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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases

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Stroke & Vascular Neurology 2020年第2期5卷 159-176页

作者： 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 Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Department of Neurology Peking Union Medical College HospitalBeijingChina Department of Neurology Guangzhou Overseas Chinese HospitalThe First Affiliated Hospital of JINAN UniversityGuangzhouChina

Aim Stroke is the leading cause of disability and death in *** stroke accounts for about 60%-80%of all *** is of considerable significance to carry out multidimensional management of ischaemic cerebrovascular *** evidence-based guideline aims to provide the latest detailed and comprehensive recommendations on the diagnosis,treatment and secondary prevention of ischaemic cerebrovascular *** 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 members discussed and determined the recommendations through *** used the level of evidence grading algorithm of Chinese Stroke Association to grade each *** draft was reviewed by the Guideline Writing Committee of Chinese Stroke Association Stroke and *** guideline is fully updated every 3 *** 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 *** This updated guideline presents a framework for the management of ischaemic cerebrovascular *** first-aid measures,professional care in the acute stage,and proactive secondary prevention will be helpful to patients.

关键词： prevention diagnosis treatment

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Performance of automated CT ASPECTS in comparison to physicians at different levels on evaluating acute ischemic stroke at a single institution in China

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Chinese Neurosurgical Journal 2021年第4期7卷 249-257页

作者： xiaochuan huo Raynald Hailan Jin Yin Yin Guangming Yang Zhongrong Miao Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China Department of R&D UnionStrong(Beijing)Technology Co.LtdBeijingChina

Background:Our aim was to evaluate the sensitivity and specificity of the automated computer-based Alberta Stroke Program Early CT Score(e-ASPECTS)for acute stroke patients and compare the result with physicians at different ***:In our center,e-ASPECTS and 9 physicians at different levels retrospectively and blindly assessed baseline computed tomography(CT)images of 55 ***,specificity,receiver-operating characteristic curves,Bland–Altman plots with mean score error,and Matthews correlation coefficients were *** were made between the scores by physicians and e-ASPECTS with diffusion-weighted imaging(DWI)being the ground *** methods for clustered data were used to estimate sensitivity and specificity in the region-based ***:In total,1100(55 patients×20 regions per patient)ASPECTS regions were *** the region-based analysis,sensitivity of e-ASPECTS was better than junior doctors and residents(0.576 vs 0.165 and 0.111,p<0.05)but inferior to senior doctors(0.576 vs 0.617).Specificity was lower than junior doctors and residents(0.883 vs 0.971 and 0.914)but higher than senior doctors(0.883 vs 0.809,p<0.05).E-ASPECTS had the best Matthews correlation coefficient of 0.529,compared to senior doctors,junior doctors,and residents(0.463,0.251,and 0.087,respectively).Conclusions:e-ASPECTS showed a similar performance to that of senior physicians in the assessment of brain CT of acute ischemic stroke patients with the Alberta Stroke Program Early CT score method.

关键词： ASPECTS Computed tomography Ischemic stroke Physicians Automatic device

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急性基底动脉闭塞血管内治疗成功再通后90天不良临床结局的发生率和相关影响因素

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中华医学杂志 2023年第29期103卷 2233-2238页

作者：孙大鹏霍晓川缪中荣首都医科大学附属北京天坛医院介入神经病学科，北京100070

目的探索急性基底动脉闭塞血管内治疗成功再通后90 d的不良临床结局的发生率和相关因素。方法本研究的研究人群来自一项于2015年6月至2017年12月的多中心、前瞻性、登记研究:血管内治疗急性缺血性脑卒中协作组(ANGEL)登记研究。收集患... 详细信息

目的探索急性基底动脉闭塞血管内治疗成功再通后90 d的不良临床结局的发生率和相关因素。方法本研究的研究人群来自一项于2015年6月至2017年12月的多中心、前瞻性、登记研究:血管内治疗急性缺血性脑卒中协作组(ANGEL)登记研究。收集患者的人口统计学特征,既往史,个人史,生命体征,美国国立卫生研究院卒中量表(NIHSS)评分,影像学检查,发病/入院/穿刺/手术结束时间点,手术相关变量,术中用药情况,术毕闭塞血管开通情况,病因分型,90 d改良Rankin量表(mRS)评分。血管内治疗术毕成功再通的定义为改良脑梗死溶栓(mTICI)分级2b~3级,不良临床结局定义为患者90 d mRS评分4~6分。多因素logistic回归模型分析来确定不良临床结局的相关因素。结果170例接受血管内治疗且成功再通的急性基底动脉闭塞患者纳入本研究,男性128例,女性42例,年龄[M(Q_(1),Q_(3))]64(55,70)岁。其中72例患者(42.4%)发生了不良临床结局,98例患者(57.6%)发生了良好临床结局。多因素logistic回归模型分析结果显示,高基线NIHSS评分(OR=1.166,95%CI:1.109~1.225,P<0.001)和高术前收缩压(OR=1.032,95%CI:1.010~1.053,P=0.003)是不良临床结局的相关影响因素。结论急性基底动脉血管内治疗成功再通后90 d不良临床结局的发生率为42.4%,高基线NIHSS评分和高术前收缩压与不良临床结局相关。

关键词：卒中血管内治疗急性基底动脉闭塞成功再通不良临床结局随访研究

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Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases:executive summary and 2023 update

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Stroke & Vascular Neurology 2023年第6期8卷 I0087-I0133页

作者： Liping Liu Zixiao Li Hongyu Zhou Wanying Duan xiaochuan huo Weihai Xu Shujuan Li Ximing Nie Huihui Liu Jinjie Liu Dapeng Sun Yufei Wei Guitao Zhang Weizhuang Yuan Lina Zheng Jingyi Liu David Wang Zhongrong Miao Yongjun Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina National Center for Healthcare Quality Management in Neurological Diseases BeijingChina Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical SciencesBeijingChina Chinese Institute for Brain Research BeijingChina Neurological Disease Center Cerebral Vascular Disease DepartmentBeijing Anzhen HospitalCapital Medical UniversityBeijingChina Department of Neurology State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Neurology National Clinical Research Center for Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Neurology and Suzhou Clinical Research Center of Neurological Disease the Second Affiliated Hospital of Soochow UniversitySuzhouChina Department of General Medicine Dalian Municipal Central Hospital Affiliated Dalian University of TechnologyDalianChina Interventional Neuroradiology Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina Neurovascular Division Department of NeurologyBarrow Neurological InstituteSt.Joseph's Hospital and Medical CenterPhoenixArizonaUSA Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina

Background China is one of the countries with the highest burden of *** multidimensional management guidelines will help clinicians practise evidence-based care,improve patient outcomes and alleviate societal *** update of the 2019 edition will provide the latest comprehensive recommendations for the diagnosis and treatment of ischaemic cerebrovascular *** We conducted a comprehensive search on MEDLINE(via PubMed)up to 31 August *** writing team established the recommendations through multiple rounds of online and offline *** recommendation was graded using the evidence grading algorithm developed by the Chinese Stroke Association(CSA).The draft was reviewed and finalised by the CSA Stroke Guidelines Writing *** This update included revisions of 15 existing recommendations and 136 new recommendations in the following areas of stroke care:emergency assessment and diagnosis of ischaemic cerebrovascular disease,acute-phase reperfusion therapy,evaluation of underlying mechanisms,antithrombotic therapy,prevention and treatment of complications,and risk factor *** This guideline updated the recommendations for the clinical management of ischaemic cerebrovascular disease from 2019.

关键词： diagnosis prevention discussions

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Endovascular therapy for Acute ischemic Stroke Trial (EAST): study protocol for a prospective, multicentre control trial in China

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Stroke & Vascular Neurology 2016年第2期1卷 44-51页

作者： Zhongrong Miao xiaochuan huo Feng Gao Xiaoling Liao Chunjuan Wang Ya Peng Yibin Cao Shengli Chen Meng Zhang Changchun Jiang Xiaoxiang Peng Cunfeng Song Liping Wei Qiyi Zhu Zaiyu Guo Li Liu Hang Lin Hua Yang Wei Wu Hui Liang Anding Xu Kangning Chen Xingquan Zhao Yuesong Pan Hao Li Liping Liu Yilong Wang Yongjun Wang EAST investigators Department of Interventional Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Vascular Neurology Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Tiantan Clinical Trial and Research Center for StrokeBeijing Tiantan HospitalCapital Medical UniversityBeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Department of Neurosurgery Changzhou No 1 People’s HospitalChangzhouChina Department of Neurology Tangshan Gongren HospitalTangshanChina Department of Neurology Chongqing Sanxia Central HospitalChongqingChina Department of Neurology Daping HospitalChongqingChina Department of Neurology Baotou Central HospitalBaotouChina Department of Neurology Hubei Zhongshan HospitalWuhanChina Department of Neurology Liaocheng Third People’s HospitalLiaochengChina Department of Neurology Luoyang Central Hospital affiliated to Zhengzhou UniversityChina Department of Neurology People’s Hospital of Linyi CityChina Department of Neurology Tianjin TEDA HospitalChina Department of Neurology Chifeng Municipal HospitalChina Department of Neurology Fuzhou PLA General HospitalChina Department of Neurology Affiliated Hospital of Guiyang Medical CollegeChina Department of Neurology Qilu Hospital of Shandong UniversityChina Department of Neurology Yantai Hill HospitalChina Department of Neurology The First Affiliated Hospital of Jinan UniversityChina Department of Neurology Xinan HospitalChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Neuro-intensive Care Unit Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina 不详

Background and purpose:5 recent trials have shown the benefit of endovascular treatment for acute ischaemic stroke(AIS)due to large vessel occlusion of the anterior *** study aims to evaluate the safety and efficacy of Solitaire thrombectomy in patients with moderate-to-severe stroke in the Chinese population,which has a high prevalence of intracranial *** and analysis:This multicentre prospective control study will involve 17 stroke centres in China,and plans to recruit 150 patients in the intervention group,and 150 patients in the medical group,in which patients meet enrolment criteria but refuse *** with AIS due to large vessel occlusion indicated for treatment with Solitaire stent retriever within 12 hours of symptom onset,and who meet the inclusion and exclusion criteria,will be enrolled in this *** primary efficacy endpoint is functional independence as defined by a modified Rankin Scale(mRS)score≤2 at 90 days or by functional improvement as defined by mRS,using shift *** procedural efficacy endpoint is arterial recanalisation of the occluded target vessel measured by a modified Thrombolysis in Cerebral Infarction(mTICI)score equal or superior to 2b right following the use of the study *** primary safety endpoint is symptomatic intracranial haemorrhage(sICH)within 24±3 hours *** and dissemination:The protocol was approved by the Ethics Committee at the coordinating centre and by the local Institutional Review Board of each participating *** registration number:NCT02350283.

关键词： prospective centre occlusion

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大脑前动脉水平段动脉瘤的血管内治疗

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中华神经外科杂志 2014年第9期30卷 865-868页

作者：霍晓川李佑祥李非姜除寒吴中学首都医科大学北京市神经外科研究所 100050 辽河油田第二职工医院

目的总结大脑前动脉水平段（A1）动脉瘤血管内治疗经验及技术要点,为该部位动脉瘤的介入治疗提供临床经验.方法回顾性分析经血管内治疗的A1段动脉瘤患者的影像及临床资料、治疗效果、手术技巧及随访情况.结果 16例A1段动脉瘤患者资料... 详细信息

目的总结大脑前动脉水平段（A1）动脉瘤血管内治疗经验及技术要点,为该部位动脉瘤的介入治疗提供临床经验.方法回顾性分析经血管内治疗的A1段动脉瘤患者的影像及临床资料、治疗效果、手术技巧及随访情况.结果 16例A1段动脉瘤患者资料被收集,均经介入栓塞治疗,其中5例患者使用球囊辅助或支架辅助栓塞技术.根据动脉瘤部位及形态,微导管头端塑形技术进入瘤腔并维持稳定.动脉瘤均完全填塞,患者预后良好.结论血管内治疗适用于A1段动脉瘤,有时需应用球囊或支架辅助技术,微导管塑形技术对于介入栓塞A1段动脉瘤至关重要.

关键词：颅内动脉瘤脑血管造影大脑前动脉

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Onyx胶栓塞结合伽玛刀治疗颅内动静脉畸形的疗效分析

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中华神经外科杂志 2015年第11期31卷 1126-1130页

作者：霍晓川李佑祥江裕华杨洪超赵阳首都医科大学北京市神经外科研究所神经介入中心 100050

目的探讨Onyx胶栓塞颅内动静脉畸形（AVM）联合伽玛刀治疗的有效性和安全性。方法回顾性分析2004年4月至2011年9月首都医科大学北京市神经外科研究所神经介入中心收治的86例经Onyx胶栓塞后联合伽玛刀治疗的颅内AVM患者，统计分析栓塞的... 详细信息

目的探讨Onyx胶栓塞颅内动静脉畸形（AVM）联合伽玛刀治疗的有效性和安全性。方法回顾性分析2004年4月至2011年9月首都医科大学北京市神经外科研究所神经介入中心收治的86例经Onyx胶栓塞后联合伽玛刀治疗的颅内AVM患者，统计分析栓塞的相关并发症及临床预后。栓塞AVM时，对合并的高危出血风险（巢内动脉瘤、血流动力性动脉瘤和AVM相关性动静脉瘘）进行评估并栓塞，将合并高危因素的颅内AVM根据危险因素栓塞与否，分为靶向栓塞组和未靶向栓塞组，评估靶向栓塞对出血风险的作用。结果总体颅内AVM患者的年出血率为1．66％，其中破裂AVM为2．26％，未破裂AVM为1．08％，年病死率为0．74％。16例栓塞相关并发症中1例出现永久性神经功能障碍。29个合并巢内动脉瘤中24个靶向栓塞；5个血流动力性动脉瘤中4个靶向栓塞；9个动静脉瘘中8个靶向栓塞。χ^2检验显示靶向栓塞组的出血并发症显著低于未靶向栓塞组（P〈0．01）。结论靶向栓塞联合伽玛刀治疗能降低颅内AVM出血的风险，改善临床预后，降低永久性并发症的发生。此方法适用于治疗体积较大、单一方案无法治愈的颅内AVM。

关键词：颅内动静脉畸形脑血管造影术放射疗法出血手术后并发症

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人参皂苷对恶性脑胶质瘤细胞BT325增殖的影响

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辽宁中医杂志 2006年第10期33卷 1319-1320页

作者：罗俊生张齐关宁霍小川锦州医学院第一附属医院辽宁锦州121001 锦州医学院第二附属医院辽宁锦州121001

目的：探索人参皂苷对恶性脑胶质瘤细胞BT325的作用.方法：MTT法测定人参皂苷对恶性脑胶质瘤细胞（BT325）增殖的影响,采用流式细胞仪检测其对恶性脑胶质瘤细胞（BT325）周期的影响.结果：10～100μg/mL人参皂苷可抑制恶性脑胶质瘤细胞... 详细信息

目的：探索人参皂苷对恶性脑胶质瘤细胞BT325的作用.方法：MTT法测定人参皂苷对恶性脑胶质瘤细胞（BT325）增殖的影响,采用流式细胞仪检测其对恶性脑胶质瘤细胞（BT325）周期的影响.结果：10～100μg/mL人参皂苷可抑制恶性脑胶质瘤细胞（BT325）增殖,流式细胞仪检测人参皂苷阻止恶性脑胶质瘤细胞（BT325）在G1/S期.结论：人参皂苷对恶性脑胶质瘤细胞（BT325）增殖具有抑制作用.

关键词：人参皂苷恶性脑胶质瘤 BT325

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血管内再通治疗对症状性颈内动脉次全闭塞患者认知功能的影响

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中国脑血管病杂志 2020年第8期17卷 425-430页

作者：何子骏罗岗莫大鹏霍晓川邓一鸣马宁首都医科大学附属北京天坛医院神经介入中心 100070

目的观察颈动脉血管内再通治疗对症状性颈内动脉次全闭塞(ICASO)患者认知功能的影响,并探讨其可能机制。方法回顾性连续纳入自2018年12月至2019年12月于北京天坛医院神经介入中心行血管内再通治疗的ICASO患者35例,分别于术前1周内和术后... 详细信息

目的观察颈动脉血管内再通治疗对症状性颈内动脉次全闭塞(ICASO)患者认知功能的影响,并探讨其可能机制。方法回顾性连续纳入自2018年12月至2019年12月于北京天坛医院神经介入中心行血管内再通治疗的ICASO患者35例,分别于术前1周内和术后3个月采用蒙特利尔认知评估(MoCA)量表评价认知功能,CT脑灌注扫描评价脑血流灌注情况[相对脑血流量(r CBF)、相对平均通过时间(r MTT)和相对脑血容量(r CBV)],并对术前术后情况进行比较。同时根据术后MoCA评分改善情况,将患者分为认知改善组(20例)和无显著改善组(15例),比较两组患者脑血流动力学指标血管再通前后变化情况。结果 (1)术后3个月,35例患者MoCA评分和r CBF较术前改善[Mo CA评分:(26.2±1.9)分比(23.5±2.4)分,t=-5.218,P <0.01;r CBF:(1.00±0.09)比(0.95±0.08),t=-2.457,P=0.008],差异均有统计学意义。(2)认知改善组中,术后r CBF、r CBV、r MTT较术前均有显著改善[分别为:(1.01±0.09)比(0.95±0.07),(0.99±0.10)比(0.94±0.08),(0.18±0.10) s比(0.24±0.12) s],差异均有统计学意义(t值分别为-2.353、-1.746、1.718;P值分别为0.012,0.044,0.047);而无显著改善组中,此3项参数手术前后差异均无统计学意义(t值分别为-0.643、0.261、0.236;P值分别为0.262、0.398、0.592)。结论血管内再通治疗能改善症状性ICASO患者的认知功能,且这种改善可能与脑血流灌注改善相关。

关键词：颈动脉次全闭塞血管内闭塞开通脑灌注认知功能

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房颤合并急性颅内大动脉闭塞患者的临床特点及机械取栓疗效分析

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中华医学杂志 2019年第39期99卷 3068-3072页

作者：张宝瑞刘爱华莫大鹏霍晓川刘鹏金恒伟缪中荣北京市神经外科研究所北京100070 首都医科大学附属北京天坛医院神经介入中心北京100070

目的探讨房颤合并急性颅内大动脉闭塞患者的临床特点及机械取栓疗效。方法纳入East(endovascular therapy for acute ischemic stroke trial)研究中房颤合并急性颅内大动脉闭塞患者58例,East研究是由北京天坛医院于2016年联合全国17家... 详细信息

目的探讨房颤合并急性颅内大动脉闭塞患者的临床特点及机械取栓疗效。方法纳入East(endovascular therapy for acute ischemic stroke trial)研究中房颤合并急性颅内大动脉闭塞患者58例,East研究是由北京天坛医院于2016年联合全国17家卒中中心同期开展的前瞻性、非随机对照研究。根据TOAST(trial of Org 10172 in acute stroke treatment)分型,将患者分为心源性栓塞组和动脉粥样硬化组(ICAS)。分析房颤合并急性颅内大动脉闭塞患者的临床特点、治疗方式及临床预后。结果本研究共纳入房颤合并急性颅内大动脉闭塞患者58例,其中栓塞组46例(79%),ICAS组12例(21%);ICAS组院前转运时间要长于心源性栓塞组(P<0.05)。房颤合并急性颅内大动脉闭塞患者取栓开通率为98.3%(57/58),90 d功能独立(改良RANKIN量表0~2分)患者比例为51.7%(30/58)。心源性栓塞组和ICAS组患者在90 d功能独立、死亡比例、颅内出血及症状性颅内出血方面差异无统计学意义。结论机械取栓治疗房颤伴发急性颅内大动脉闭塞是一项有效的治疗方法。

关键词：房颤颅内栓塞血栓切除术预后

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