Compilation of stroke research progress in 2022

Recently, Dr.
Sun Wen, Director of the Department of Neurology, The First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital), and Dr.
Zhang Hanhong produced a promotional video on stroke treatment and prevention, showing the cause of the disease and the treatment process from the perspective of the uncle's illness, and then popularizing the knowledge
of stroke to the public.
Authorized by
brainnews inside and outside of God.

"Cerebral stroke", also known as "stroke" and "cerebrovascular accident", is an acute cerebrovascular disease, mainly caused by sudden rupture of blood vessels in the brain or blood vessels blocked and blood cannot flow into the brain and causing brain tissue damage, including ischemic and hemorrhagic stroke
.
Revascularization and angiogenesis, as substrates for continuous collateral circulation, play a crucial role
in determining the severity and clinical outcome of acute ischemic stroke (AIS) caused by large vessel occlusion (LVO).
The development of auxiliary biomarkers to help identify and monitor collateral status will contribute to the diagnosis and prognosis
of stroke.
Recently, Wang Wei's team at Huazhong University of Science and Technology published a research paper
in Signal Transduction and Targeted Therapy.

To screen for potential biomarkers, proteomic analyses were performed in the study to identify those different plasma protein profiles
in AIS due to LVOs with different collateral states.
The study demonstrated that the FSAP inhibitor high molecular weight hyaluronic acid (HMW-HA) enhances proangiogenic vascular factors, improves the integrity of the cerebral blood barrier, and promotes ischemic newly formed cerebral microvessels, thereby improving neurological function
.
FSAP may represent a potential biomarker for posterior collateral status of LVO, as well as promising therapeutic targets to explore in stroke treatment
.
Ischemic stroke is one of the important causes of cognitive neurological dysfunction, and its main cause is a large number of neuronal apoptosis
.
Tetrahedral skeletal nucleic acids (tFNAs) have excellent biocompatibility and multiple biological functions, and researcher Lin Yunfeng of Sichuan University has studied
the neuronal protective performance of tFNA in ischemic stroke.

Studies have shown that tFNA effectively improves the ischemic hemispheric microenvironment by interfering with the in vitro ischemic cascade (excitotoxicity and oxidative stress) to prevent apoptosis of neurons (SHSY-5Y cells) caused by oxygen-glucose deprivation/reoxidation, thereby reversing neuronal loss
.
This study fully demonstrates that tFNA is a safe and versatile nanoneuroprotective agent, which is expected to be developed as an effective strategy
for the treatment of ischemic stroke.
The findings were published in
ACS Nano.
Designing antioxidant drugs that scavenge free radicals generated during cerebral ischemic stroke reperfusion and reduce nerve damage is one of the main strategies for the treatment of
ischemic stroke.
Recently, Professor Xu Anding and Professor Chen Chengfeng of the First Affiliated Hospital of Jinan University synthesized a biomimetic Mn3O4 nanoenzyme (HSA-Mn3O4) and used it to inhibit ischemic stroke reperfusion-induced neurological damage
.

The nanosystem has the properties of reducing inflammation level, prolonging the circulation time in the body and effectively scavenging reactive oxygen species, and has good neuroprotective ability
against ischemic stroke and reperfusion injury of brain tissue.

5, Stroke: hypotension after stroke, or increased risk of death

Hypertension (BP) is a recognized risk factor
for stroke and death secondary to cardiovascular disease.
However, the specific goal of lowering blood pressure after ischemic stroke, especially in older people, remains uncertain
.
To this end, Hugo J.
Aparicio et al.
of Boston University, who investigated the relationship between pre-stroke blood pressure and mortality in a large observation cohort of ischemic stroke veterans in the United States, found that hypotension before stroke was associated with post-stroke mortality compared with normal blood pressure, particularly in patients
with at least one comorbidity.
The findings were published in
Stroke.

6, Stroke: What are the characteristics of brain imaging in patients with minor cerebral stroke with obvious vascular blockage

Most people with ischaemic stroke have mild or transient neurological symptoms
.
Despite appearing benign, up to one-third of these patients died or became disabled
at 3 months follow-up.
Approximately 15% of patients with mild stroke have significant intracranial occlusion
on noninvasive vascular imaging.
Identifies patients with mild stroke with intracranial occlusion who are unlikely to reopen without reperfusion therapy
.

In this way, H.
H.
of the University of Miami Lee Lau et al.
published a study
in Stroke.
Mild strokes with intracranial occlusion have been found to have different vasoocclusive patterns but similar
thrombopermeability compared with moderate/severe stroke.
Higher thrombospermeability and alteplase use were associated with successful recanalization, although most did not
.

7, Chinese large group research! NEJM: Consuming "alternative salt" significantly reduces stroke, cardiovascular morbidity and mortality!

According to statistics, the average salt intake of Chinese reached 10.
5 grams / day, far exceeding the 5 grams / day recommended by the WHO, ranking in the forefront
of the world.
Salt reduction measures are difficult to adhere to and promote for a long time, so alternative salt with low sodium and high potassium came into being
.
The alternative salt consists of 75% sodium chloride and 25% potassium chloride and tastes similar to regular salt, but with significantly less
sodium.

Recently, a team led by Peking University and The George Institute for Global Health announced the results of the Chinese group "Relationship between Alternative Salt and Stroke" completed in 2021 on NEJM, which proved that alternative salt consumption in hypertensive patients can effectively reduce the incidence of stroke and cardiovascular disease and all-cause mortality, and has good
safety.

8, Stroke: endovascular treatment of acute ischemic stroke during pregnancy/puerperium

Although rare, acute ischemic stroke (AIS) is a catastrophic complication
associated with pregnancy and the early postpartum period.
Potential mechanisms leading to cerebral infarction in pregnant women include hemodynamic changes and venous stasis, which lead to hypercoagulable physiology
.
Short-term efficacy was similar in pregnant and postpartum women after any acute reperfusion therapy (thrombolytic, endovascular, or catheter), but the study did not evaluate mechanical thrombectomy (MT) itself
.

A study published today in Stroke used data from a national inpatient sample to test the efficacy
of endovascular MT during pregnancy and the postpartum period.
MT has been found to be a safe and effective treatment
for AIS during pregnancy and postpartum.
Pregnant and postpartum women treated with MT experienced no deaths or miscarriages
during their hospital stay.

9,Stroke: Pre-stroke dyskinesia, endovascular therapy, what is the outcome?

Large-vessel occlusion accounts for about one-third of all acute stroke cases and predicts a worse
prognosis than stroke without large-vessel occlusion.
In patients with large vessel occlusion, treatment with endovascular thrombectomy (EVT) reduces mortality and improves functional outcomes
.
Since the publication of the pivotal trial in 2015, there has been a focus on expanding patient options for
EVT.

Recently, Yale University's Rachel Beekman et al.
used a large national stroke registry to describe the frequency
of real-world pre-stroke mobility disorder (PSMI) in patients treated with EVT.
The study found that although procedural adverse outcomes were not high in PSMI patients, further research was needed to determine the clinical benefit
in this population.

10, JAHA: Differences in the prevalence of atheroembolism in patients with cryptogenic stroke

Cerebrovascular disease is a common comorbidity
in cancer patients.
Although active cancer leads to ischemic stroke through a variety of pathological conditions, including thromboembolism attributable to Trousseau syndrome, the relationship between stroke and inactive cancer is poorly
understood.

Recently, JAHA, an authoritative journal in the field of cardiovascular diseases, published a research article showing that it is not uncommon
for cancer patients to have cryptogenic stroke through transesophageal echocardiography.
While patients with active cancer have more multiple infarctions, patients with inactive cancer have more sources of atheroembolism, which can lead to arterial stroke
.

11.
Guidelines consensus | How to manage aphasia after stroke is the latest Chinese expert consensus

Post-stroke aphasia (PSA) refers to acquired language disorders caused by impairment of the dominant brain hemisphere language functional area caused by stroke, and the six parts of language function of spontaneous speech, listening comprehension, retelling, naming, reading and writing are impaired
to varying degrees.
At present, there is relatively insufficient
experience in clinical management of PSA in China.

In order to promote clinicians and rehabilitation therapists to evaluate PSA more standardized, systematically, and comprehensively, and to provide individualized rehabilitation treatment, experts in relevant domestic fields refer to relevant research and guidelines at home and abroad, comprehensively review the relevant literature of PSA, and combine the actual clinical situation in China to compile the expert consensus on clinical management of PSA in China, which provides reference standards
in terms of intervention timing, clinical management, rehabilitation management, etc.

12, Neurology: The effect of small vessel disease progression on long-term cognitive and functional changes after stroke

The severity of white matter hyperintensity in stroke patients is associated with
dementia and dependence after stroke.
However, white matter hyperintensity can decrease or increase after stroke, and the prediction of cognitive decline is imprecise
.
In a study published in Neurology, researchers recruited patients within three months of a minor ischemic stroke to assess the longitudinal correlation
between white matter hyperintense changes, cognition and function.

Studies have found that fluctuating white matter hyperintensity after stroke means that the volume of white matter hyperintensity at one year after stroke rather than baseline is strongly correlated with
cognitive scores over the same period.
The co-vertical decline in cognition and independence after stroke is central to the diagnosis of dementia and is associated with
an increase in the hypersignal volume of white matter.

13, JAMA Network Open: Chinese studies have found that mothers who breastfeed for a long time have a low risk of stroke

Most previous studies have focused on the link between
lactation and cardiovascular disease.
However, few studies have explored the relationship between
breastfeeding and stroke subtypes.
Previous studies have found that longer lactation periods are associated with a lower risk of stroke, but the association between lactation and different pathological subtypes of stroke (e.
g.
, ischaemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) has not been assessed
.
To this end, Ziyang Ren et al.
published a research article
in JAMA Network Open magazine.

The study found that women who breastfed for at least 7 months had a lower
risk of ischemic stroke and intracerebral hemorrhage compared to postmenopausal women who had never breastfed.
Breastfeeding is significantly associated with a reduced risk of stroke, particularly ischaemic stroke, highlighting the importance of
promoting breastfeeding as a targeted stroke prevention strategy.

14, stroke: cerebral stroke, endovascular treatment in recent years, the treatment effect, the situation is gratifying!

Posterior circulation large vessel occlusion (LVO) accounts for about 1% of all ischemic strokes and is associated with
high rates of disability and mortality.
Since endovascular therapy (EVT) has been shown to be safe and effective for large vessel occlusive strokes in the anterior circulation, it seems necessary to generalize it to the posterior circulation
.
However, recent trials in patients with basilar artery occlusion (BAO) stroke have not shown an advantage
of EVT over optimal medical management.

Recently, several Dutch stroke intervention centers participated in the BASICS trial (Basebase Artery International Cooperation Study), which tested the efficacy
of EVT in patients with BAO in a randomized setting.
The study found that despite the high mortality rate, high clinical outcomes and successful reperfusion rates
were achieved with EVT treatment of PCS.

15, Stroke: What are the characteristics of brain imaging in patients with minor cerebral stroke with obvious vascular blockage

Most people with ischaemic stroke have mild or transient neurological symptoms
.
Despite appearing benign, up to one-third of these patients died or became disabled
at 3 months follow-up.
Approximately 15% of patients with mild stroke have significant intracranial occlusion
on noninvasive vascular imaging.

Recently, H.
H.
of the University of Miami Lee Lau et al.
published a study in Stroke and found that mild strokes with intracranial occlusion have different vasoocclusive patterns but similar
thrombopermeability compared with moderate/severe stroke.
Higher thrombospermeability and alteplase use were associated with successful recanalization, although most did not
.
Randomised controlled trials are needed to assess the efficacy
of new thrombolytic agents and endovascular therapies in this population.

16，STTT | Lei Peng/Dong Biao/Dai Lunzhi of Sichuan University identified potential therapeutic targets for ischemic stroke

Ischemic stroke is a major danger
for humans, especially the elderly.
Interventions can only remove clots, and the mechanism of neuronal death during ischemic stroke remains controversial
.
Iron death is increasingly recognized as a mechanism
of cell death following ischemia in various organs.
Recently, Lei Peng, Dong Biao and Dai Lunzhi of Sichuan University jointly published a research paper
in Signal Transduction and Targeted Therapy.

This study reported that serine protease thrombin initiates iron death signaling
by promoting arachidonic acid mobilization and subsequent esterification of the iron-killing gene acyl-CoA synthase long-chain family member 4 (ACSL4).
The thrombin-ACSL4 axis may be a key therapeutic target for improving iron-dead neuronal damage during ischemic stroke
.

17.
How to risk assess the risk and comprehensive intervention of falls after stroke? Take a look at the latest expert consensus

With the aging of society, stroke is a serious threat to the health of
the elderly.
In order to have a more scientific understanding of falls after stroke, a number of domestic experts in related fields have formulated an expert consensus on post-stroke fall risk assessment and comprehensive intervention with reference to domestic and foreign literature and guidelines, aiming to better promote the prevention and standardized management
of falls after stroke.

The consensus advocates the joint efforts of all parties, the improvement and implementation of policies and the application of new technologies, and the management measures such as early, comprehensive and individualized intervention for stroke patients to reduce the occurrence of falls and improve the quality of life
.
The consensus was recently published in the Journal of
Clinical Medicine.

18, Neurology: Effects of small-vessel disease progression on long-term cognitive and functional changes after stroke

The severity of white matter hyperintensity in stroke patients is associated with
dementia and dependence after stroke.
However, white matter hyperintensity can decrease or increase after stroke, and the prediction of cognitive decline is imprecise
.
Recently, a study published in Neurology in which researchers recruited patients within three months of a minor ischemic stroke and found that after stroke, fluctuating white matter hyperintensity means that white matter hyperintensity volume at one year after stroke rather than baseline is closely related
to cognitive scores over the same period.
The co-vertical decline in cognition and independence after stroke is central to the diagnosis of dementia and is associated with
an increase in the hypersignal volume of white matter.

19, JAMA sub-journal: A study of more than 20,000 people found that LDL-C less than 1.
8 mmol/L may reduce recurrent stroke

A recent meta-analysis published in JAMA Neurology found that statin therapy that lowers low-density lipoprotein cholesterol (LDL-C) may reduce the risk of recurrent stroke but increase
the risk of hemorrhagic stroke in patients with a history of ischemic stroke.
The findings suggest that intensive statin-based lipid-lowering therapy with LDL-C levels reduced to <1.
8 mmol/L in patients with a history of ischemic stroke reduce the risk of recurrent stroke, but only in patients
with atherosclerosis.

20.
Chinese interpretation | Predictive factors analysis of dysphagia screening and pneumonia in Chinese acute ischemic stroke patients: findings from the Chinese Stroke Center Alliance (CSCA).

Stroke is the primary cause of death and disability in China, among which ischemic stroke (AIS) is the most common type of stroke, dysphagia is considered to be an independent risk factor for the occurrence and development of pneumonia, and the identification and management of dysphagia is the key to improving the prognosis of
stroke patients.
Recently, the team of Professor Wang Yongjun from Beijing Tiantan Hospital affiliated to Capital Medical University and the National Clinical Research Center for Neurological Diseases published relevant new research
in Stroke & Vascular Neurology.

Studies have found that older age, male sex, severe disease, coronary heart disease or atrial fibrillation are all associated with the occurrence of pneumonia in AIS patients, of which dysphagia is the most important influencing factor
.
Although screening for dysphagia has become a routine intervention for patients with AIS, clinical implementation is inconsistent across regions of China, and the overall implementation rate, although improving, is still lower than the international level
.
The study identified a strong need to further promote AIS's healthcare quality improvement program to eliminate regional disparities, especially in the western region
.

21.
Effect of repeated transcranial magnetic stimulation of the dorsovenal dorsal lobe of the affected side on cognitive recovery in patients with subacute stroke

Cognitive dysfunction and depression are common complications after stroke, leading to slow
recovery of functioning of daily living.
Repetitive transcranial magnetic stimulation (rTMS) has emerged as an alternative treatment for neurological recovery after stroke, and rTMS therapy to stimulate the dorsolateral left frontal lobe (DLPFC) has been widely used to treat refractory depression
.
Treatment with rTMS on left-sided DLPFC enhances working memory and executive function
in stroke patients.
However, clinical studies investigating the effects of rTMS on right-sided DLPFC are relatively insufficient
.

Front Neurol ，DLPFCrTMS
。，DLPFCrTMS
。，DLPFCrTMS
。

22，Lancet：

，，
。，
。，，
。

，Wouter van der SteenLancet MR CLEAN-MED，
。，，，
。

23, European Radiology: This imaging indicator has become an emerging predictor of malignant cerebral edema in acute stroke!

Cerebral edema (CED) is an important complication
of ischemic stroke with large vessel occlusion (LVO).
Malignant cerebral edema (MCE), which peaks 2 to 5 days after onset, can lead to irreversible tissue damage, cerebral blood flow insufficiency, increased intracranial pressure, and even cerebral herniation
.
Therefore, identifying early risk factors for CED can help improve the prognosis
of patients with MCE.

Recently, a study published in the journal European Radiology used auto-ASPECTS technology to quantify the early affected area resulting from the quantification of early CT scores of automated stroke programs with noncontrast CT and CTA-SI at admission to enable early identification
of patients at risk of cerebral edema after acute LLO.
In addition, CTA-ASPECTS-NWU is an independent predictor of MCE, which provides convenient technical support
for early treatment and prognosis assessment of these patients.

24，Autophagy | The research team of Professor Xing Shihui/Professor Zeng Jinsheng of the First Affiliated Hospital of Sun Yat-sen University has made important progress in the research of autophagy and angiogenesis in the distant septal site of stroke

Recently, the research team of Xing Shihui and Professor Zeng Jinsheng of the Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University have made important progress
in the research of autophagy and angiogenesis in the distant septal site of stroke.
The researchers found that after focal cortical infarction, ipsilateral thalamic neurons and oligodendrocyte Nogo-A upregulate and activate the Δ20 receptor S1PR2 pathway
on their blood vessels.
The use of gene silencing technology to block the Nogo-A/S1PR2 signaling pathway can significantly inhibit the autophagy activation of thalamic endothelial cells and promote angiogenesis
.

The study further confirmed that Nogo-A/S1PR2 regulates the level of
vascular autophagy flow by promoting autophagy initiation and inhibiting autophagosome degradation.
This study is the first to elucidate the molecular mechanism of Nogo-A affecting angiogenesis in distant sites after cerebral infarction by regulating angioautophagy activity, which provides a new perspective
for the prevention and treatment of distant septal damage after stroke and the improvement of neurological function.

25，Nat Cardio Res | Yue Lixia's team revealed the molecular mechanism of TRPM2 in atherosclerosis

Globally, atherosclerosis and its associated myocardial infarction and ischaemic stroke are the most common causes
of death in the population.
The main feature of atherosclerosis is the formation
of foam cells in the plaque.
Infiltrated macrophages transform into highly pro-inflammatory foam cells after excessive phagocytosis of deposited lipids (oxLDL), so inhibiting foam cell formation can be used as a new idea
for the treatment of atherosclerosis.

TRPM2 is widely expressed in myeloid cells, and TRPM2-mediated calcium influx is essential
for phagocytic function and inflammatory activation of macrophages.
But whether TRPM2 is involved in regulating the formation of foam cells remains unclear
.
Recently, the team of Lixia Yue of the University of Connecticut School of Medicine published an article in the journal Nature Cardiovascular Research, revealing a crucial positive feedback loop that promotes mutual activation during atherosclerosis progression and foam cell formation
.
Inhibition of TRPM2 will simultaneously inhibit the macrophage inflammatory response mediated by CD36 and TRPM2, thus providing an important new strategy
for the treatment of atherosclerosis.

26, BMJ: Taking anti-dopaminergic antiemetics, can lead to an increased risk of ischemic stroke

In large observational studies, central antidopaminergic antipsychotics have increased the risk of ischaemic stroke in patients, particularly in older and dementia populations
.
At present, non-antipsychotic dopamine receptor antagonists
are also widely used in clinical practice.
A study published today in BMJ conducted case-control to confirm the risk
of ischaemic stroke associated with the use of anti-dopaminergic antiemetics.
The use of anti-dopaminergic antiemetics was found to be associated with an increased risk of ischaemic stroke, with medetoprazine and metoclopramide having the highest
risk.

27.
Tai Chi can delay cognitive decline! Multiple studies have shown even more health benefits.
.
.

In recent years, some studies have paid attention to the benefits of tai chi on health factors
such as cognition, motor function, and weight.
Recently, two studies led by Chinese teams have revealed more benefits of tai chi - helping to delay cognitive decline and helping stroke patients recover
.
In one of the studies published in Alzheimer's & Dementia, scientists from Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine found that the overall cognitive level of the tai chi + cognitive training group and the cognitive training group were improved, and the tai chi + cognitive training group improved more significantly
.

In another study published in Stroke, a team led by City University of Hong Kong revealed how tai chi can help
stroke survivors.
The research team developed a seated tai chi and found that after 3 months of sitting tai chi training, stroke survivors had improved hand and arm strength, balance control and shoulder range of motion when sitting and standing were better than those of the control group
.

28, Neuron: New technology offers new ways to prevent neuronal death from stroke

Despite the widespread effects of stroke, there is still a lack of effective treatment
.
Researchers from the University of Connecticut School of Medicine published a new study
in Neuron.
Stroke damage occurs
when an ion channel called TRPM2 interacts with NMDA receptors under oxidative stress conditions.
The researchers found a short (16 amino acid long) sequence on TRPM2 that is responsible for the interaction
that leads to neuronal death.

The researchers created a peptide that mimics the TRPM2 sequence and binds to NMDA receptors, disrupting the interaction
between TRPM2 and NMDA receptors.
This interfering peptide can be used
immediately after a stroke.
After injection of peptides in a mouse model of stroke, brain injury in mice was reduced from 37% to 18-19%.

29，Neuron | Yue Lixia's team revealed that TRPM2-extrasynaptic NMDA receptor coupling aggravates brain injury in ischemic stroke

Ischemic stroke is an important cause of
death and disability in the population.
Many factors work together to promote neuronal damage in cerebral ischemia, among which NMDA receptor (NMDAR)-mediated calcium overload is particularly prominent
.
TRPM2 is a non-selective cation channel that is thought to be an oxidative stress receptor for cells
.
Cellular oxidative stress is one of the hallmark events of
ischaemic stroke.
In addition, TRPM2 has also been found to aggravate ischemic brain injury, but the molecular mechanism by which TRPM2 promotes brain injury remains unclear
.

Recently, Lixia Yue's team at the University of Connecticut School of Medicine published an article in Neuron revealing that TRPM2 expressed on neurons plays an important role
in NMDAR-mediated excitotoxicity.
This study has identified an important molecular mechanism
that exacerbates the excitotoxicity of NMDAR in ischemic stroke.
Moreover, the interfering small peptide TAT-EE3 developed by this institute has promising clinical application value, which provides a new strategy
for the clinical treatment of ischemic stroke.

30, Stroke: Bilateral percutaneous electrical nerve stimulation improves upper limb motor function in stroke patients

Upper extremity dysfunction is a common but serious sequelae of
stroke.
Transcutaneous electrical nerve stimulation (TENS) has been used for stroke rehabilitation for decades
.
Bilateral TENS of hemiplegia combined with non-hemiplegic upper limbs can input additional sensations from the non-hemiplegic side to mitigate hemiplegia by rebalancing interhemisphere inhibition, activating homologous neural networks for undamaged and damaged hemispheres, and restoring neural networks for undamaged hemispheres
.

A study published today in Stroke took a 4-group parallel design and found that patients in the Bi-TENS+TOT group had a more significant
improvement in upper limb Fugl-Meyer scores compared with Uni-TENS+TOT, placebo-TENS+TOT and controls.
Both Bi-TENS+TOT and Uni-TENS+TOT showed significant within-group improvements
in upper limb Fugl-Meyer scores.
In the middle of the intervention, the within-group improvement in upper limb Fugl-Meyer scores in the Bi-TENS+TOT group was earlier than in the Uni TENS+TOT group
.
These improvements were maintained
at 3 months follow-up.

31, JAMA N: Ischemic stroke recurrence rate in young ESUS

Since the 80s of the 20th century, the incidence of ischemic stroke in young people has steadily increased
compared to the elderly.
About 30% to 40% of youth strokes are classified as embolic strokes of unknown origin (ESUS).

Recently, Kanjana S.
Perera from Canada et al.
published the results of the Young ESUS study in JAMA Neurology, with the aim of determining the incidence of recurrent ischemic stroke and death in young people and new-onset atrial fibrillation (AF) and related factors
.

The study found that the recurrence rate of ischemic stroke was relatively low and the incidence of new-onset AF was low
in this large cohort of young adult ESUS patients.
Most recurrent strokes also meet the criteria for ESUS, suggesting that further research is needed to improve our understanding of the underlying mechanisms of
stroke in this population.

32, time is the brain! "The Lancet" blockbuster: stroke "first aid medicine" has a new choice!

Stroke is one of the leading causes of
disability and death.
Acute ischaemic stroke accounts for about 80% of all types of stroke, and the key to its treatment is to open the blocked blood vessel as early as possible and rescue the ischemic semi-dark zone
.
Intravenous thrombolysis is the most important measure to restore blood flow, and the effective time window for saving semi-dark zone tissue may be less
than 4.
5 hours.
Currently, alteplase is the standard of care in intravenous thrombolysis
.
Recently, THE LANCET published the results of
the AcT study.

Studies provide strong evidence that tenecteplase and an active comparator (alteplase) are comparable
in efficacy, impact on quality of life, and safety outcomes in patients with acute ischaemic stroke.
Results support tenecteplase as an alternative to standard intravenous thrombolysis for acute ischaemic stroke
.
This study is the first phase 3 randomized controlled trial
to show that the efficacy and safety of intravenous thrombolysis of tenecteplase are comparable to those of alteplase within 4.
5 hours of the onset of acute ischemic stroke symptoms.
The authors stress that the results of this study "have the potential to revolutionize the current global landscape of stroke care.
"

33, Stroke: Anticoagulation timing of atrial fibrillation-related stroke

In practice, anticoagulation of direct oral anticoagulants (DOACs) after non-valvular atrial fibrillation (NVAF)-associated acute ischemic stroke (IS) or transient ischemic attack (TIA) reduced the risk of adverse clinical outcomes compared with warfarin, mainly due to the reduced risk of
intracranial haemorrhage (ICH).
However, the best time to launch DOAC after IS remains unclear
.

Recently, Kimura Shunsuke et al.
from Japan published their findings in Stroke and found that in Japanese and European populations, depending on stroke severity, starting DOACs early within 1, 2, 3 or 4 days seems to reduce the risk of recurrent stroke or systemic embolism without increasing the risk of
major bleeding.
These findings support ongoing randomized trials to better determine the best time for
DOAC initiation.

34.
This disease may have existed before the stroke, affecting more than 10 years!

Depression is one of the most common complications of
stroke (stroke).
There can be a complex bidirectional association
between stroke and depression.
Recently, Neurology published blockbuster research results, finding that stroke patients may have early progression of depression before the acute event occurred, and depression is further aggravated
after the stroke event.
The results suggest that special attention needs to be paid to depression-related symptoms, especially those related to fatigue
, in the long-term care of stroke patients.

35, Nature: Protocols for clinically relevant models of focal embolic cerebral ischemia induced by thrombosis and thrombolysis in rhesus monkeys

Over the past few years, chemical thrombolysis and mechanical thromboctomy have been established as the standard of
care for patients with ischemic stroke.
Now, the focus is shifting to emphasize focal ischemia and subsequent reperfusion to develop clinically relevant stroke models
in the brains of non-human primates (NHPs).
Recently, the team of Ji Xunming of Capital Medical University published a research paper
online in Nature Protocols.

This article describes an embolization model
of occlusion of the middle cerebral artery in adult rhesus monkeys.
Autologous clots are bound to microcatheters or microfilaments by endovascular surgery and reperfusion
is achieved by local intraarterial thrombolysis with tissue plasminogen activators.
Researchers have demonstrated that these models have successfully used them to test potential treatments and adjuvants prior to clinical studies, making them clinically relevant
.

36.
25 million women's data: Exogenous hormone therapy causes stroke? This time period is especially important!

Previous epidemiological analyses have shown that premenopausal women are less likely to have a stroke than men of similar age or postmenopausal women, which may be related
to the protective effects of estrogen.
Endogenous estrogen has a potent beneficial effect on arterial endothelial cells and promotes vasodilation and blood flow
.
Hormone replacement therapy (HRT) can be used to replace lost endogenous estrogen, and oral contraceptives can be used to suppress and stabilize fluctuations
in estrogen and progesterone over time.

A study published today in Stroke, based on data from 257194 women from the UK Biobank, showed that hormone exposure not only increases the overall risk of stroke, but also has a more pronounced effect
at the start of treatment (the first year of treatment).
The effect of hormonal exposure on stroke risk may be related to
short-term changes in bleeding and haemostasis balance in treated subjects.

37, "The Lancet": Ischemic stroke large vessel occlusion, bridging thrombectomy or more suitable for Asian patients

Stroke has become the number one cause of
death in China.
Previous studies have confirmed that bridging thrombolysis is better than intravenous thrombolysis alone, restoring cerebral blood flow and recanalizing blood vessels as soon as possible, and improving functional outcomes, but it is more difficult to operate, which may affect the optimal timing of mechanical thrombectomy, and intravenous thrombolysis also increases the risk of
intracranial hemorrhage.
Therefore, direct mechanical thrombectomy and bridging thrombectomy have become a hot spot in endovascular treatment, which is worth discussing
.

Recently, The Lancet published the results
of the DIRECT-SAFE trial.
This large, prospective, international multicenter, open-label, blind-endpoint, non-inferiority trial failed to demonstrate that direct mechanical thrombectomy is not inferior to bridging embolectomy, especially in Asian populations, reaffirming the value of
bridging embolectomy.
From a geographically segmented perspective, the primary outcome of bridging thrombectomy was better
in Asian populations.

38, Cell Reports: Promoting neurological repair in animal models of stroke, a major breakthrough that promises to change the paradigm of stroke treatment

Stroke is one of the leading causes of death and disability worldwide, but current treatment strategies are primarily neuroprotective rather than reparative, and are limited
by narrow time windows.
Researchers from the University of California have published a groundbreaking preclinical study in the journal Cell Reports and found that a drug called NVG-291-R can repair the nervous system and achieve significant functional recovery
in animal models of severe ischemic stroke.
Gene deletion at drug molecular targets showed similar effects
on neural stem cells.

39, frequent naps, strokes come to find! Zhongnan Xiangya team surveyed 360,000 people and found that frequent naps increased the risk of stroke by 24%

Compared with people in Europe and the United States, Chinese has a "nap culture"
.
A large Internet survey shows that 67.
38% and 30.
49% of people in China will take lunch breaks frequently or occasionally, and only 2.
13% do not take
naps for various reasons.
However, napping is not "harmless" and may even have some negative health effects
.

Recently, a prospective cohort study combined with Mendelian randomization by the team of Xiangya Hospital of Central South University, covering nearly 360,000 people and followed up for about 11 years, showed that frequent napping during the day may be a risk factor
for hypertension and ischemic stroke.
Frequent napping is associated with a 12% higher risk of high blood pressure and a 24%
higher risk of stroke compared to people who never take a nap.
The study was published in
Hypertension.

40, Neurology: Pay attention not only to post-stroke depression, but also to "pre-stroke depression"

New-onset depression after stroke is common clinically, and a person's pre-existing depressive symptoms can also worsen
after stroke.
A new study published today in Neurology further suggests that depression levels may have begun to rise months or years before stroke
.

In other words, stroke and depression may be preludes
to each other.
Not only post-stroke depression, "pre-stroke depression" also needs to attract clinical attention, especially in the elderly with mood and fatigue-related depressive symptoms
.
The study highlights the importance of early recognition and management of
depression.

41.
Why are there so many stroke patients? New research finds that nearly 70% of people don't know they are in danger!

The most common cause of ischemic stroke (stroke) is cerebral artery embolism, how many people with ischemic stroke already know they are at high risk at the time of onset? What are the most common risk factors in these populations? A study presented at the 2022 Congress of the European Society of Neurology (EAN) revealed that nearly two-thirds of patients with acute ischemic stroke have at least one major undiagnosed risk factor
.
Among them, the most common factors are dyslipidemia, hypertension, and atrial fibrillation
.

Studies have found that about 90% of ischemic strokes are caused by modifiable risk factors, including hypertension, dyslipidemia, diabetes, atrial fibrillation, high body mass index, smoking, psychosocial factors, physical inactivity, and an unhealthy diet
.
67.
7% of patients had at least one major risk factor
.

42.
Focus on the relationship between cognitive reserve and vascular cognitive impairment

Vascular cognitive impairment (VCI) is one of the leading causes of cognitive impairment in the elderly population, which seriously affects the quality of life and longevity
of patients.
Cognitive reserve compensates for cognitive impairment due to aging and pathological impairment
.
Cognitive reserve is closely related to cognitive impairment after stroke, not only with the severity of cognitive impairment after stroke, but also with the speed
of recovery from cognitive impairment.
Cognitive reserve is also associated
with cognitive impairment associated with cerebral small vessel disease.

A study recently published in the Chinese Journal of Neurology believes that the relationship between cognitive reserve and VCI has received more attention, but there are still many problems
.
Cognitive reserve is a theoretical hypothesis, and the anatomical and physiological mechanisms behind it remain unclear; The quantification of cognitive reserve mostly relies on socioeconomic indicators, which cannot really reflect the definition of cognitive reserve.
Most of the current studies on cognitive reserve and VCI are retrospective cross-sectional studies with low level of evidence, and prospective cohort studies are urgently needed to further clarify the relationship between
the two.

43, more than 200,000 Asians 10-year follow-up study: "poor disease" "top"! Stroke risk can increase by up to 63%!

Socioeconomic factors are important factors in the occurrence of
stroke.
Several past studies have reported that low socioeconomic status, such as low income, increases the risk of
stroke.
MetS (metabolic syndrome) is a group of comorbidities that increase the risk of cardiovascular disease
.
MetS is known to increase the risk of
stroke.

A study published today in Diabetology & Metabolic Syndrome found that all other income groups had a significantly increased
risk of being diagnosed with two or more MetS components compared to the high-income group.
Low income is an important risk factor
for simultaneous diagnosis of major MetS components and stroke.
Co-diagnosis of the MetS component plays an important mediating role
between income level and stroke incidence.

44, JAMA: Significant progress has been made in the adaptation of distant ischemia to the treatment of acute ischemic stroke

Reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy, has been recommended by current guidelines as the most effective strategy
for acute ischaemic stroke (AIS).
However, due to treatment time windows and technical requirements, only a small percentage of the population can receive reperfusion therapy
.
The current research focus is to find new neuroprotective strategies to reduce AIS-induced disability
.
There is increasing evidence that in preclinical studies, distant ischemic adaptation (RIC) exerts neuroprotective effects
by reducing cerebral infarction and improving neuroprognosis.

Recently, Professor Chen Huisheng and others from the General Hospital of the Northern Theater of China published a study in JAMA to evaluate the efficacy
of RIC in acute moderate ischemic stroke.
Studies have found that in adults with acute moderate ischaemic stroke, distant ischemic adaptation therapy can significantly increase the likelihood
of excellent neurological function at 90 days compared with usual care.
However, these findings could only be concluded if validated in another trial
.

45.
The relationship between stroke lesion type and white matter high-intensity load and stroke severity and prognosis

A study published in Neurology explored whether high white matter high intensity (WMH) loads are associated
with higher stroke severity and worse functional outcomes.
The study integrated the interaction between stroke lesions and high and low WMH loads through a hierarchical model structure
.

Studies have shown that higher WMH loads may be associated with increased stroke severity, involving the insulal, parietal, and inferior frontal regions
of the left cerebral hemisphere.
Patients with specific WMH loads and lesion locations may derive greater benefit
from acute recanalization.

46.
Stratification of risk of symptomatic intracranial atherosclerotic disease based on conventional vascular risk factors and cerebral hemodynamics

Despite the availability of optimal medical therapy, symptomatic intracranial atherosclerotic stenosis (sICAS) is associated
with a considerable risk of stroke recurrence.
The severity of sICAS luminal stenosis and its hemodynamic significance quantified by computational fluid dynamics (CFD) modeling are associated
with the risk of stroke recurrence.

A study published today in Stroke & Vascular Neurology found that D2H2A nomograms, which combine conventional vascular risk factors with the hemodynamic significance of sICAS assessed in CFD models, may be a useful tool
for stratifying the risk of recurrent stroke in patients with sICAS with the best medical treatment over the same period.

47, JAMA Neurol: Comparison of general anesthesia or sedation in endovascular therapy in patients with posterior circulation ischemic stroke

There are no clear conclusions
about the optimal choice of anaesthesia for endovascular therapy in patients with acute posterior circulation stroke.
To investigate whether sedation (CS) can replace general anaesthesia (GA) in patients with acute posterior circulation stroke, a recent JAMA Neurology study
was published.
The findings suggest that CS is no better than GA for the primary outcome of functional recovery, and may be worse
for the secondary outcome of successful reperfusion.

48, Stroke: Natural history of asymptomatic moderate carotid artery stenosis

There is some uncertainty
as to whether moderate carotid artery stenosis is a risk factor for ischaemic stroke.
Therefore, practical recommendations are lacking
.
Recently, Robert W.
Chan et al.
from the United States published their findings in Stroke, exploring the long-term risk
of stroke in patients with asymptomatic moderate carotid artery stenosis in the integrated healthcare system.

Overall, moderate stenosis
of 11,614 arteries was found in 9803 patients.
Of the arteries diagnosed for stroke, 50 (27.
8%) developed severe stenosis or occlusion
.
In this community-based sample of asymptomatic patients with moderate internal carotid artery stenosis, the cumulative incidence of stroke up to 10 years was low
at a mean follow-up of 5 years.
Further research is needed to optimize management strategies
for this group.