Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial

静脉注射阿替普酶的早期再灌注治疗可恢复急性视网膜中央动脉阻塞的视力 (修订版): III期试验的研究方案

Meta-analyses of case series of non-arteritic central retinal artery occlusion (CRAO) indicate beneficial effects of intravenous thrombolysis when initiated early after symptom onset. Randomized data are lacking to address this question. The REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION) investigates intravenous alteplase within 4.5 h of monocular vision loss due to acute CRAO. By enrolling patients within 4.5 h of CRAO onset, REVISION uses insights from meta-analyses of CRAO case series and randomized thrombolysis trials in acute ischemic stroke. Increased rates of early reperfusion and good neurological outcomes in stroke may translate to CRAO with its similar pathophysiology.

非动脉炎性视网膜中央动脉阻塞 (CRAO) 病例系列的荟萃分析表明，在症状发作后早期开始静脉溶栓具有有益作用。缺乏随机数据来解决这个问题。在急性视网膜中央动脉阻塞 (修订) 中，使用静脉阿替普酶进行视力恢复的再灌注治疗研究了由于急性CRAO引起的单眼视力丧失4.5小时内的静脉阿替普酶。通过在CRAO发病后4.5小时内招募患者，REVISION使用来自CRAO病例系列和急性缺血性卒中随机溶栓试验的荟萃分析的见解。中风的早期再灌注率增加和良好的神经系统预后可能会转化为具有相似病理生理学的CRAO。

REF: Poli S, Grohmann C, Wenzel DA, et al. Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial. Int J Stroke. Published online June 25, 2024. doi:10.1177/17474930241248516 PMID: 38591748

Endovascular treatment to improve outcomes for medium vessel occlusions: The ESCAPE-MeVO trial

改善中等血管闭塞预后的血管内治疗: ESCAPE-MeVO试验

Clinical outcomes in acute ischemic stroke due to medium vessel occlusion (MeVO) are often poor when treated with best medical management. Data from non-randomized studies suggest that endovascular treatment (EVT) may improve outcomes in MeVO stroke, but randomized data on potential benefits and risks are hitherto lacking. Thus, there is insufficient evidence to guide EVT decision-making in MeVO stroke. The ESCAPE-MeVO trial will demonstrate the effect of endovascular thrombectomy in addition to best medical management vis-à-vis best medical management in patients with acute ischemic stroke due to MeVO and provide data for evidence-based treatment decision-making in acute MeVO stroke.

当采用最佳药物治疗时，由于中等血管闭塞 (MeVO) 引起的急性缺血性中风的临床结果通常很差。来自非随机研究的数据表明，血管内治疗 (EVT) 可能会改善MeVO卒中的结局，但迄今为止缺乏有关潜在益处和风险的随机数据。因此，没有足够的证据来指导MeVO卒中的EVT决策。Escescape-MeVO试验将证明除最佳医疗管理外，血管内血栓切除术相对于最佳医疗管理在因MeVO导致的急性缺血性卒中患者中的作用，并为急性MeVO卒中的循证治疗决策提供数据。

REF: Ospel JM, Dowlatshahi D, Demchuk A, et al. Endovascular treatment to improve outcomes for medium vessel occlusions: The ESCAPE-MeVO trial. Int J Stroke. Published online June 20, 2024. doi:10.1177/17474930241262642 PMID: 38845180

Prevalence of right-to-left shunt in stroke patients with cancer

癌症卒中患者右向左分流的患病率

Cancer is associated with an increased risk of acute ischemic stroke (AIS) and venous thromboembolism. The role of a cardiac right-to-left shunt (RLS) as a surrogate parameter for paradoxical embolism in cancer-related strokes is uncertain. We sought to investigate the relationship between the presence of an RLS and cancer in AIS patients. RLS was diagnosed less frequently in AIS patients with cancer than in cancer-free patients, suggesting that arterial sources may play a larger role in cancer-related strokes than paradoxical venous embolization. Future studies are needed to validate these findings and evaluate potential therapeutic implications, such as the general indication, or lack thereof, for patent foramen ovale (PFO) closure in this patient population.

癌症与急性缺血性中风 (AIS) 和静脉血栓栓塞的风险增加有关。心脏右向左分流 (RLS) 作为癌症相关卒中反常栓塞的替代参数的作用尚不确定。我们试图调查AIS患者中RLS的存在与癌症之间的关系。与无癌症患者相比，AIS患者中RLS的诊断频率较低，这表明动脉来源在癌症相关的中风中可能比矛盾的静脉栓塞发挥更大的作用。需要进一步的研究来验证这些发现并评估潜在的治疗意义，例如该患者群体中卵圆孔未闭 (PFO) 闭合的一般适应症或缺乏适应症。

REF: Steinauer F, Bücke P, Buffle E, et al. Prevalence of right-to-left shunt in stroke patients with cancer. Int J Stroke. Published online June 13, 2024. doi:10.1177/17474930241260589 PMID: 38816936

Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population

亚洲多民族人群中卒中患者复发和预后的相关人口统计学因素

There is a paucity of studies investigating the outcomes among Asian stroke patients. Identifying subgroups of stroke patients at risk of poorer outcomes could identify patients who would benefit from targeted interventions. Therefore, the aim of this study was to identify which ischemic stroke patients at high risk of recurrent events and mortality. This study found that older stroke patients are at risk of poorer outcomes. Within the young stroke population specifically, males were predisposed to recurrent stroke and AMI but were protected against all-cause and stroke-related deaths. Males were also at reduced risk of all-cause and stroke-related deaths in the older stroke population. In addition, Malay and Indian patients experience poorer outcomes after first stroke. Further optimization of risk factors targeting these high-priority populations are needed to achieve high-quality care.

关于亚洲卒中患者结局的研究还很缺乏。识别中风患者的预后较差的风险亚组可以确定哪些患者将受益于有针对性的干预措施。因此，本研究的目的是确定哪些缺血性卒中患者复发事件和死亡的高风险。这项研究发现，老年中风患者有预后较差的风险。特别是在年轻的卒中人群中，男性容易发生复发性卒中和AMI，但可以防止全因和卒中相关的死亡。在老年中风人群中，男性的全因死亡和中风相关死亡的风险也降低了。此外，马来人和印度患者在首次中风后的预后较差。需要进一步优化针对这些高优先级人群的风险因素，以实现高质量的护理。

REF: Lee KS, Siow I, Riandini T, Narasimhalu K, Tan KB, De Silva DA. Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population. Int J Stroke. Published online June 6, 2024. doi:10.1177/17474930241257759 PMID: 38751129

Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: A multicenter study in 1568 stroke patients

与卒中后认知障碍相关的战略性白质高强度位置: 1568卒中患者的多中心研究

Post-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear. We determined if WMH in strategic white matter tracts explain cognitive performance after stroke. The results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH.

中风后认知障碍 (PSCI) 发生在多达50% 的中风幸存者中。预先存在的血管性脑损伤的存在，特别是白质高信号 (WMH) 的程度，与中风后较差的认知结果相关，但WMH位置在这种关联中的作用尚不清楚。我们确定了战略性白质束中的WMH是否可以解释中风后的认知表现。结果显示，缺血性中风后WMH体积与认知能力之间的道特异性关系，与总WMH体积无关。这意味着PSCI中战略性病变的概念超出了急性梗塞的范围，还涉及预先存在的WMH。

REF: Coenen M, de Kort FA, Weaver NA, et al. Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: A multicenter study in 1568 stroke patients. Int J Stroke. Published online June 2, 2024. doi:10.1177/17474930241252530 PMID: 38651756