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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 | 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 |
| 3 | 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 |
| 4 | Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis显示文摘Aim Cerebral venous sinus thrombosis(CVST)is a less common cerebrovascular disease that predominantly affects young patients.The incidence of CVST is 2-5/10000000/year,accounting for 0.5%-1%of all stroke.To reduce mortality and morbidity associated with CVST,Chinese Stroke Association commissioned the authors to write the current guideline on the management of CVST.Methods PubMed(MEDLINE),CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July 2019.Data were synthesised by evidence tables.Each recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow Committees.Levels of evidence grading algorithm of Chinese Stroke Association was used to grade each recommendation.results This guideline mainly focuses on the diagnostic evaluation,therapeutic strategies and secondary prevention of CVST.CT/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected CVST.Anticoagulation therapy with low-molecular weight heparin should be initiated in patients with CVST immediately.After the acute stage,warfarin is recommended for 3-6 months to prevent the recurrence of CVST and other venous thromboembolic events.Conclusions The guideline summarises the current evidence regarding the management of CVST,and provides references for diagnosis,treatment and secondary prevention of CVST in China. | Yuhua Fan Jian Yu Hongbing Chen Jian Zhang Jiangang Duan Dapeng Mo Wenhao Zhu Bo Wang Fubing Ouyang Yicong Chen Linfang Lan Jinsheng Zeng Chinese Stroke Association Stroke Council CVST Guideline Writing Committee | 2020 | Stroke & Vascular Neurology2020，5，2： | 14 |
| 5 | Multidisciplinary experts consensus for assessment and management of vestibular migraine显示文摘Introduction Vestibular migraine (VM), a common disorder with familiar predisposition, is characterized by recurrent episode of dizziness or vertigo and accompanying symptoms of nausea, vomiting, and/or headaches.The patients with VM may require neurologic, emergency, or otorhinolaryngologic services, and the disorder is often misdiagnosed with posterior circulation ischemia (PCI) or transient ischemic attack (TIA), peripheral vestibular vertigo, Meniere’s disease (MD), and multiple (lacunar) cerebral infarctions.Report from population-based study showed that the prevalence of VM was up to 1%,^[1] which was one of the common disorders causing dizziness/vertigo, and the rate of misdiagnosis was up to 80%.[2] Thus, a multidisciplinary expert consensus about the definition, characteristics, related work-ups, and diagnostic criteria is needed for the accurate diagnosis and standardized management. | Stroke and Vertigo Association of Chinese Stroke Association Xiao-Kun Qi Xing-Quan Zhao | 2019 | Chinese Medical Journal2019，，2： | 14 |
| 6 | Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders:executive summary and 2019 update of the management of high-risk population显示文摘Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here,we present the evidence-based guideline suitable for the Chinese population.Methods Literature search of PubMed and Cochrane library(from January 1964 to June 2019)was done.After thorough discussion among the writing group members,recommendations were listed and summarised.This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.Results This evidence-based guideline was written in three parts:controlling the risk factors of stroke,utilisation of antiplatelet agents and assessing the risks of first-ever stroke.All recommendations were listed along with the recommending classes and levels of evidence.Conclusions This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China.Controlling related risk factors,appropriately using antiplatelet agents,assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China. | Yilong Wang Shangrong Han Haiqiang Qin Huaguang Zheng Bin Jiang Yong Cao Yuan Gao Ling Guan Qian Jia Yong Jiang Yuming Jiao Shuya Li Yapeng Li Zixiao Li Wei Liu Xiaojuan Ru Dongling Sun Haixin Sun Penglian Wang Tingting Wang Lixia Zong Lei Guo Xuewei Xie Yuming Xu Yuyuan Xu Xiaomeng Yang Yingying Yang Mengyuan Zhou Wenzhi Wang Chinese Stroke Association Stroke Council Guideline Writing Committee | 2020 | Stroke & Vascular Neurology2020，5，3： | 11 |
| 7 | Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders:executive summary and 2019 update on organizational stroke management显示文摘Aim Stroke is characterised by high morbidity,mortality and disability,which seriously affects the health and safety of the people.Stroke has become a serious public health problem in China.Organisational stroke management can significantly reduce the mortality and disability rates of patients with stroke.We provide this evidence-based guideline to present current and comprehensive recommendations for organisational stroke management.Methods A formal literature search of MEDLINE(1 January 1997 through 30 September 2019)was performed.Data were synthesised with the use of evidence tables.Writing group members met by teleconference to discuss data-derived recommendations.The Chinese Stroke Association’s Levels of Evidence grading algorithm was used to grade each recommendation.results Evidence-based guidelines are presented for the organisational management of patients presenting with stroke.The focus of the guideline was subdivided into prehospital first aid system of stroke,rapid diagnosis and treatment of emergency in stroke centre,organisational management of stroke unit and stroke clinic,construction of regional collaborative network among stroke centres and evaluation and continuous improvement of stroke medical quality.Conclusions The guidelines offer an organisational stroke management model for patients with stroke which might help dramatically. | Min Lou Jing Ding Bo Hu Yusheng Zhang Hao Li ZeFeng Tan Yan Wan An-Ding Xu Chinese Stroke Association Stroke Council Guideline Writing Committee | 2020 | Stroke & Vascular Neurology2020，5，3： | 7 |
| 8 | 脑梗死患者脑白质病变及其危险因素显示文摘目的探讨脑梗死患者脑白质病变(white matter lesions,WML)患病情况及其危险因素。方法采用多中心横断面研究和病例一病例对照研究。收集全国12家医院2004年5月至12月连续就诊的1~6个月内脑梗死患者720例的临床资料。分别对头 MRI 显示的脑梗死部位、大小、血管分布、血管类型做出判断,用年龄相关性白质改变评分法(Age-Related White Matter Changes Scales,ARWMC)测量脑白质病变,阅片者不了解患者的临床资料。采用 Logistic 回归检验独立危险因素。结果 MRI 图像质量完好700例[平均年龄(59.93±9.86)岁,男/女为481/219],WML 患病率77.4%,随年龄增长患病率和病变严重程度增加。额叶病变最多,程度最重。Logistic 回归显示高龄(OR 1.09,95%CI1.067~1.114)、舒张压升高(OR 1.039,95%CI1.018~1.06)、基底节梗死(OR2.244,95%CI1.609~3.708)与 WML 存在独立相关。结论脑梗死患者 WML 普遍存在。病变以额叶最明显。高龄、舒张压升高、基底节梗死是发生 WML 的独立危险因素。 | Cilostazol Stroke Prevention Study In China | 2007 | 中华神经科杂志2007，40，3： | 6 |
| 9 | Chinese expert consensus on the diagnosis of cardiogenic stroke(2019)显示文摘Cardioembolic stroke(CES),also known as cardiogenic stroke,refers to a clinical syndrome caused by a cardiogenic embolus from the heart,leading to cerebral artery embolism through circulation,and it consequently results in corresponding brain dysfunction.CES is associated with greater severity,poor outcomes,and a relatively high recurrence rate,compared with other subtypes of ischemic stroke. | Guang-Zhi Liu Rong Hu Dan-Tao Peng Geriatric Neurology Grop,Geriatric Branch of Chinese Medical Association Writing Group of Chinese expert consensus on diagnosis of cardiogenic stroke | 2021 | Chinese Medical Journal2021，，5： | 3 |
| 10 | Recommendationes on stroke prevention,iagnosis ,nd therapy显示文摘 | Report of the WHO Task Force on Stroke and other Cetebrovascular Disordes | 1989 | Stroke1989，0，10： | 2 |
| 11 | Guidelines for management of ischaemic stroke and transient ischaemic attack 2008显示文摘 | European Stroke Organisarion (ESO) Executive Committee ESO Writing Committee | | Cerebrovascular Diseases0，，： | 2 |
| 12 | A systems approach to immediate evaluation and management of hyperacute stroke : experience at eight centers and implications for community practice and patient care显示文摘 | The National Institute of Neurological Disorders and Stroke (NINDS) rt - PA Stroke Study Group | 1997 | Stroke1997，28，8： | 1 |
| 13 | Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke显示文摘 | The NINDS t-PA Stroke Study Group | 1997 | Stroke a journal of cerebral circulation1997，28，11： | 1 |
| 14 | Bleeding during antithrombotic therapy in patients with atrial fibrillation显示文摘 | The stroke prevention in atrial fibrillation investigation | 1996 | Arch Intern Med1996，156，： | 1 |
| 15 | Recommendations on stroke prevention, diagnosis and therapy显示文摘 | Report of the WHO task force on stroke and other cerebrovasular disorders | 1989 | Stroke1989，20，10： | 1 |
| 16 | Thrombolysis for acute ischemic stroke : results of the Canadian Aheplase for Stroke Effectiveness Study显示文摘 | Hill MD Buchan AM Canadian Aheplase for Stroke Effectiveness Study (CASES) Investigators | 2005 | CMAJ2005，172，10： | 1 |
| 17 | Guidelines for management of ischaemic stroke and transient ischaemic attack 2008 显示文摘 | European Stroke Organisation (ESO) Executive Committee ESO Writing Committee | 2008 | Cerebrovasc Dis2008，25，5： | 1 |
| 18 | Guidelines for management of ischaemic stroke and transient ischaemic attack 2008显示文摘 | The European Stroke Organisation(ESO)Executive Committee and the ESO Writing Committee | 2008 | Cerebrovasc Dis2008，25，： | 1 |
| 19 | Prioritizing interventions to improve rates of thrombolysis for ischemic stroke 显示文摘 | California Acute Stroke Pilot Registry (CASPR) Investigators | 2005 | Neurology2005，64，4： | 1 |
| 20 | CAST:randomized placebo - controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroker显示文摘 | Chinese acute stroke trial collaborative group | 1997 | Lancet1997，349，： | 1 |
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