Table of Content

20 December 2025, Volume 20 Issue 12

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Two Decades of Medical Quality Management of Stroke in China

CHENG Aichun, YANG Xin, ZHANG Jing, WANG Caiyun, WANG Chunjuan, LI Zixiao, MA Xudong

2025, 20(12):  1471-1479.  DOI: 10.3969/j.issn.1673-5765.2025.12.001

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Over the past two decades, the stroke care quality control system has been continuously refined in China, leading to remarkable improvements in stroke prevention and treatment. Since the initiation of the national stroke care quality control program in 2010, a three-tier organizational and quality control network—encompassing national, provincial, and municipal levels—has been established and is now being extended to county and district-level medical institutions. A comprehensive system of stroke care quality control indicators, covering both cerebral infarction and intracerebral hemorrhage, has been developed and widely implemented nationwide through this network, effectively promoting the standardization and homogenization of stroke diagnosis and treatment. Meanwhile, China has leveraged the hospital quality monitoring system and the single-disease medical quality monitoring database to build a big data-driven, information-based quality monitoring platform, enabling dynamic evaluation and continuous feedback on medical quality. The establishment of this stroke care quality control system has significantly enhanced the stroke diagnosis, treatment capabilities, and patient safety across all levels of medical institutions, laying a solid foundation for the sustained advancement of stroke prevention and control in China.



Current Challenges and Future Directions in the Surgical Treatment of Intracerebral Hemorrhage

WANG Qiao, ZHANG Dong

2025, 20(12):  1480-1486.  DOI: 10.3969/j.issn.1673-5765.2025.12.002

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Intracerebral hemorrhage is a common cerebrovascular disease characterized by high mortality and high disability rates. Surgical treatment plays a crucial role in its management, yet it still faces multiple challenges. Conventional craniotomy is plagued by the issue of imbalance between trauma and benefits, with poor efficacy for deep-seated hematomas. Although minimally invasive surgery has certain advantages, it is limited by insufficient standardization and weak evidence support, failing to form a universally applicable and efficient protocol. Additionally, disparities in medical resources between urban and rural areas lead to the uneven outcomes of surgical treatment for intracerebral hemorrhage. To improve the efficacy of surgical treatment for intracerebral hemorrhage, it is essential to accurately define surgical indications, establish a comprehensive preoperative evaluation system, and integrate emerging technologies such as artificial intelligence to achieve personalized treatment. The efficiency and safety of minimally invasive hematoma evacuation should be enhanced through emerging technologies such as surgical robots. Advanced treatment concepts and technologies need to be extended to grassroots medical institutions via telesurgery, lightweight devices, and cloud-based collaboration. Multidisciplinary collaboration and linkage with hierarchical medical systems should be strengthened to realize efficient surgical treatment of intracerebral hemorrhage. In the future, with the in-depth integration of various technologies, surgical treatment for intracerebral hemorrhage will move toward a more precise, accessible, and high-quality stage.

Minimally Invasive Therapy for Intracerebral Hemorrhage

ZHANG Dong

2025, 20(12):  1487-1487. 

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Intelligent Intracerebral Hemorrhage Treatment: Clinical Advances and Technological Breakthroughs Driven by Demand

ZHAO Runsheng, LI Xinwei, WANG Qiao, ZHANG Xu, ZHANG Dong

2025, 20(12):  1488-1492.  DOI: 10.3969/j.issn.1673-5765.2025.12.003

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Clinical management of intracerebral hemorrhage (ICH) faces multiple challenges, including ill-defined surgical timing, low hematoma clearance efficiency, and substantial surgical trauma. Conventional surgical approaches, such as craniotomy hematoma removal and stereotactic hematoma aspiration, often fall short of meeting clinical demands due to limitations of high invasiveness and insufficient precision. In recent years, propelled by artificial intelligence and novel imaging technologies, the treatment of ICH has accelerated its transition toward intelligence and precision. Preoperatively, diagnostic models provide an accurate basis for surgical decision-making by improving the accuracy of ICH etiology identification and the ability to predict hematoma expansion risk. Intraoperatively, intelligent auxiliary systems further optimize surgical outcomes through brain shift monitoring and real-time trajectory adjustments. Notably, robot-assisted minimally invasive stereotactic puncture therapy, leveraging multi-modal image fusion technology and micrometer-level execution precision of robotic arms, significantly shortens operative time and reduces the risk of complications, thereby being progressively adopted in clinical practice. This article reviews the clinical application effects and latest technological advancements in robot-assisted ICH surgery, aiming to provide references for the breakthroughs and development of intelligent ICH treatment technologies in the context of medical-engineering integration.

Report of Two Cases of Robot-Assisted Stereotactic Intracranial Hematoma Aspiration

HUANG Weihong, ZHENG Jun, ZHANG Dong

2025, 20(12):  1493-1498.  DOI: 10.3969/j.issn.1673-5765.2025.12.004

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Stereotactic minimally invasive surgery plays an important role in the surgical treatment of hypertensive intracerebral hemorrhage (HICH). However, due to its localization errors, it has limitations in treating intracranial hemorrhage that is small in volume and requires precise localization. This article reports two patients with HICH who underwent minimally invasive treatment: one involving brainstem hemorrhage and the other involving basal ganglia hemorrhage. Both cases were treated with robot-assisted stereotactic intracranial hematoma aspiration. After most of the hematoma was aspirated intraoperatively, no drainage catheter was placed. Postoperative cranial CT showed that the hematoma was almost completely resolved, and the patients recovered well. By analyzing and discussing the diagnosis and treatment processes for these two cases of HICH, this article aims to provide a reference for the treatment of HICH using robot-assisted stereotactic technology.

Development and Validation of an Early Neurological Deterioration Prediction Model for Patients with Cerebral Infarction Caused by Moderate-to-Severe Symptomatic Intracranial Arterial Stenosis

XIONG Zini, PENG Zhuli, WANG Xindi, LIU Haolin, CHEN Xiaolong, BAI Xiaoxin

2025, 20(12):  1499-1507.  DOI: 10.3969/j.issn.1673-5765.2025.12.005

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Objective  To analyze the risk factors for early neurological deterioration (END) in patients with cerebral infarction caused by moderate-to-severe symptomatic intracranial arterial stenosis, and to develop and validate a prediction model for END based on independent risk factors.
Methods  This was a retrospective study that consecutively enrolled patients with cerebral infarction caused by moderate-to-severe symptomatic intracranial arterial stenosis, who were admitted to the Department of Cerebrovascular Disease, Guangdong Provincial Hospital of Chinese Medicine between January 2019 and December 2023. Patients were divided into the END group and the non-END group based on the occurrence of END within 7 days of onset. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for END. A nomogram regression prediction model was subsequently constructed based on these factors, and its validity was verified using the Bootstrap resampling method within the original dataset. 
Results  A total of 152 patients were included, with 47 in the END group and 105 in the non-END group. The END group consisted of 47 patients aged 65 (57-75) years, including 33 males (70.21%); the non-END group consisted of 105 patients aged 64 (54-75) years, including 72 males (68.57%). Univariate and multivariate logistic regression analyses identified acute cerebral watershed infarction, severe stenosis of the responsible vessel, and a higher age, blood pressure, clinical features, duration of symptoms, diabetes, dual transient ischemic attack, ipsilateral carotid stenosis, infarction on diffusion-weighted-imaging (ABCD3-I) score as independent risk factors for END. A nomogram regression prediction model was constructed based on these three factors, with an AUC of 0.85 (95%CI 0.78-0.92) and an optimal cut-off value of 0.43. The sensitivity and specificity were 0.77 and 0.79, respectively. Internal validation of the model was performed using the Bootstrap resampling method, yielding an AUC of 0.85 (95%CI 0.84-0.89).
Conclusions  The END prediction model constructed in this study incorporates acute cerebral watershed infarction, severe stenosis of the responsible vessel, and the ABCD3-I score, demonstrating good predictive performance. Internal validation indicates good model stability.


Construction and Application of a Nomogram Prediction Model based on the Modified Total Burden Score of Cerebral Small Vessel Disease for Spontaneous Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Reperfusion Therapy

OU Ru, LIU Yimin, QIN Yan, XU Zhijian, HUANG Wenchun

2025, 20(12):  1508-1517.  DOI: 10.3969/j.issn.1673-5765.2025.12.006

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Objective  To construct and validate a nomogram prediction model based on the modified total burden score of cerebral small vessel disease for the precise prediction of spontaneous hemorrhagic transformation in acute ischemic stroke patients without reperfusion therapy.
Methods   Acute ischemic stroke patients without reperfusion therapy hospitalized in Sixth People’s Hospital of Nanhai District, Foshan from January 2021 to July 2024 were prospectively enrolled. They were randomly divided into a training set and an internal validation set at a ratio of 7∶3. Additionally, patients who met the inclusion and exclusion criteria and were admitted to the same hospital during different time periods (January to December 2020, and August 2024 to October 2025) were recruited as an external validation set. Data including gender, age, past medical history, hematological and imaging examination results were collected for all patients. Imaging markers of cerebral small vessel disease were evaluated based on cranial MRI examination results, and each marker was assigned a value according to its location and severity to calculate the modified total burden score of cerebral small vessel disease. The diagnosis of spontaneous hemorrhagic transformation was determined based on the results of the second cranial CT or MRI examination during hospitalization. With the occurrence of spontaneous hemorrhagic transformation as the dependent variable, univariate and multivariate logistic regression analyses were performed on the training set to screen for predictive factors, which were then used to construct the nomogram prediction model. Calibration curve was used to assess the consistency of the model, ROC curve was applied to evaluate the prediction efficacy of the model, and decision curve analysis and clinical impact curve were used to evaluate the clinical application value of the model.
Results  A total of 1430 acute ischemic stroke patients without reperfusion therapy were included, with a mean age of (67.9±10.4) years, including 716 females (50.1%). The training set comprised 547 patients, with a mean age of (68.2±10.4) years, including 279 females (51.0%). Multivariate logistic regression analysis showed that the modified total burden score of cerebral small vascular disease (OR 2.817, 95%CI 2.210-3.591, P<0.001) and large hemispheric infarction (OR 2.642, 95%CI 1.115-6.260, P=0.027) were independent risk factors for spontaneous hemorrhagic transformation after acute ischemic stroke. The calibration curve of the nomogram prediction model in the training set showed good agreement between the predicted and observed values. The ROC curve showed an AUC of 0.835 (95%CI 0.789-0.880), indicating that the model had good predictive efficacy. The decision curve analysis results revealed that the net benefit was the highest when the threshold probability was from 0.06 to 0.77. The clinical impact curve analysis suggested that the model had an acceptable cost-benefit ratio, indicating high clinical application value. The internal validation set included 235 patients, with a mean age of (68.3±10.4) years, including 119 females (50.6%), and the ROC curve showed an AUC of 0.847 (95%CI 0.785-0.910). The external validation set included 648 patients, with a mean age of (67.4±10.4) years, including 318 females (49.1%), and the ROC curve showed an AUC of 0.870 (95%CI 0.795-0.931).
Conclusions  The nomogram prediction model constructed in this study can effectively predict the risk of spontaneous hemorrhagic transformation after acute ischemic stroke.


Construction and Validation of a Nomogram Prediction Model for Medical Decision-Making Delay in Patients with Acute Ischemic Stroke

BAN Yue, HU Minli, LI Zhihui, DENG Liping, XIE Xiaohua

2025, 20(12):  1518-1526.  DOI: 10.3969/j.issn.1673-5765.2025.12.007

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Objective  To explore the important risk factors of medical decision-making delay in patients with acute ischemic stroke (AIS) and construct a nomogram prediction model, aiming to provide an individualized assessment tool for early identification of high-risk patients with medical decision-making delay.
Methods  AIS patients admitted to three hospitals in Shenzhen between September 2024 and April 2025 were prospectively enrolled. Patients were divided into a delay group (>1 h) and a non-delay group (≤1 h) based on the time interval from symptom onset or recognition to the first decision to seek medical help. Multivariate logistic regression analysis was used to identify independent influencing factors of medical decision-making delay, and a nomogram prediction model was constructed. The model performance was evaluated using ROC curves, Hosmer-Lemeshow goodness of fitting test, calibration curves, and decision curve analysis. 
Results  A total of 344 AIS patients were enrolled in this study, among whom 201 had medical decision-making delay. Multivariate logistic regression analysis showed that compared with the non-delay group, patients in the delay group had a younger mean age (OR 2.303, 95%CI 1.201-4.416, P=0.012), lower educational level (OR 3.908, 95%CI 1.460-10.463, P=0.007), higher proportion of diabetes mellitus history (OR 1.923, 95%CI 1.054-3.509, P=0.033), lower NIHSS scores at onset (OR 3.245, 95%CI 1.700-6.191, P<0.001), higher proportion of poorer understanding of stroke (OR 3.262, 95%CI 1.247-8.532, P=0.016), and higher proportion of tendency to adopt negative coping style (OR 11.436, 95%CI 6.069-21.550, P<0.001). The AUC of the nomogram prediction model constructed based on these six factors was 0.861 (95%CI 0.820-0.902). The Hosmer-Lemeshow goodness of fitting test indicated that the model had a good fit (χ²=8.064, P=0.427). The calibration curves showed a high degree of consistency between the predicted values and observed values of the model. Decision curve analysis showed that the model yielded a high clinical net benefit within a wide range of risk thresholds.
Conclusions  The nomogram prediction model constructed with age, educational level, history of diabetes mellitus, NIHSS score at onset, understanding of stroke, and disease coping style as core variables can serve as a valid predictive tool for clinically assessing the risk of medical decision-making delay in patients with AIS.


Establishment and Validation of a Nomogram Prediction Model for Symptomatic Intracranial Hemorrhage after Recanalization with Endovascular Thrombectomy in Anterior Circulation Large Vessel Occlusive Acute Ischemic Stroke

YANG Zhichao, HUANG Zhengqian, ZHAO Yikun, SUN Yong

2025, 20(12):  1527-1538.  DOI: 10.3969/j.issn.1673-5765.2025.12.008

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Objective  To investigate the risk factors for symptomatic intracranial hemorrhage (sICH) after recanalization with endovascular thrombectomy (EVT) in patients with anterior circulation large vessel occlusive acute ischemic stroke (AIS), and to establish and validate a nomogram prediction model.
Methods  Patients with anterior circulation large vessel occlusive AIS who underwent EVT and achieved successful recanalization at the Department of Neurointervention, the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2021 to December 2024 were retrospectively enrolled. Their clinical data were collected and patients were followed up until 36 hours post-treatment. Patients were divided into the sICH group and the non-sICH group based on the occurrence of sICH after EVT. Patients enrolled from January 2021 to December 2023 were assigned to the training set for model development, while those enrolled from January to December 2024 comprised the validation set for model performance evaluation. In the training set, variables with P<0.05 in univariate analysis were included in the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis. Independent risk factors for sICH after recanalization with EVT in patients with anterior circulation large vessel occlusive AIS were identified and used to construct a nomogram prediction model. The predictive performance of the model was evaluated in the validation set using the ROC curve, decision curve analysis (DCA), and calibration curve.
Results  A total of 316 patients with anterior circulation large vessel occlusive AIS were included, including 224 in the training set and 92 in the validation set. In the training set, 37 patients (16.52%) developed sICH. After univariate analysis, twelve variables (P<0.05) were initially included in the LASSO regression analysis, and six variables were ultimately identified: stress hyperglycemia ratio, neutrophil-to-lymphocyte ratio, number of stent retriever passes, history of diabetes mellitus, NIHSS score, and internal carotid artery as the responsible vessel. Multivariate logistic regression analysis showed that a higher stress hyperglycemia ratio (OR 20.24, 95%CI 4.76-86.08, P<0.001), a greater number of stent retriever passes (OR 1.78, 95%CI 1.18-2.67, P=0.005), and a history of diabetes mellitus (OR 4.64, 95%CI 1.63-13.19, P=0.004) were independent risk factors for sICH after EVT recanalization in patients with anterior circulation large vessel occlusive AIS. The ROC curve analysis revealed that the AUC values of the training set and the validation set were 0.86 and 0.76, respectively. The calibration curve demonstrated good consistency between predicted and observed values, and the DCA indicated that the prediction model yielded a favorable net benefit across a wide range of risk thresholds.
Conclusions  The nomogram prediction model constructed in this study demonstrates a good ability to predict the risk of sICH after recanalization with EVT in patients with anterior circulation large vessel occlusive AIS.


Analysis of Influencing Factors of Early Depressive Symptoms after Acute Ischemic Stroke and Construction of a Multimodal Prediction Model

LUO Dongliang, JIA Liyan, LIU Wei

2025, 20(12):  1539-1546.  DOI: 10.3969/j.issn.1673-5765.2025.12.009

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Objective  To explore the influencing factors of early depressive symptoms after acute ischemic stroke and construct a prediction model.
Methods  A retrospective cohort analysis was conducted. The study included patients with acute ischemic stroke who were admitted to the Affiliated Hospital of Shandong Second Medical University from July 2023 to July 2024, had their first onset of the disease, were diagnosed by cranial MRI, were admitted within 48 hours of onset, had a mini-mental state examination score≥15 points, and had complete clinical and follow-up data. The baseline data, assessment of early depressive symptoms after acute ischemic stroke, laboratory examination, stroke-related scale scores, and imaging data were collected. Based on the Hamilton depression scale (HAMD) scores of outpatient follow-up at (30±3) days after stroke, patients were divided into the depressive symptom group and the non-depressive symptom group. R 4.3.0 software was used to compare the data differences between the two groups. Multivariate logistic regression analysis was used to screen the independent predictors of early depressive symptoms after acute ischemic stroke. Backward stepwise regression was applied to determine the final variables for constructing the prediction model. The model’s performance was evaluated using the ROC curve.
Results  A total of 211 patients with acute ischemic stroke were ultimately included in this study, with 110 patients (52.13%) in the non-depressive symptom group and 101 patients (47.87%) in the depressive symptom group. Compared with the non-depressive symptom group, the depressive symptom group had lower LDL-C and red blood cell count, but higher admission C-reactive protein, admission NIHSS score, mRS score, Hamilton anxiety scale (HAMA) score, HAMD score, and discharge NIHSS score (all P＜0.05). Imaging analysis showed that the depressive symptom group had a higher proportion of multiple infarctions and infarctions in the frontal lobe and thalamus (all P＜0.05). Multivariate logistic regression analysis showed that admission C-reactive protein, admission NIHSS score, mRS score, HAMD score, frontal lobe infarction, and multiple infarctions were independent risk factors for early depressive symptoms after acute ischemic stroke (all P＜0.05). Discharge NIHSS score was an independent protective factor, while red blood cell count and HAMA score were potential protective and risk factors, respectively. The prediction model constructed based on these factors demonstrated an AUC of 0.923 (95%CI 0.888-0.959). The Hosmer-Lemeshow test yielded a χ2 value of 8.244 (P=0.41). At the optimal cutoff value of 0.763 determined by the maximum Youden index, the model achieved a sensitivity of 88.1% and a specificity of 88.2%. 
Conclusions  The admission C-reactive protein, admission NIHSS score, mRS score, HAMD score, discharge NIHSS score, frontal lobe infarction, and multiple infarctions are important influencing factors for early depressive symptoms after acute ischemic stroke. The prediction model constructed based on these factors has good clinical discrimination efficiency.


Trends and Predictions of Ischemic Stroke Incidence and Disease Burden among Middle-Aged and Older Adults in China and the United Kingdom

WANG Jinhua, LIN Sihan, CHEN Shuqi, ZHENG Huiyan, YANG Huiwen, LIN Yanwei

2025, 20(12):  1547-1557.  DOI: 10.3969/j.issn.1673-5765.2025.12.010

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Objective  To assess and predict the trends of ischemic stroke (IS) incidence and disability-adjusted life years (DALYs) among middle-aged and older adults in China and the United Kingdom, and to provide evidence for formulating IS prevention policies in countries at different developmental stages.
Methods  Data were retrieved from the global burden of disease database 2021, including the number of IS cases, DALYs, and their crude rates among adults aged 40 years and above (middle-aged and older adults) in China and the United Kingdom. The estimated annual percentage change (EAPC) was used to analyze the temporal trends. The age-period-cohort model was applied to estimate the effects of age, period, and birth cohort. Additionally, the Bayesian age-period-cohort model was used to predict the number of IS cases, age-standardized incidence rate, DALYs, and age-standardized DALYs rate among middle-aged and older adults in the two countries from 2022 to 2035.
Results  Between 1990 and 2021, the EAPC of IS age-standardized incidence rate among middle-aged and older adults in China was 0.99% (P<0.001), while the EAPC of IS age-standardized DALYs rate was -0.49% (P<0.001). In the United Kingdom, the EAPCs of IS age-standardized incidence rate and age-standardized DALYs rate in this population were -2.42% and -4.41%, respectively (both P<0.001). Age effect analysis indicated that the RR of IS age-standardized incidence rate increased most rapidly between the 55-59 and 60-64 year age groups in Chinese middle-aged and older adults, whereas the RR of IS age-standardized DALYs rate increased most rapidly between the 45-49 and 50-54 year age groups. The RRs of both IS age-standardized incidence rate and age-standardized DALYs rate in middle-aged and older adults in the United Kingdom continued to rise with increasing age. Period effect analysis indicated that the RRs of age-standardized incidence rate and age-standardized DALYs rate of IS in Chinese middle-aged and older adults both presented an upward trend between 1990 and 2021, whereas those in the United Kingdom showed a trend of initial decrease followed by a slight increase. Projections indicated that by 2035, the EAPCs of IS age-standardized incidence rate and age-standardized DALYs rate among Chinese middle-aged and older adults would be 2.71% and 1.62%, respectively (both P<0.001). Meanwhile, the EAPC of IS age-standardized incidence rate among middle-aged and older adults in the United Kingdom would be 0.92% (P<0.001), the EAPC of age-standardized DALYs rate was -0.28%, with no statistical significance. 
Conclusions  Strengthening health management for IS among middle-aged and older adults remains a common public health priority for countries at different developmental stages.




Non-Ketotic Hyperglycemia Encephalopathy with Stroke-like Episodes in a Young Adult: A Case Report and Literature Review

TAN Yi, YU Linjie, XU Yun

2025, 20(12):  1558-1564.  DOI: 10.3969/j.issn.1673-5765.2025.12.011

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Non-ketotic hyperglycemia (NKH) encephalopathy is a relatively rare disease with diverse manifestations, which is easily misdiagnosed or underdiagnosed. This paper reports a case of a young patient with NKH encephalopathy who exhibited stroke-like episodes as the primary symptom. It reviews the clinical manifestations, imaging features, diagnosis, and management of the case, illustrating the lesion features through multimodal MRI. Furthermore, this paper summarizes the core neuroimaging characteristics and underlying pathophysiological mechanisms of NKH encephalopathy, aiming to provide reliable imaging evidence for disease diagnosis.



A Case Report of N₂O Abuse-Induced Straight Sinus Thrombosis in a Female Patient Harboring MTHFR C677T Homozygous Mutation

LI Xue, SHI Jina, LIU Yanjun, LIU Wei

2025, 20(12):  1565-1570.  DOI: 10.3969/j.issn.1673-5765.2025.12.012

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Cerebral venous thrombosis (CVT) is a rare type of stroke pathologically characterized by thrombus formation within the intracranial veins or venous sinuses. This paper reports a case of a patient harboring a homozygous mutation (TT genotype) of methylenetetrahydrofolate reductase (MTHFR) C677T, who developed straight sinus thrombosis following nitrous oxide (N2O) inhalation and hyperhomocysteinemia, with concurrent vitamin B12 deficiency and megaloblastic anemia. After six months of anticoagulation therapy, along with vitamin B12 and folic acid supplementation, the patient’s symptoms improved, and the extent of straight sinus thrombosis significantly decreased. This case suggests that genetic susceptibility (MTHFR 677TT genotype), environmental exposure (N2O abuse), and vitamin B12 deficiency collectively contribute to the pathophysiological process of CVT. This case report enhances clinicians’ awareness of early screening and intervention for high-risk populations, and it also holds significant social significance in advocating public prevention and control of N2O abuse.



A Case Report of Klinefelter Syndrome Presenting with Ischemic Stroke as the Initial Manifestation

GONG Yutian, LIANG Xinming, QU Hui, ZHOU Heng, CHEN Weiqi, WANG Yilong

2025, 20(12):  1571-1575.  DOI: 10.3969/j.issn.1673-5765.2025.12.013

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Klinefelter syndrome (KS) is a rare congenital disorder caused by a sex chromosome abnormality (47, XXY). Its associated glucose and lipid metabolism disorders increase the risk of ischemic stroke in affected individuals. Therefore, early diagnosis and timely intervention are crucial for improving patient prognosis. This article reports the diagnosis and treatment process of a case of ischemic stroke associated with KS and reviews the relevant literature to elaborate on the clinical characteristics, pathogenesis, treatment, and prognosis. By emphasizing the value of multidisciplinary collaboration in the management of stroke with complex etiologies, this article aims to provide clinical insights for the diagnosis and treatment of cerebrovascular diseases related to KS.



Construction and validation of a Biological Sample Quality Management System for Multicenter Clinical Research of Cerebrovascular Diseases

LIN Jinxi, LI Shangzhi, WANG Mengxing, MENG Xia

2025, 20(12):  1576-1582.  DOI: 10.3969/j.issn.1673-5765.2025.12.014

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Objective  To explore the role of the quality management system in enhancing the standardized management of biological samples in multicenter clinical research on cerebrovascular diseases, thereby providing evidence for promoting the quality improvement of biological samples in multicenter clinical research.
Methods  Based on the actual needs of specialized cohort studies on cerebrovascular diseases and referring to the experience of previous multicenter clinical trial projects, this paper explores the biological sample management process suitable for multicenter clinical research on cerebrovascular diseases in China from multiple dimensions such as pre-preparation, protocol design, operation norms, and quality management.
Results  A full-process quality management system for biological samples in multicenter clinical research on cerebrovascular diseases has been established to standardize the quality management of biological samples in multicenter clinical research projects.
Conclusions  Implementing a unified and standardized biological sample quality management system in multicenter clinical research can provide high-quality biological sample resources for clinical research on cerebrovascular diseases, facilitating the development of precision medicine research and resource sharing in this field.


Advances of Residual Inflammatory Risk in Cerebral Artery Atherosclerotic Disease

SHI Xinxin, YU Ying, HE Xin, LOU Yake, MA Ning

2025, 20(12):  1583-1589.  DOI: 10.3969/j.issn.1673-5765.2025.12.015

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Cerebral artery atherosclerotic disease (CAAD) is a major pathological basis of ischemic stroke. Recent studies have identified residual inflammatory risk (RIR) as a key driver of atherosclerotic progression and recurrent vascular events. Current evidence indicates that RIR is strongly associated with vulnerable plaques in both intracranial and carotid arteries and independently predicts stroke recurrence and poor functional outcomes, with a stronger correlation particularly in patients with large-artery atherosclerosis. Although anti-inflammatory therapy has shown clear benefits in coronary heart disease, its efficacy in cerebrovascular disease remains controversial. Trials of colchicine have yielded inconsistent results, while agents targeting the IL-1β or IL-6 pathways (such as Canakinumab and Ziltivekimab) are still under investigation. Overall, RIR is evolving from a simple inflammatory marker to a potential therapeutic target. It shows promise for stratifying high-risk CAAD patients and for informing precision anti-inflammatory strategies, including combined lipid-lowering and anti-inflammatory (dual-target) approaches.



No-Reflow Phenomenon after Mechanical Thrombectomy for Acute Ischemic Stroke with Large Vessel Occlusion: Imaging Assessment and Treatment Progress

YANG Keke, LI Chenwei, WANG Xiaojun, RAN Jianglin, FENG Zhiheng, PENG Huiyuan

2025, 20(12):  1590-1597.  DOI: 10.3969/j.issn.1673-5765.2025.12.016

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Mechanical thrombectomy is the standard treatment for acute ischemic stroke with large vessel occlusion (AIS-LVO) within 24 hours of onset. However, some patients who achieve successful vascular recanalization after mechanical thrombectomy still suffer from insufficient microcirculatory perfusion in the ischemic area, a condition known as no-reflow phenomenon (NRP). NRP following mechanical thrombectomy can significantly compromise the prognosis of AIS-LVO patients. As current angiography cannot effectively identify no-reflow areas, accurate assessment, prevention, and treatment of NRP remain challenges. This article systematically reviews the imaging assessment methods, prevention and treatment strategies of NRP after mechanical thrombectomy in AIS-LVO patients based on recent domestic and international literature, with the aim of providing a reference for clinical decision-making.