Sex Differences in Participation Restriction in Social Activities Among Older Stroke Survivors: A Nationwide Study

老年卒中幸存者参与社交活动限制的性别差异: 一项全国性研究

Women experience more poststroke physical activity limitations, but sex differences in social activity participation, an important patient-reported outcome for stroke recovery, remain uncertain. Social participation restrictions are prevalent among older stroke survivors, particularly for women, which appears to be attributable to sex differences in social factors and prestroke health. Future interventions targeting vulnerable subgroups, including socially isolated women and women with poorer health, should be considered.

女性经历了更多的卒中后体力活动限制，但是在社会活动参与方面的性别差异仍然不确定，这是患者报告的卒中恢复的重要结果。社会参与限制在老年卒中幸存者中普遍存在，尤其是女性，这似乎归因于社会因素和卒中前健康方面的性别差异。应考虑未来针对弱势亚群体的干预措施，包括社会孤立的妇女和健康状况较差的妇女。

REF: Chen C, Reeves MJ, Lisabeth LD. Sex Differences in Participation Restriction in Social Activities Among Older Stroke Survivors: A Nationwide Study. Stroke. Published online December 30, 2024. doi:10.1161/STROKEAHA.124.048773 PMID: 39772666

Single-Cell Analysis in Cerebrovascular Research: Primed for Breakthroughs and Clinical Impact

脑血管研究中的单细胞分析: 为突破和临床影响做好准备

Data generated using single-cell RNA-sequencing has the potential to transform understanding of the cerebral circulation and advance clinical care. However, the high volume of data, sometimes generated and presented without proper pathophysiological context, can be difficult to interpret and integrate into current understanding of the cerebral circulation and its disorders. Furthermore, heterogeneity in the representation of brain regions and vascular segments makes it difficult to compare results across studies. There are currently no standards for tissue collection and processing that allow easy comparisons across studies and analytical platforms. There are no standards either for single-cell data analysis and presentation. This topical review introduces single-cell RNA-sequencing to physicians and scientists in the cerebrovascular field, with the goals of highlighting opportunities and challenges of applying this technology in the cerebrovascular field and discussing key concepts and knowledge gaps that can be addressed by single-cell RNA-sequencing.

使用单细胞RNA测序生成的数据有可能改变对脑循环的理解并促进临床护理。然而，有时在没有适当的病理生理背景的情况下生成和呈现的大量数据可能难以解释并整合到对脑循环及其疾病的当前理解中。此外，大脑区域和血管节段表示的异质性使得难以比较研究之间的结果。目前没有组织收集和处理的标准，允许在研究和分析平台之间进行简单的比较。单细胞数据分析和呈现也没有标准。这篇专题综述向脑血管领域的医生和科学家介绍了单细胞RNA测序，目的是强调在脑血管领域应用这项技术的机遇和挑战，并讨论单细胞RNA测序可以解决的关键概念和知识差距。

REF: Albertson AJ, Winkler EA, Yang AC, et al. Single-Cell Analysis in Cerebrovascular Research: Primed for Breakthroughs and Clinical Impact. Stroke. Published online December 30, 2024. doi:10.1161/STROKEAHA.124.049001 PMID: 39772596

Is Reperfusion Injury a Largely Intra-Ischemic Injury?

再灌注损伤主要是缺血内损伤吗？

Reperfusion injury (RI) refers to an array of detrimental cellular and biochemical processes that are widely believed to be triggered by reperfusion following focal cerebral ischemia and to contribute to infarct extension and poor outcome despite complete recanalization. Accordingly, it is widely recommended that therapies targeting RI be administered after recanalization. The present topical review demonstrates, however, that the vast majority of, and possibly all, processes considered part of RI are not actually provoked by reperfusion but develop during the ischemic phase. This notion has significant implications for clinical trials. Thus, for optimal efficacy, treatments targeting RI should accordingly be started before recanalization. Conversely, interventions aimed at protecting the ischemic penumbra, either pharmacological or nonpharmacological, during arterial occlusion are likely to also benefit RI-related processes and should probably be continued after recanalization. Overall, RI is largely an intra-ischemic process that has important ramifications for drug development and clinical trials and more broadly for the management of patients with hyperacute ischemic stroke before, and following, recanalization.

再灌注损伤 (RI) 是指一系列有害的细胞和生化过程，它们被广泛认为是由局灶性脑缺血后的再灌注触发的，并且尽管完全再通，但仍导致梗塞扩展和不良结果。因此，广泛推荐在再通后施用靶向RI的疗法。然而，本专题综述表明，绝大多数，甚至可能是所有被认为是RI一部分的过程实际上并不是由再灌注引起的，而是在缺血期发展的。这一概念对临床试验具有重要意义。因此，为了获得最佳疗效，应在再通之前开始靶向RI的治疗。相反，在动脉闭塞期间旨在保护缺血半暗带的干预措施，无论是药理学的还是非药理学的，都可能使RI相关过程受益，并且可能应在再通后继续进行。总体而言，RI在很大程度上是缺血内的过程，其对于药物开发和临床试验具有重要的影响，并且更广泛地用于在再通之前和之后的超急性缺血性卒中患者的管理。

REF: Baron JC. Is Reperfusion Injury a Largely Intra-Ischemic Injury?. Stroke. Published online December 30, 2024. doi:10.1161/STROKEAHA.124.049541 PMID: 39772553

Long-Term Risk of Acute Myocardial Infarction in Patients With a Transient Ischemic Attack: A Danish Nationwide Cohort Study

短暂性脑缺血发作患者发生急性心肌梗死的长期风险: 丹麦全国性队列研究

Sparse information regarding the long-term risk of acute myocardial infarction (MI) following a transient ischemic attack (TIA) emphasizes further research to guide preventive strategies and risk stratification in patients with a TIA. Patients with first-time TIA had a low 5-year incidence of MI, which was not significantly different from that of the general population and patients with first-time ischemic stroke after adjustments for comorbidities. However, patients with TIA had a 25% higher all-cause mortality rate than the general population, which was not readily explained by MI risk. Hence, the findings do not endorse the need to raise further awareness regarding MI in patients with TIA.

关于短暂性脑缺血发作 (TIA) 后急性心肌梗死 (MI) 的长期风险的稀疏信息强调了进一步的研究，以指导TIA患者的预防策略和风险分层。首次TIA患者的5年MI发生率较低，这与普通人群和经合并症校正后的首次缺血性卒中患者没有显着差异。然而，TIA患者的全因死亡率比普通人群高25%，这并不容易用MI风险来解释。因此，研究结果并不支持需要进一步提高对TIA患者MI的认识。

REF: Safi H, Kristensen SL, Sørensen R, et al. Long-Term Risk of Acute Myocardial Infarction in Patients With a Transient Ischemic Attack: A Danish Nationwide Cohort Study. Stroke. Published online December 27, 2024. doi:10.1161/STROKEAHA.123.045605 PMID: 39727078

Associated Factors of Long-Term Functional Outcome and Recovery Pattern After Intracerebral Hemorrhage: A Prospective Population-Based Study in Ulaanbaatar, Mongolia

脑出血后长期功能预后和恢复模式的相关因素: 蒙古乌兰巴托的一项基于人群的前瞻性研究

Long-term patterns of functional outcome after intracerebral hemorrhage (ICH) have not been well elucidated in population-based studies from low- and middle-income countries. The aim of this study was to define long-term functional outcomes, associated prognostic factors, and recovery patterns for patients with acute ICH. The prognosis from ICH in low- and middle-income countries is dismal, with 56% of patients dead and 77% having an unfavorable functional outcome at 365 days, although there was a pattern of continuous recovery over this time period. These findings stress the importance of developing effective primary prevention and continuous active care for survivors to reduce the burden of ICH in low- and middle-income countries.

在低收入和中等收入国家的基于人群的研究中，脑出血 (ICH) 后功能预后的长期模式尚未得到很好的阐明。这项研究的目的是确定急性ICH患者的长期功能结局，相关的预后因素和恢复模式。在低收入和中等收入国家，ICH的预后是令人沮丧的，56% 的患者死亡，77% 在365天时具有不利的功能结果，尽管在此期间有一种持续恢复的模式。这些发现强调了在低收入和中等收入国家开展有效的初级预防和持续积极护理以减轻ICH负担的重要性。

REF: Sakamoto Y, Bosookhuu O, Ouyang M, et al. Associated Factors of Long-Term Functional Outcome and Recovery Pattern After Intracerebral Hemorrhage: A Prospective Population-Based Study in Ulaanbaatar, Mongolia. Stroke. Published online December 27, 2024. doi:10.1161/STROKEAHA.123.046253 PMID: 39727025

Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial

确定颅外-颅内旁路手术的最佳年龄: 对CMOSS随机试验的事后分析

Previous trials have failed to demonstrate the benefits of extracranial-intracranial (EC-IC) bypass surgery for patients with carotid or middle cerebral artery occlusion. However, little evidence has focused on the effect of age on prognosis. This study aimed to explore whether EC-IC bypass surgery can provide greater benefits than medical therapy alone in specific age groups. In patients aged 55.5 years or younger with symptomatic atherosclerotic occlusion of the internal carotid artery or middle cerebral artery and hemodynamic insufficiency, the addition of EC-IC bypass surgery to medical therapy significantly improved prognosis. These findings suggest that the clinical application of EC-IC bypass surgery needs more research to explore refined patient selection criteria incorporating more clinical features.

先前的试验未能证明颅外-颅内 (ec-ic) 搭桥手术对颈动脉或大脑中动脉闭塞患者的益处。然而，很少有证据关注年龄对预后的影响。这项研究旨在探讨在特定年龄组中，ec-ic搭桥手术是否比单独药物治疗能提供更大的益处。对于年龄在55.5岁或以下，有症状的颈内动脉或大脑中动脉动脉粥样硬化闭塞且血流动力学不足的患者，在药物治疗中增加ec-ic旁路手术可显着改善预后。这些发现表明，ec-ic旁路手术的临床应用需要更多的研究，以探索结合更多临床特征的精细患者选择标准。

REF: Li X, Li Y, Wang T, et al. Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial. Stroke. Published online December 27, 2024. doi:10.1161/STROKEAHA.124.048766 PMID: 39727027

High-Risk Embolic Sources on Cardiac Computed Tomography in Patients With Acute Ischemic Stroke: A Case-Control Study

急性缺血性卒中患者心脏计算机断层扫描的高危栓塞来源: 病例对照研究

Cardiac computed tomography (CT) is increasingly used to search for cardioembolic sources of acute ischemic stroke (AIS). We assessed the association between high-risk cardioembolic sources on cardiac CT and AIS. A high-risk source of cardioembolism was detected on cardiac CT more frequently in patients with AIS than in patients with SMi. These data substantiate the clinical relevance of cardioembolic sources detected on acute cardiac CT in patients with ischemic stroke.

心脏计算机断层扫描 (CT) 越来越多地用于寻找急性缺血性卒中 (AIS) 的心脏栓塞来源。我们评估了心脏CT上的高危心脏栓塞来源与AIS之间的关系。与SMi患者相比，AIS患者在心脏CT上更频繁地检测到心脏栓塞的高风险来源。这些数据证实了缺血性卒中患者在急性心脏CT上检测到的心脏栓塞来源的临床相关性。

REF: Nio SS, Rinkel LA, van Schuppen J, et al. High-Risk Embolic Sources on Cardiac Computed Tomography in Patients With Acute Ischemic Stroke: A Case-Control Study. Stroke. Published online December 20, 2024. doi:10.1161/STROKEAHA.124.048349 PMID: 39704069

Randomized Study Comparing First-Line Dual Versus Single-Stent Retriever Technique: TWIN2WIN

比较一线双支架与单支架回收器技术的随机研究: TWIN2WIN

The double-stent retriever (SR) technique has been described as an effective rescue technique when single-SR fails to induce recanalization. We aimed to assess the safety and efficacy of first-line double-SR in patients with stroke undergoing thrombectomy. In patients with stroke undergoing thrombectomy, first-line double-SR is safe and superior to single-SR in achieving first-pass recanalization but not final recanalization. Implications on clinical outcomes should be studied in specifically designed trials.

当单支架无法诱导再通时，双支架回收器 (SR) 技术已被描述为一种有效的抢救技术。我们旨在评估接受血栓切除术的卒中患者一线双重SR的安全性和有效性。在接受血栓切除术的卒中患者中，一线双重SR是安全的，并且在实现首过再通而不是最终再通方面优于单一SR。应在专门设计的试验中研究对临床结果的影响。

REF: Tomasello A, Moreu M, Terceño M, et al. Randomized Study Comparing First-Line Dual Versus Single-Stent Retriever Technique: TWIN2WIN. Stroke. Published online December 20, 2024. doi:10.1161/STROKEAHA.124.048496 PMID: 39704055

Large-Scale Plasma Proteomics Profiles for Predicting Ischemic Stroke Risk in the General Population

预测普通人群缺血性卒中风险的大规模血浆蛋白质组学概况

We aimed to develop and validate a protein risk score for ischemic stroke (IS) risk prediction and to compare its predictive capability with IS clinical risk factors and IS polygenic risk score. A simple model, including age, sex, and the IS protein risk score (or only the top 5 proteins) had a good predictive performance for IS risk.

我们旨在开发和验证用于缺血性卒中 (IS) 风险预测的蛋白质风险评分，并将其预测能力与IS临床风险因素和IS多基因风险评分进行比较。一个简单的模型，包括年龄，性别和IS蛋白质风险评分 (或仅前5种蛋白质) 对IS风险具有良好的预测性能。

REF: Gan X, Yang S, Zhang Y, et al. Large-Scale Plasma Proteomics Profiles for Predicting Ischemic Stroke Risk in the General Population. Stroke. Published online December 20, 2024. doi:10.1161/STROKEAHA.124.048654 PMID: 39704077