases. This article reviews the significant impacts and key mechanisms of these four types of risk factors on cerebrocardiovascular diseases, and highlights innovative intervention strategies with evidence-based support, convenience, feasibility, and strong accessibility, including the Chinese heart-healthy diet pattern, “snackable exercise”, artificial intelligence-enabled digital therapy, and neuromodulation therapy. It aims to provide a reference for clinicians, public health practitioners, and policymakers in formulating behavioral and lifestyle intervention strategies for cerebrocardiovascular diseases.

Core Strategies and Digital Health Technology Empowerment for Co-Rehabilitation of Cerebrocardiovascular Diseases

ZHOU Jing, YUAN Jian, YE Liang, WANG Yulong

2025, 20(11):  1371-1379.  DOI: 10.3969/j.issn.1673-5765.2025.11.005

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Cerebrocardiovascular diseases exhibit a high degree of comorbidity, interacting through neural pathways, baroreceptor pathways, and biochemical pathways. The conventional department-based rehabilitation model is limited to a single organ system, making it difficult to address issues such as conflicts in exercise intensity setting and poor patient compliance. The co-rehabilitation of cerebrocardiovascular diseases model based on the theory of neurocardiology relies on the multidisciplinary collaboration of neurology, cardiology, and rehabilitation medicine. With “comprehensive assessment, risk stratification, dynamic adjustment, and individualized intervention” as its core principles, it builds a closed-loop management system of “assessment-stratification-intervention-reassessment”. This system encompasses multiple dimensions, including comprehensive assessment, risk stratification, individualized exercise, neurorehabilitation and neuromodulation, psychological rehabilitation, nutritional management and risk factor control, as well as digital health technologies. By integrating individualized exercise prescription with neurodevelopmental therapy, transcranial magnetic stimulation, brain-computer interfaces, and virtual reality technology, the model facilitates the repair of cardiac and neurological functions. With the support of digital health technologies, such as wearable devices, mobile health applications, and artificial intelligence-powered big data analysis, it enables remote monitoring and dynamic program adjustment, ultimately providing a precise and efficient integrated rehabilitation program for patients with comorbid cerebrocardiovascular diseases.



Research Progress on the Application of Cerebrocardiac Combined Multimodal Examination in the Diagnosis of Vasovagal Syncope

WANG Jingyi, XIONG Yunhui, JIANG Hongliang, CAO Liming

2025, 20(11):  1380-1386.  DOI: 10.3969/j.issn.1673-5765.2025.11.006

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Vasovagal syncope (VVS), as the most common type of syncope, is highly dependent on the head-up tilt test (HUTT) for diagnosis. However, this gold standard also has several limitations. In recent years, cerebrocardiac combined multimodal examination has emerged, aiming to enhance diagnostic performance by integrating functional imaging techniques. Among these, the synchronous combined mode (HUTT combined with TCD or near infrared spectrometry) has demonstrated core value in enhancing diagnostic accuracy and efficiency, as well as improving examination safety. Meanwhile, the asynchronous combination of HUTT with advanced imaging techniques such as cerebral blood flow perfusion imaging or functional magnetic resonance imaging plays a significant role in the differential diagnosis of VVS and the in-depth analysis of its central regulatory mechanisms. The application of cerebrocardiac combined multimodal examination aims to promote the advancement of VVS diagnosis and treatment toward precision and individualization.

Application of Cerebrocardiac Contrast-Enhanced Ultrasound in the Diagnosis of Patent Foramen Ovale

HUANG Xuming, GAN Qingyue, CAO Liming

2025, 20(11):  1387-1393.  DOI: 10.3969/j.issn.1673-5765.2025.11.007

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This article systematically reviews the application status, technical characteristics, existing challenges, and future prospects of cerebrocardiac contrast-enhanced ultrasound in the precision diagnosis of patent foramen ovale (PFO). Compared with single-modality contrast-enhanced ultrasound, cerebrocardiac contrast-enhanced ultrasound integrates the advantages of contrast-enhanced transcranial Doppler, contrast-enhanced transthoracic echocardiography, and contrast-enhanced transesophageal echocardiography, enabling “structural-functional” dual-dimensional assessment, significantly improving the detection rate and diagnostic accuracy of PFO. Among them, the synchronous cerebrocardiac contrast-enhanced ultrasound allows single-contrast injection with dual-modality assessment, thereby optimizing the diagnosis and treatment process and reducing costs. The asynchronous cerebrocardiac contrast-enhanced ultrasound can provide key anatomical and functional evidence for the selection of indications for PFO closure, determination of device specifications, and prediction of stroke risk. This article also discusses the challenges faced by cerebrocardiac contrast-enhanced ultrasound, such as strong operator dependence and non-unified standards, and prospects future development directions including artificial intelligence empowerment, equipment innovation, and consensus formulation, aiming to provide theoretical basis and clinical practical guidance for promoting precision diagnosis and treatment of PFO.

Precision Diagnosis and Risk Stratification Strategies for Patent Foramen Ovale-Related Stroke

LIU Junying, SU Ying, JIANG Hongliang, CAO Liming

2025, 20(11):  1394-1401.  DOI: 10.3969/j.issn.1673-5765.2025.11.008

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Patent foramen ovale (PFO) is one of the most common congenital cardiac anomalies in adults. As an intervenable cause of cryptogenic stroke, ischemic stroke induced by PFO is characterized by a high recurrence rate, severe neurological impairment, and potential risk of multi-organ embolism. Precise identification of PFO-related stroke patients and treatment with transcatheter PFO closure can significantly improve neurological prognosis. PFO can cause stroke through mechanisms such as paradoxical embolism and in-situ thrombosis. Therefore, the management of PFO-related stroke requires integrating information including PFO anatomical and functional characteristics as well as clinical manifestations of stroke. Risk assessment should be performed using the risk of paradoxical embolism score and the PFO-associated stroke causal likelihood classification system, followed by the formulation of reasonable and individualized treatment plans (such as drug treatment, interventional therapy, and surgical treatment) to reduce stroke recurrence risk and enhance patient outcomes. This article reviews the risk assessment, imaging characteristics, and diagnostic strategies for PFO-related stroke, aiming to provide evidence for precise identification and intervention of PFO-related stroke and reducing stroke recurrence.


Correlation between White Matter Hyperintensities and Glymphatic System Function in Patients with Recent Small Subcortical Infarcts

ZHANG Xue, ZHANG Min, WU Peng, YUN Wenwei

2025, 20(11):  1402-1410.  DOI: 10.3969/j.issn.1673-5765.2025.11.009

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Objective  To investigate the correlation between different regions and severities of white matter hyperintensities (WMH) and glymphatic system (GS) function in patients with recent small subcortical infarct (RSSI).
Methods  Patients with RSSI admitted consecutively to the Third Affiliated Hospital of Nanjing Medical University (Changzhou Second People’s Hospital), from December 2023 to December 2024 were retrospectively enrolled. All patients completed cranial MRI examination within 3 days after admission, including diffusion tensor imaging sequences. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) technique was used to calculate the DTI-ALPS index for evaluating GS function. The volumes of total white matter hyperintensity (WMH), periventricular white matter hyperintensity (PWMH), and deep white matter hyperintensity (DWMH) were measured. WMH was scored and grouped using the Fazekas scale. According to the Fazekas scale scores, patients with PWMH or DWMH scores of 0-1 points were classified as the none-to-mild group, while those with scores of 2-3 points were classified as the moderate-to-severe group for the corresponding region. The total WMH grade was determined by summing the scores of the two regions, and patients were further grouped accordingly: grade 0-1 (0-2 points) were defined as the none-to-mild WMH group, and grade 2-3 (3-6 points) as the moderate-to-severe WMH group. Univariate analysis was performed to compare clinical data and the DTI-ALPS index among different groups. Multivariate logistic regression analysis was used to identify independent influencing factors of WMH in different regions. Spearman correlation analysis was conducted to assess the relationship between WMH volume and the DTI-ALPS index, and mediation analysis was performed to examine the mediating effect of the DTI-ALPS index on the relationship between age and WMH volume. 
Results  Univariate analysis showed that in the comparisons of WMH, PWMH, and DWMH groups, significant differences in the DTI-ALPS index and age were observed between the moderate-to-severe and none-to-mild groups. The moderate-to-severe groups had lower DTI-ALPS indices and were older than the none-to-mild groups (both P<0.05). Multivariate logistic regression analysis indicated that the DTI-ALPS index was a independent influencing factor for WMH severity in different regions. In the WMH, PWMH, and DWMH groups, the OR of the DTI-ALPS index were 0.002 (95%CI 0.000-0.243, P=0.012), 0.009 (95%CI 0.000-0.779, P=0.038), and 0.002 (95%CI 0.000-0.223, P=0.011), respectively. Spearman correlation analysis further revealed that WMH volume was negatively correlated with the DTI-ALPS index in RSSI patients (WMH: rs=−0.479, P<0.001; PWMH: rs=−0.355, P=0.004; DWMH: rs=−0.460, P<0.001). Mediation analysis demonstrated that age indirectly affected WMH volume through the DTI-ALPS index, with a significant indirect effect accounting for 35.629% of the total effect.
Conclusions  In RSSI patients, the DTI-ALPS index was an independent influencing factor for WMH severity, showed negative correlations with WMH volumes in all regions, and mediated the relationship between age and WMH volume.


Effects of Infarct Location and Volume on Upper Limb Functional Rehabilitation in Subacute Ischemic Stroke

WU Yuqian, ZANG Dawei, PANG Wenbin, HU Anming, HAN Yujuan

2025, 20(11):  1411-1419.  DOI: 10.3969/j.issn.1673-5765.2025.11.010

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Objective  To explore the effects of infarct location and volume on upper limb functional rehabilitation in patients with subacute ischemic stroke. 
Methods   A prospective study was conducted on patients with subacute ischemic stroke who were hospitalized in the Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, and the Tiantan Xiaotangshan Rehabilitation Center, Beijing Xiaotangshan Hospital, from June 2022 to September 2023. Based on infarct locations identified by cranial MRI at admission, patients were divided into the supratentorial subcortical group, infratentorial group, and supratentorial mixed group. The severity of upper limb dysfunction in patients was evaluated using the Fugl-Meyer motor assessment-upper extremity (FMA-UE), with scores of 0-22 points indicating severe dysfunction and 23-50 points indicating moderate dysfunction. All patients received rehabilitation treatment twice daily, 5 days a week, for 3 consecutive months. Among patients with different degrees of upper limb dysfunction, the effects of different infarct locations on upper limb functional rehabilitation were compared, and multiple linear regression analysis was used to explore the relationships between infarct locations, infarct volumes, other clinical characteristics, and upper limb functional rehabilitation.
Results  Repeated measures analysis of variance showed that patients with severe upper limb dysfunction had improved upper limb function at both 1 month and 3 months post-treatment compared with baseline, and the infratentorial group had better outcomes in upper limb functional rehabilitation than the supratentorial mixed group (1 month post-treatment: P=0.020, 3 months post-treatment: P=0.002). Patients with moderate upper limb dysfunction also showed improved upper limb function at 1 month and 3 months post-treatment compared with baseline. Multiple linear regression analysis revealed that gender (β=-0.223, P=0.016), infarct volume (β=-0.257, P=0.005), and MoCA score (β=0.394, P<0.001) were associated with FMA-UE scores at 1 month post-treatment. Gender (β=-0.243, P=0.008), infarct volume (β=-0.281, P=0.002), and MoCA score (β=0.370, P<0.001) were associated with FMA-UE scores at 3 months post-treatment. However, age, smoking, alcohol consumption, hypertension, diabetes mellitus, hyperlipidemia, infarct location, hemiplegic side, and onset time of rehabilitation had no statistically significant association with FMA-UE scores at either 1 or 3 months post-treatment.
Conclusions  Rehabilitation therapy can promote upper limb function in patients with subacute ischemic stroke. For patients with severe upper limb dysfunction, the upper limb functional rehabilitation outcomes of infratentorial infarction are better than those of supratentorial mixed infarction. Gender, infarct volume, and cognitive function are associated with upper limb functional rehabilitation outcomes at 1 month and 3 months post-treatment.


Correlation between Asymmetry Rate of Cerebral Peduncle and Compensation of Language and Motor Functions in Non-Dominant Hemisphere after Dominant Hemisphere Stroke in Middle-Aged and Elderly Patients

DU Xiuyu, GUO Xiaochuan, ZHOU Xiaobao, LU Haitao, ZHI Debao, MAO Jiao

2025, 20(11):  1420-1427.  DOI: 10.3969/j.issn.1673-5765.2025.11.011

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Objective  To explore the correlation between asymmetry rate of cerebral peduncle (ARCP) and compensatory potential of language and motor functions in non-dominant hemisphere after dominant hemisphere stroke in middle-aged and elderly patients.
Methods  Consecutive retrospective collection was conducted on the clinical data of middle-aged and elderly patients with recurrent stroke after dominant hemispheric stroke, who received treatment at Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine from October 2022 to October 2024. Indicators including aphasia quotient (AQ), Fugl-Meyer motor assessment scale (FMA) scores, and ARCP were collected before and after recurrent stroke, and changes in the above indicators before and after recurrent stroke were observed. Patients were divided into two groups based on ARCP values (ARCP≤0.75 and ARCP>0.75). The changes in AQ and FMA scores before and after recurrent stroke between the two groups, as well as their correlation with ARCP were analyzed.
Results  Among the 17 patients with recurrent stroke, 7 were male and 10 were female, aged 51-80 years. There were 6 cases of left-sided recurrent stroke and 11 cases of right-sided recurrent stroke, including 2 cases of recurrent hemorrhagic stroke and 15 cases of ischemic stroke. The time interval from the first stroke to recurrent stroke was 5 to 12 months. Compared with before recurrent stroke: among the 9 patients with right-sided recurrent stroke and ARCP≤0.75, AQ decreased from 8.5 to 59.2 points, with a median decrease of 33.5 points; FMA scores of the right limb decreased from 5 to 47 points, with a median decrease of 22 points; and FMA scores of the left limb decreased from 6 to 50 points, with a median decrease of 24 points. Among the 4 patients with left-sided recurrent stroke and ARCP≤0.75, AQ decreased from 0 to 1.2 points, with a median decrease of 0 points; FMA scores of the right limb decreased from 0 to 8 points, with a median decrease of 2 points; and FMA scores of the left limb decreased from 0 to 2 points, with a median decrease of 1 point. For the 2 patients with right-sided recurrent stroke and ARCP>0.75, FMA scores of the left limb decreased (from 100 to 86 points, and from 96 to 91 points, respectively). Among the 2 patients with left-sided recurrent stroke and ARCP>0.75, 1 patient had no change in AQ, while the other had AQ decreased from 96.0 to 76.4 points; FMA scores of the right limb decreased in both patients (from 96 to 81 points, and from 95 to 72 points, respectively). A positive correlation was observed between AQ after the first left-sided stroke and ARCP (r=0.767, P=0.003); a positive correlation was found between FMA scores of the right limb after the first left-sided stroke and ARCP (r=0.630, P=0.007); AQ after right-sided recurrent stroke was positively correlated with ARCP (r=0.835, P=0.001); and FMA scores of the right limb after right-sided recurrent stroke were positively correlated with ARCP (r=0.773, P=0.005). 
Conclusions  For middle-aged and elderly patients with ARCP≤0.75 after dominant hemisphere stroke, the recovery of language and motor functions is closely related to the compensation of the non-dominant hemisphere.


Chinese Expert Consensus on Endovascular Treatment Technology for Acute Ischemic Stroke 2025

Chinese Interventional Neuroradiology Society of Chinese Stroke Association

2025, 20(11):  1428-1459.  DOI: 10.3969/j.issn.1673-5765.2025.11.012

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Advances and Future Directions in Reperfusion Therapy for Medium Vessel Occlusion Ischemic Stroke

MA Yujie, WANG Liyuan, XIONG Yunyun

2025, 20(11):  1460-1470.  DOI: 10.3969/j.issn.1673-5765.2025.11.013

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Ischemic stroke caused by medium vessel occlusion (MeVO) has emerged as a research hotspot in the field of cerebrovascular disease diagnosis and treatment in recent years, yet the choice of reperfusion therapy strategy remains controversial. This article provides a comprehensive review of the latest advances in research related to reperfusion therapy for MeVO. Current evidence indicates that endovascular treatment has limited efficacy in MeVO patients and may increase safety risks. In contrast, intravenous thrombolysis has shown considerable therapeutic potential due to its favorable vascular recanalization rate and clinical accessibility, but it still lacks high-level evidence regarding its efficacy and safety. This article summarizes the limitations of current clinical trial designs for MeVO reperfusion therapy, analyzes the reasons why most endovascular treatment trials have yielded negative outcomes, and compiles updates on several ongoing clinical trials. It aims to provide a reference for clarifying the precise treatment pathway and future research directions for MeVO.