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| 1 | China Stroke Statistics 2019:A Report From the National Center for Healthcare Quality Management in Neurological Diseases,China National Clinical Research Center for Neurological Diseases,the Chinese Stroke Association,National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations显示文摘China faces the greatest challenge from stroke in the world.The death rate for cerebrovascular diseases in China was 149.49 per 100000,accounting for 1.57 million deaths in 2018.It ranked third among the leading causes of death behind malignant tumours and heart disease.The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100000 population and 246.8 per 100000 person-years,respectively.According to the Global Burden of Disease Study 2017,the years of life lost(YLLs)per 100000 population for stroke increased by 14.6%;YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017.The absolute numbers and rates per 100000 population for all-age disability-adjusted life years(DALYs)for stroke increased substantially between 1990 and 2017,and stroke was the leading cause of all-age DALYs in 2017.The main contributors to cerebrovascular diseases include behavioural risk factors(smoking and alcohol use)and pre-existing conditions(hypertension,diabetes mellitus,dyslipidaemia and atrial fibrillation(AF)).The most prevalent risk factors among stroke survivors were hypertension(63.0%-84.2%)and smoking(31.7%-47.6%).The least prevalent was AF(2.7%-7.4%).The prevalences for major risk factors for stroke are high and most have increased over time.Based on the latest national epidemiological data,26.6%of adults aged≥15 years(307.6 million adults)smoked tobacco products.For those aged≥18 years,age-adjusted prevalence of hypertension was 25.2%;adjusted prevalence of hypercholesterolaemia was 5.8%;and the standardised prevalence of diabetes was 10.9%.For those aged≥40 years,the standardised prevalence of AF was 2.31%.Data from the Hospital Quality Monitoring System showed that 3010204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018.Of those,2466785(81.9%)were ischaemic strokes(ISs);447609(14.9%)were intracerebral haemorrhages(ICHs);and 95810(3.2%)were subarachnoid haemorrhages(SAHs).The average age of patients admitted was 66 years old,and nearly 60%were male.A total of 1555(0.1%),2774(0.6%)and 1347(1.4%)paediatric strokes(age<18 years)were identified among IS,ICH and SAH,respectively.Over one-third(1063892(35.3%))of the patients were covered by urban resident basic medical insurance,followed by urban employee basic medical insurance(699513(23.2%))and new rural cooperative medical schema(489361(16.3%)).The leading risk factor was hypertension(67.4%for IS,77.2%for ICH and 49.1%for SAH),and the leading comorbidity was pneumonia or pulmonary infection(10.1%for IS,31.4%for ICH and 25.2%for SAH).In-hospital death/discharge against medical advice rate was 8.3%for stroke inpatients,ranging from 5.8%for IS to 19.5%for ICH.The median and IQR of length of stay was 10.0(7.0-14.0)days,ranging from 10.0(7.0-13.0)in IS to 14.0(8.0-22.0)in SAH.Data from the Chinese Stroke Center Alliance demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS,ICH and SAH were 0.77±0.21,0.72±0.28 and 0.59±0.32,respectively. | Yong-Jun Wang Zi-Xiao Li Hong-Qiu Gu Yi Zhai Yong Jiang Xing-Quan Zhao Yi-Long Wang Xin Yang Chun-Juan Wang Xia Meng Hao Li Li-Ping Liu Jing Jing Jing Wu An-Ding Xu Qiang Dong David Wang Ji-Zong Zhao On behalf of China Stroke Statistics 2019 Writing Committee | 2020 | Stroke & Vascular Neurology2020，5，3： | 181 |
| 2 | Artificial intelligence in healthcare:past,present and future显示文摘Artificial intelligence(AI)aims to mimic human cognitive functions.It is bringing a paradigm shift to healthcare,powered by increasing availability of healthcare data and rapid progress of analytics techniques.We survey the current status of AI applications in healthcare and discuss its future.AI can be applied to various types of healthcare data(structured and unstructured).Popular AI techniques include machine learning methods for structured data,such as the classical support vector machine and neural network,and the modern deep learning,as well as natural language processing for unstructured data.Major disease areas that use AI tools include cancer,neurology and cardiology.We then review in more details the AI applications in stroke,in the three major areas of early detection and diagnosis,treatment,as well as outcome prediction and prognosis evaluation.We conclude with discussion about pioneer AI systems,such as IBM Watson,and hurdles for real-life deployment of AI. | Fei Jiang Yong Jiang Hui Zhi Yi Dong Hao Li Sufeng Ma Yilong Wang Qiang Dong Haipeng Shen Yongjun Wang | 2017 | Stroke & Vascular Neurology2017，2，4： | 76 |
| 3 | Update on cerebral small vessel disease: a dynamic whole-brain disease显示文摘Cerebral small vessel disease(CSVD)is a very common neurological disease in older people.It causes stroke and dementia,mood disturbance and gait problems.Since it is difficult to visualise CSVD pathologies in vivo,the diagnosis of CSVD has relied on imaging findings including white matter hyperintensities,lacunar ischaemic stroke,lacunes,microbleeds,visible perivascular spaces and many haemorrhagic strokes.However,variations in the use of definition and terms of these features have probably caused confusion and difficulties in interpreting results of previous studies.A standardised use of terms should be encouraged in CSVD research.These CSVD features have long been regarded as different lesions,but emerging evidence has indicated that they might share some common intrinsic microvascular pathologies and therefore,owing to its diffuse nature,CSVD should be regarded as a‘whole-brain disease’.Single antiplatelet(for acute lacunar ischaemic stroke)and management of traditional risk factors still remain the most important therapeutic and preventive approach,due to limited understanding of pathophysiology in CSVD.Increasing evidence suggests that new studies should consider drugs that target endothelium and blood–brain barrier to prevent and treat CSVD.Epidemiology of CSVD might differ in Asian compared with Western populations(where most results and guidelines about CSVD and stroke originate),but more community-based data and clear stratification of stroke types are required to address this. | Yulu Shi Joanna M Wardlaw | 2016 | Stroke & Vascular Neurology2016，1，3： | 74 |
| 4 | Trend of declining stroke mortality in China:reasons and analysis显示文摘Introduction There is a downward trend of stroke-related mortality in the USA.By reviewing all published articles on stroke mortality in China,we analysed its trend and possible factors that have influenced the trend.Methods Both English and Chinese literatures were searched on the mortality of stroke or cerebrovascular diseases in China.Potential papers related to this topic were identified from PubMed,Medline,Embase,Cochrane Library,Wanfang Database,SINOMED and China National Knowledge Infrastructure databases.Results Comparing the results from the most recent population-based epidemiological survey and databank from the national Center for Disease Control and Prevention,the age-adjusted stroke mortality rate has shown a downward trend among both urban and rural population in the past 30 years in China.Comparing with 30 years ago,the rate of stroke mortality has decreased by more than 31%in urban/suburban population and 11%in rural population.In men,the age-adjusted stroke mortality rate decreased by 18.9%and in women by 24.9%between 1994 and 2013.Factors that may have contributed to the trend of decreased stroke mortality rate include(1)improved healthcare coverage and healthcare environment;(2)improved treatment options and medical technology;(3)support by government to educate the public on stroke and stroke prevention;and(4)improved public knowledge on stroke.Conclusions The age-adjusted stroke mortality rate in China has shown a downward trend among both urban and rural population in the past 30 years.The major influencing factors that helped in reducing stroke mortality in China included improved healthcare coverage,healthcare environment,the updated treatment options and modern medical technology. | Wenzhi Wang David Wang Hongmei Liu Haixin Sun Bin Jiang Xiaojuan Ru Dongling Sun Zhenghong Chen Yongjun Wang | 2017 | Stroke & Vascular Neurology2017，2，3： | 52 |
| 5 | The Chinese Stroke Association scientific statement:intravenous thrombolysis in acute ischaemic stroke显示文摘The most effective medical treatment for acute ischaemic stroke(AIS)is to offer intravenous thrombolysis during the ultra-early period of time after the onset.Even based on the Consensus of Chinese Experts on Intravenous Thrombolysis for AIS in 2012 and 2014 Chinese Guidelines on the Diagnosis and Treatment of AIS,the rate of thrombolysis for AIS in China remained around 2.4%,and the rate of intravenous tissue plasminogen activator usage was only about 1.6%in real world.The indication of thrombolysis for AIS has been expanded,and contraindications have been reduced with recently published studies.In order to facilitate the standardisation of treating AIS,improve the rate of thrombolysis and benefit patients who had a stroke,Chinese Stroke Association has organised and developed this scientific statement. | Qiang Dong Yi Dong Liping Liu Anding Xu Yusheng Zhang Huaguang Zheng Yongjun Wang 无 | 2017 | Stroke & Vascular Neurology2017，2，3： | 56 |
| 6 | Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases显示文摘Aim Stroke is the leading cause of disability and death in China.Ischaemic stroke accounts for about 60%-80%of all strokes.It is of considerable significance to carry out multidimensional management of ischaemic cerebrovascular diseases.This evidence-based guideline aims to provide the latest detailed and comprehensive recommendations on the diagnosis,treatment and secondary prevention of ischaemic cerebrovascular diseases.Methods We had performed comprehensive searches of MEDLINE(via PubMed)(before 30 June 2019),and integrated the relevant information into charts and distributed to the writing group.Writing group members discussed and determined the recommendations through teleconference.We used the level of evidence grading algorithm of Chinese Stroke Association to grade each recommendation.The draft was reviewed by the Guideline Writing Committee of Chinese Stroke Association Stroke and finalised.This guideline is fully updated every 3 years.results This evidence-based guideline is based on the treatment,care and prevention of ischaemic cerebrovascular diseases,which emphasises on pathogenesis evaluation,intravenous thrombolysis,endovascular therapy,antiplatelet therapy,prevention and treatment of complications,and risk factor management.Conclusions This updated guideline presents a framework for the management of ischaemic cerebrovascular diseases.Timely first-aid measures,professional care in the acute stage,and proactive secondary prevention will be helpful to patients. | Liping Liu Weiqi Chen Hongyu Zhou Wanying Duan Shujuan Li Xiaochuan Huo Weihai Xu Li'an Huang Huaguang Zheng Jingyi Liu Hui Liu Yufei Wei Jie Xu Yongjun Wang | 2020 | Stroke & Vascular Neurology2020，5，2： | 42 |
| 7 | The efficacy and safety of endovascular recanalization of occluded large cerebral arteries during the subacute phase of cerebral infarction:a case series report显示文摘background Intravenous tissue plasminogen activator with or without mechanical thrombectomy during the acute phase are approved therapies for ischaemic stroke.Due to the short treatment time window(<6 hours)and often treatment failure,these patients would still have an intracranial arterial occlusion(IAO).It is unclear whether these patients can benefit from subsequent interventional recanalizationof their occluded artery in the subacute phase.In this retrospective study,we have examined the efficacy and safety in patients who have received either percutaneous transluminal angioplasty(PTA)or percutaneous transluminal angioplasty and stenting(PTAS)for IAO in the subacute phase of their stroke.Methods Patients with subacute symptomatic ischaemic stroke caused by IAO were assessed to identify the responsible artery and low perfusion areas by CT angiography,MR angiography or digital subtraction angiography.In eligible patients,a PTA or PTAS was performed to reopen the occluded artery.Regular antithrombotic therapy,use of statins,control of risk factors and rehabilitation therapy were prescribed after the procedure.All patients had regular follow-up up to 12 months.results PTA or PTAS was performed in 16 patients with cerebral infarction caused by IAO in the subacute phase.After the procedure,12 cases were recanalized,two were partially recanalized and two failed to open.One patient with left C6 segment occlusion of the carotid artery had a central retinal artery embolism after PTAS.The perioperative adverse events were 6.25%.At 3 months,the distribution of modified Rankin scale scores was 0(seven cases),1(three cases),2(five cases)and 3(one case).conclusion Selective PTA or PTAS could be performed in ischaemic stroke patients with a small infarct size and large area of hypoperfusion from an occluded large cerebral artery after the acute phase.It may improve neurological dysfunction and reduce the incidence of disability. | Kangning Chen Xianhua Hou Zhenhua Zhou Guangjian Li Qu Liu Li Gui Jun Hu Shugui Shi | 2017 | Stroke & Vascular Neurology2017，2，3： | 41 |
| 8 | Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders:executive summary and 2019 update of clinical management of stroke rehabilitation显示文摘Stroke is the third leading cause of long-term disability.Effective stroke rehabilitation should be provided to patients with a moderate or severe stroke so as to achieve functional recovery.Also,stroke rehabilitation is moving towards more intense therapy models that incorporate technologies such as robotics and computer games.Evidence-based guidelines are useful for promoting the best possible clinical practices.This guideline summarises the modes of stroke rehabilitation in China-three-stage rehabilitation network,rehabilitation of stroke dysfunction,training for activities of daily living,stroke complications and rehabilitation care.The aim of this guideline was to provide a synopsis of best clinical practices in the stroke rehabilitation of adult patients in China. | Tong Zhang Jun Zhao Xueping Li Yulong Bai Baojun Wang Yun Qu Bingjie Li Shengjie Zhao Chinese Stroke Association Stroke Council Guideline Writing Committee | 2020 | Stroke & Vascular Neurology2020，5，3： | 38 |
| 9 | Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017显示文摘Collateral circulation plays a vital role in sustaining blood flow to the ischaemic areas in acute,subacute or chronic phases after an ischaemic stroke or transient ischaemic attack.Good collateral circulation has shown protective effects towards a favourable functional outcome and a lower risk of recurrence in stroke attributed to different aetiologies or undergoing medical or endovascular treatment.Over the past decade,the importance of collateral circulation has attracted more attention and is becoming a hot spot for research.However,the diversity in imaging methods and criteria to evaluate collateral circulation has hindered comparisons of findings from different cohorts and further studies in exploring the clinical relevance of collateral circulation and possible methods to enhance collateral flow.The statement is aimed to update currently available evidence and provide evidence-based recommendations regarding grading methods for collateral circulation,its significance in patients with stroke and methods under investigation to improve collateral flow. | Liping Liu Jing Ding Xinyi Leng Yuehua Pu Li-An Huang Anding Xu Ka Sing Lawrence Wong Xin Wang Yongjun Wang 无 | 2018 | Stroke & Vascular Neurology2018，3，3： | 37 |
| 10 | Insomnia is associated with increased mortality in patients with first-ever stroke:a 6-year follow-up in a Chinese cohort study显示文摘Objective Insomnia is a highly prevalent disorder among patients suffering from stroke.The association between insomnia and stroke mortality is less studied,particularly using the latest diagnostic criteria.The current study examined the relationship between insomnia and mortality among patients with first-evonal hazard models were used to calculate HRs for stroke er stroke in China.Methods Patients with acute cerebrovascular diseases(stroke)were recruited from 56 hospitals in China's Mainland.Insomnia was defined as difficulty falling asleep,or difficulty staying asleep or waking up early,for at least two consecutive visits.Demographic data,medical history and clinical data were collected.Four follow-up visits occurred within the first year after stroke,and the last follow-up call was conducted 6 years later.Cox proportional hazard models were used to calculate HRs for stroke mortality.results Insomnia was reported by 38.4%(489/1273)of patients at baseline.During the 6 years of follow-up,after adjusting for all confounders,insomnia was found to be associated with increased mortality(HR=1.66,95%CI 1.10 to 2.48).Old age(HR=1.08,95%CI 1.06 to 1.10),stroke recurrence in the first year of follow-up(HR=2.53,95%CI 1.48 to 4.31)and stroke survivors with hypertension(HR=1.62,95%CI 1.04 to 2.53)had substantially higher risk of mortality.Conclusions Besides old age,stroke recurrence in the first year of follow-up and hypertension,insomnia is associated with increased risk of mortality in patients with first-ever stroke in China.More studies about prompt and efficient interventions for insomnia are expected in the future.Trial registration number rctn62169508. | Li-Jun Li Yang Yang Bo-Yuan Guan Qi Chen An-Xin Wang Yong-Jun Wang Ning Zhang Chun-Xue Wang | 2018 | Stroke & Vascular Neurology2018，3，4： | 38 |
| 11 | Chinese Stroke Center Alliance:a national effort to improve healthcare quality for acute stroke and transient ischaemic attack:rationale,design and preliminary findings显示文摘Background In June 2015,the Chinese Stroke Association(CSA)initiated the Chinese Stroke Center Alliance(CSCA)to establish the national hospital-based stroke care quality assessment and improvement platform.This article outlines its objectives,operational structure,patient population,quality improvement(QI)intervention tools,data elements,data collection methodology and current patient and hospital data.Methods The CSCA is a national,hospital-based,multicentre,voluntary,multifaceted intervention and continuous QI initiative.This multifaceted intervention includes stroke centre development,written care protocols,workshops and a monitoring/feedback system of evidencebased performance measures.The data coordinating centre of the CSCA resides at the China National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital.results As of July 2017,1576 hospitals in China have contributed detailed clinical information to serve as a benchmark for the stroke care quality of 433264 patients with acute stroke/transient ischaemic attacks(TIA),including 352572(81.38%)acute ischaemic stroke,30362(7.01%)TIA,42080(9.71%)spontaneous intracranial haemorrhage,5505(1.27%)subarachnoid haemorrhage and 2745(0.63%)not specified stroke.Conclusion The CSCA programme is designed to establish a continuous national stroke registry and help healthcare providers develop stroke centres and treat patients in a consistent manner in accordance with accepted national guidelines and,ultimately,improve patient outcomes.It supports the CSA mission to reduce stroke burden in China. | Yongjun Wang Zixiao Li Yilong Wang Xingquan Zhao Liping Liu Xin Yang Caiyun Wang Hongqiu Gu Fuying Zhang Chunjuan Wang Ying Xian David Z Wang Qiang Dong Anding Xu Jizong Zhao Chinese Stroke Center Alliance investigators | 2018 | Stroke & Vascular Neurology2018，3，4： | 38 |
| 12 | Iron toxicity, lipid peroxidation and ferroptosis after intracerebral haemorrhage显示文摘Intracerebral haemorrhage (ICH) is a devastating type of stroke with high mortality and morbidity. However, we have few options for ICH therapy and limited knowledge about post-ICH neuronal death and related mechanisms. In the aftermath of ICH, iron overload within the perihaematomal region can induce lethal reactive oxygen species (ROS) production and lipid peroxidation, which contribute to secondary brain injury. Indeed, iron chelation therapy has shown efficacy in preclinical ICH studies. Recently, an iron-dependent form of non-apoptotic cell death known as ferroptosis was identified. It is characterised by an accumulation of iron-induced lipid ROS, which leads to intracellular oxidative stress. The ROS cause damage to nucleic acids, proteins and lipid membranes, and eventually cell death. Recently, we and others discovered that ferroptosis does occur after haemorrhagic stroke in vitro and in vivo and contributes to neuronal death. Inhibition of ferroptosis is beneficial in several in vivo and in vitro ICH conditions. This minireview summarises current research on iron toxicity, lipid peroxidation and ferroptosis in the pathomechanisms of ICH, the underlying molecular mechanisms of ferroptosis and the potential for combined therapeutic strategies. Understanding the role of ferroptosis after ICH will provide a vital foundation for cell death-based ICH treatment and prevention. | Jieru Wan Honglei Ren Jian Wang | 2019 | Stroke & Vascular Neurology2019，4，2： | 32 |
| 13 | Stenting for symptomatic intracranial arterial stenosis in China:1-year outcome of a multicentre registry study显示文摘background and purpose A multicentre prospective registry study of individually tailored stenting for a patient with symptomatic intracranial atherosclerotic stenosis(ICAS)combined with poor collaterals in China showed that the short-term safety and efficacy of stenting was acceptable.However,it remained uncertain whether the low event rate could be of a long term.We reported the 1-year outcome of this registry study to evaluate the long-term efficacy of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.Methods Patients with symptomatic ICAS caused by 70%-99% stenosis located at the intracranial internal carotid,middle cerebral,intracranial vertebral or basilar arteries combined with poor collaterals were enrolled.Balloon-mounted stent or balloon plus self-expanding stent were selected based on the ease of vascular access and lesion morphology determined by the operators.The primary outcome was the rate of 30-day stroke,transient ischaemic attack and death,and 12-month ischaemic stroke within the same vascular territory,haemorrhagic stroke and vascular death after stenting.results From September 2013 to January 2015,300 patients(ages 58.3±9.78 years)were recruited.Among them,159 patients were treated with balloon-mounted stent and 141 with balloon plus self-expanding stent.During the 1-year follow-up,25 patients had a primary end point event.The probability of primary outcome at 1 year was 8.1%(95% CI 5.3% to 11.7%).In 76 patients with digital subtraction angiography follow-up,27.6%(21/76)had re-stenosis≥50% and 18.4%(14/76)had re-stenosis≥70%.No baseline characteristic was associated with the primary outcome.Conclusion The event rate remains low over 1 year of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.Further randomised trial of comparing individually tailored stenting with best medical therapy is needed. | Ning Ma Yong Zhang Jie Shuai Changchun Jiang Qiyi Zhu Kangning Chen Li Liu Baomin Li Xiangqun Shi Lianbo Gao Yajie Liu Feng Wang Yongli Li Tieyan Liu Hongbo Zheng Dapeng Mo Feng Gao Yilong Wang Yongjun Wang Lei Feng Zhongrong Miao | 2018 | Stroke & Vascular Neurology2018，3，3： | 29 |
| 14 | Reversible Middle Cerebral Artery Occlusion Without Craniectomy in Rats显示文摘 | Enrique Zea Longa Philip R. Weinstein Sara Carlson Robert Cummins | 1989 | Stroke1989，，1： | 27 |
| 15 | Ginkgo biloba extract improved cognitive and neurological functions of acute ischaemic stroke:a randomised controlled trial显示文摘Purpose To evaluate the efficacy and safety of Ginkgo biloba extract(GBE)in acute ischaemic stroke and its impact on the recurrence of vascular events.Methods We conducted a multicentre,prospective,randomised,open label,blinded,controlled clinical trial enrollingpatients with an onset of acute stroke within 7 days from five hospitals in China Jiangsu Province.Participants were assigned to the GBE group(450 mg GBE with 100 mg aspirin daily)or the control group(100 mg aspirin daily)for 6 months.The primary outcome was the decline in the Montreal Cognitive Assessment score at 6 months.Secondary outcomes were other neuropsychological tests of cognitive and neurological function,the the incidence of adverse events and vascular events.results 348 patients were enrolled:179 in the GBE group and 169 in the control group.With 18 patients lost to follow-up,the dropout rate was 5.17%.Admission data between two groups were similar,but in the GBE group there was a marked slow down in the decline in the Montreal Cognitive Assessment scores(−2.77±0.21 vs−1.99±0.23,P=0.0116(30 days);−3.34±0.24 vs−2.48±0.26,P=0.0165(90 days);−4.00±0.26 vs−2.71±0.26,P=0.0004(180 days))compared with controls.The National Institutes of Health Stroke Scale scores at 12 and 30 days,the modified Rankin Scale scores for independent rate at 30,90 and 180 days,and the Barthel Index scores at 30,90 and 180 days in the GBE group were significantly improved compared with controls.Improvements were also observedin GBE groups for Mini-Metal State Examination scores of 30,90 and 180 days,Webster's digit symbol test scores at 30 days and Executive Dysfunction Index scores at 30 and 180 days.No significant differences were seen in the incidence of adverse events or vascular events.conclusions We conclude that GBE in combination with aspirin treatment alleviated cognitive and neurological deficits after acute ischaemic stroke without increasing the incidence of vascular events. | Shanshan Li Xinjiang Zhang Qi Fang Junshan Zhou Meijuan Zhang Hui Wang Yan Chen Biyun Xu Yanfeng Wu Lai Qian Yun Xu | 2017 | Stroke & Vascular Neurology2017，2，4： | 25 |
| 16 | Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke:a meta-analysis显示文摘The benefits and safety of intravenous recombinant tissue plasminogen activator(IV-tPA)for patients with mild ischaemic stroke(MIS)are still unclear.The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS.We performed a systematic literature search across MEDLINE,Embase,Central,Global Health and Cumulative Index to Nursing and Allied Health Literature(CINAHL),from inception to 10 November 2016,to identify all related studies.Where possible,data were pooled for meta-analysis with odds ratio(OR)and corresponding 95%confidence interval(CI)using the fixed-effects model.MIS was defined as having National Institutes of Health Stroke Scale score of≤6.We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria.The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0-1(OR=1.43;95%CI 1.14 to 1.79;P=0.002,I2=35%)in patients treated with IV-tPA compared with those not treated with IV-tPA(74.8%vs 67.6%).There was a high risk of symptomatic intracranial haemorrhage(sICH)with IV-tPA treatment(OR=10.13;95%CI 1.93 to 53.02;P=0.006,I2=0%)(1.9%vs 0.0%)but not mortality(OR=0.78;95%CI 0.43 to 1.43;P=0.43,I2=0%)(2.4%vs 2.9%).Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS,although there was an increased risk of sICH.Randomised trials are warranted to confirm these findings. | Shoujiang You Anubhav Saxena Xia Wang WeeYong Tan Qiao Han Yongjun Cao Chun-Feng Liu | 2018 | Stroke & Vascular Neurology2018，3，1： | 24 |
| 17 | Red blood cell distribution width and ischaemic stroke显示文摘The red blood cell distribution width(RDW)is a measure of red blood cell(RBC)size heterogeneity,which is easily calculated by dividing the SD of erythrocyte volumes for the mean corpuscular volume.Recent reporter suggested that,besides haematological diseases and anaemia,many human disorders may be closely associated with the elevated RDW.A literature review has revealed the RDW may be closely related to the development of ischaemic stroke,carotid artery atherosclerosis and cerebral embolism.Higher RDW could independently predict adverse outcomes in patients in these conditions. | Gang-Hua Feng Hai-Peng Li Qiu-Li Li Ying Fu Ren-Bin Huang | 2017 | Stroke & Vascular Neurology2017，2，3： | 24 |
| 18 | Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study显示文摘Background and purpose COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2).Apart from respiratory complications,acute cerebrovascular disease(CVD)has been observed in some patients with COVID-19.Therefore,we described the clinical characteristics,laboratory features,treatment and outcomes of CVD complicating SARS-CoV-2 infection.Materials and methods Demographic and clinical characteristics,laboratory findings,treatments and clinical outcomes were collected and analysed.Clinical characteristics and laboratory findings of patients with COVID-19 with or without new-onset CVD were compared.Results Of 219 patients with COVID-19,10(4.6%)developed acute ischaemic stroke and 1(0.5%)had intracerebral haemorrhage.COVID-19 with new onset of CVD were significantly older(75.7±10.8 years vs 52.1±15.3 years,p<0.001),more likely to present with severe COVID-19(81.8%vs 39.9%,p<0.01)and were more likely to have cardiovascular risk factors,including hypertension,diabetes and medical history of CVD(all p<0.05).In addition,they were more likely to have increased inflammatory response and hypercoagulable state as reflected in C reactive protein(51.1(1.3-127.9)vs 12.1(0.1-212.0)mg/L,p<0.05)and D-dimer(6.9(0.3-20.0)vs 0.5(0.1-20.0)mg/L,p<0.001).Of 10 patients with ischemic stroke;6 received antiplatelet treatment with aspirin or clopidogrel;and 3 of them died.The other four patients received anticoagulant treatment with enoxaparin and 2 of them died.As of 24 March 2020,six patients with CVD died(54.5%).Conclusion Acute CVD is not uncommon in COVID-19.Our findings suggest that older patients with risk factors are more likely to develop CVD.The development of CVD is an important negative prognostic factor which requires further study to identify optimal management strategy to combat the COVID-19 outbreak. | Yanan Li Man Li Mengdie Wang Yifan Zhou Jiang Chang Ying Xian David Wang Ling Mao Huijuan Jin Bo Hu | 2020 | Stroke & Vascular Neurology2020，5，3： | 22 |
| 19 | Chinese Atherosclerosis Risk Evaluation(CARE II)study:a novel cross-sectional,multicentre study of the prevalence of high-risk atherosclerotic carotid plaque in Chinese patients with ischaemic cerebrovascular events-design and rationale显示文摘Background:Carotid atherosclerotic plaque is identified as one of the main sources of ischaemic stroke.However,the prevalence of carotid high-risk atherosclerotic plaque in Chinese patients with ischaemic cerebrovascular events has been inconsistently reported and needs to be investigated in a large population.Objectives:The primary objective of CARE II study was to determine the prevalence and characteristics of high-risk features of atherosclerotic plaques in the carotid arteries in Chinese patients with recent ischaemic stroke or transient ischaemia attack(TIA).The relationship between carotid plaque features and cerebral infarcts,the differences of carotid plaque patterns among different regions of China and the gender specific characteristics of carotid plaque will be also determined.Study design:The CARE II study will enrol 1000 patients with recent ischaemic stroke or TIA and carotid plaque from 13 hospitals and medical centres across China.In this cross-sectional,non-randomised,observational,multicentre study,all patients will undergo carotid artery MRI of bilateral carotid arteries and routine brain MRI with standardised protocols.The MRI will be interpreted at core reading centres to evaluate the characteristics of morphology and compositions of carotid plaque.Conclusions:This is a cross-sectional,multicentre study to investigate the prevalence and characteristics of high-risk atherosclerotic carotid plaque in Chinese patients with stroke and TIA by using high-resolution MRI of vessel wall.This trial is sufficiently powered to demonstrate the prevalence of carotid high-risk plaque and to explore regional differences in Chinese patients who suffered stroke. | Xihai Zhao Rui Li Daniel S Hippe Thomas S Hatsukami Chun Yuan CARE-II Investigators | 2017 | Stroke & Vascular Neurology2017，2，1： | 21 |
| 20 | Contribution of diffusion,perfusion and functional MRI to the disconnection hypothesis in subcortical vascular cognitive impairment显示文摘Vascular cognitive impairment(VCI)describes all forms of cognitive impairment caused by any type of cerebrovascular disease.Early identification of VCI is quite difficult due to the lack of both sensitive and specific biomarkers.Extensive damage to the white matter tracts,which connect the cortical and subcortical regions,has been shown in subcortical VCI(SVCI),the most common subtype of VCI that is caused by small vessel disease.Two specific MRI sequences,including diffusion tensor imaging(DTI)and functional MRI(fMRI),have emerged as useful tools for identifying subtle white matter changes and the intrinsic connectivity between distinct cortical regions.This review describes the advantages of these two modalities in SVCI research and the current DTI and fMRI findings on SVCI.Using DTI technique,a variety of studies found that white matter microstructural damages in the anterior and superior areas are more specific to SVCI.Similarly,functional brain abnormalities detected by fMRI have also been mainly shown in anterior brain areas in SVCI.The characteristic distribution of brain abnormalities in SVCI interrupts the prefrontal-subcortical loop that results in cognitive impairments in particular domains,which further confirms the‘disconnection syndrome’hypothesis.In addition,another MRI technique,arterial spin labelling(ASL),has been used to describe the disconnection patterns in a variety of conditions by measuring cerebral blood flow.The role of the ASL technique in SVCI research is also assessed.Finally,the review proposes the application of multimodality fusion in the investigation of SVCI pathogenesis. | Qing Ye Feng Bai | 2018 | Stroke & Vascular Neurology2018，3，3： | 20 |
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