Multicentre prospective, randomised open-label, endpoint-blinded study to evaluate the safety and efficacy of propranolol for the prevention of stroke-associated pneumonia in patients with intracerebral haemorrhage (PROCHASE): rationale and design

评估普萘洛尔预防脑出血患者卒中相关肺炎的安全性和有效性的多中心前瞻性，随机开放标签，终点盲法研究 (PROCHASE): 原理和设计

Stroke-induced transient immune suppression is believed to contribute to post-stroke infections. The β-adrenergic receptor antagonist, propranolol, has been shown to prevent stroke-associated pneumonia (SAP) via reversing post-stroke immunosuppression in preclinical studies and in retrospective analysis in stroke patients. However, whether propranolol can reduce the risk of SAP has not been tested in prospective, randomised controlled trials. The PROCHASE trial aims to generate clinical evidence regarding the safety and efficacy of propranolol in preventing SAP in patients with ICH.

卒中诱导的瞬时免疫抑制被认为有助于卒中后感染。在临床前研究和卒中患者的回顾性分析中，β-肾上腺素能受体拮抗剂普萘洛尔已被证明可通过逆转卒中后免疫抑制来预防卒中相关肺炎 (SAP)。然而，普萘洛尔是否可以降低SAP的风险尚未在前瞻性，随机对照试验中进行测试。PROCHASE试验旨在获得有关普萘洛尔预防ICH患者SAP的安全性和有效性的临床证据。

REF: Gao B, Shi K, Pan Y, et al. Multicentre prospective, randomised open-label, endpoint-blinded study to evaluate the safety and efficacy of propranolol for the prevention of stroke-associated pneumonia in patients with intracerebral haemorrhage (PROCHASE): rationale and design. Stroke Vasc Neurol. Published online December 31, 2024. doi:10.1136/svn-2024-003630 PMID: 39740854

Development of a deep learning method to identify acute ischaemic stroke lesions on brain CT

开发一种基于脑部CT的急性缺血性卒中病变的深度学习方法

CT is commonly used to image patients with ischaemic stroke but radiologist interpretation may be delayed. Machine learning techniques can provide rapid automated CT assessment but are usually developed from annotated images which necessarily limits the size and representation of development data sets. We aimed to develop a deep learning (DL) method using CT brain scans that were labelled but not annotated for the presence of ischaemic lesions.DL methods can be designed for ischaemic lesion detection on CT using the vast quantities of routinely collected brain scans without the need for lesion annotation. Ultimately, this should lead to more robust and widely applicable methods.

CT通常用于对缺血性卒中患者进行成像，但放射科医生的解释可能会延迟。机器学习技术可以提供快速的自动化CT评估，但通常是从注释图像开发的，这必然限制了开发数据集的大小和表示。我们的目标是开发一种深度学习 (DL) 方法，该方法使用CT脑部扫描进行标记但未注释缺血性病变的存在。DL方法可以设计为使用大量常规收集的脑部扫描进行CT缺血性病变检测，而无需进行病变注释。最终，这将导致更健壮和广泛应用的方法。

REF: Fontanella A, Li W, Mair G, et al. Development of a deep learning method to identify acute ischaemic stroke lesions on brain CT. Stroke Vasc Neurol. Published online December 25, 2024. doi:10.1136/svn-2024-003372 PMID: 39572171

Dual antiplatelet versus alteplase in anterior and posterior circulation minor stroke

双重抗血小板与阿替普酶在前后循环小卒中中的应用

The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy (DAPT) to alteplase in minor non-disabling stroke. This prespecified secondary analysis aimed to investigate whether the treatment effects were similar across stroke territories. Among ischaemic stroke with minor non-disabling symptoms, DAPT was similar with intravenous alteplase regarding long-term functional outcome and better safety regardless of ACS or PCS. The potential benefit of intravenous alteplase regarding early neurological improvement in patients with ACS warrants further investigation.

抗血小板与r-tpa治疗急性轻度缺血性卒中试验表明，在轻度非致残卒中中，双重抗血小板治疗 (DAPT) 与阿替普酶的非劣效性。这项预先设定的次要分析旨在调查卒中地区的治疗效果是否相似。在伴有轻微非致残症状的缺血性卒中中，无论ACS或PCS，DAPT与静脉注射阿替普酶的长期功能结局和更好的安全性相似。静脉注射阿替普酶对ACS患者早期神经功能改善的潜在益处值得进一步研究。

REF: Cui Y, Chen HS. Dual antiplatelet versus alteplase in anterior and posterior circulation minor stroke. Stroke Vasc Neurol. Published online December 11, 2024. doi:10.1136/svn-2024-003705 PMID: 39663175

Association of APOE genotype with CT markers of cerebral amyloid angiopathy in spontaneous intracerebral haemorrhage

自发性脑出血中APOE基因型与脑淀粉样血管病的CT标志物的关联

We investigated the association of APOE alleles with CT-based cerebral amyloid angiopathy (CAA) markers including subarachnoid extension (SAE) and finger-like projection (FLP). In patients with spontaneous supratentorial ICH, APOE ε2 and ε4 alleles were associated with SAE and FLP, respectively, suggesting APOE allele-specific effects on CT markers of CAA and their potential mechanisms.

我们调查了APOE等位基因与基于CT的脑淀粉样血管病 (CAA) 标志物的关联，包括蛛网膜下腔延伸 (SAE) 和手指样投射 (FLP)。在自发性幕上ICH患者中，apoeε2和 ε4等位基因分别与SAE和FLP相关，表明APOE等位基因对CAA的CT标志物及其潜在机制的特异性影响。

REF: Yang Q, Zeng X, Tang L, et al. Association of APOE genotype with CT markers of cerebral amyloid angiopathy in spontaneous intracerebral haemorrhage. Stroke Vasc Neurol. Published online December 8, 2024. doi:10.1136/svn-2024-003477 PMID: 39647920

Baseline systolic blood pressure and efficacy of dual antiplatelet in acute ischaemic stroke

急性缺血性卒中的基线收缩压和双重抗血小板疗效

Systolic blood pressure (SBP) affects the risk of early neurological deterioration (END). This subgroup analysis of Antiplatelet Therapy in Acute Mild to Moderate Ischemic Stroke (ATAMIS) trial aimed to explore whether SBP at admission affected the efficacy of different antiplatelet therapies in preventing END. The risk of END increases with elevated SBP at admission among patients with acute mild-to-moderate ischaemic stroke who are not suitable for reperfusion treatments. Fewer END occurred following clopidogrel plus aspirin compared with aspirin alone across different SBP levels. The finding should be interpreted cautiously.

收缩压 (SBP) 影响早期神经系统恶化 (END) 的风险。急性轻中度缺血性卒中抗血小板治疗亚组分析 (ATAMIS) 试验旨在探讨入院时SBP是否影响不同抗血小板治疗预防END的疗效。在不适合再灌注治疗的急性轻度至中度缺血性卒中患者中，END的风险随着入院时SBP升高而增加。在不同的SBP水平下，氯吡格雷联合阿司匹林与单用阿司匹林相比，END发生更少。这一发现应谨慎解释。

REF: Cui Y, Wang Y, Chen HS. Baseline systolic blood pressure and efficacy of dual antiplatelet in acute ischaemic stroke. Stroke Vasc Neurol. Published online December 8, 2024. doi:10.1136/svn-2024-003615 PMID: 39647919

Should patients with minor strokes be given thrombolytics?

轻微中风患者应该接受溶栓治疗吗？

Mild stroke symptoms are cited as the reason for not using tissue-type plasminogen activator in 29-43% of time-eligible patients. Previous studies suggested that not all of these patients had a good recovery or even survival to hospital discharge. Since then, stroke guidelines worldwide recommended thrombolysis in minor but disabling strokes.Dual antiplatelet treatment with aspirin and clopidogrel was more effective than aspirin alone for reducing subsequent events in patients with minor stroke if started within 24 hours of onset in both CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) and POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischaemic Stroke) trials. Recently, both PRISMS (The Potential of rtPA for Ischemic Strokes With Mild Symptoms) trial and TEMPO-2 (Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion) trial showed that treatment with thrombolysis versus antiplatelet did not increase the likelihood of favourable functional outcome at 90 days among patients with minor non-disabling acute ischaemic strokes. Therefore, a narrative review on thrombolysis for patients with minor strokes from published studies may help practicing clinicians.

轻度卒中症状被认为是在29-43% 名符合时间条件的患者中不使用组织型纤溶酶原激活剂的原因。先前的研究表明，并非所有这些患者都有良好的恢复甚至存活到医院出院。从那时起，全世界的卒中指南建议对轻度但致残性中风进行溶栓治疗。如果在发病24小时内开始，阿司匹林和氯吡格雷双重抗血小板治疗比单独使用阿司匹林更有效地减少轻度卒中患者的后续事件 (氯吡格雷用于急性非致残性脑血管事件的高危患者) 和点(新的TIA和轻微缺血性卒中的血小板导向抑制) 试验。最近，两项prism (rtPA对轻度症状的缺血性中风的潜力) 试验和TEMPO-2 (替奈普酶与已证实闭塞的轻度缺血性卒中的护理标准)试验表明，溶栓治疗与抗血小板治疗并没有增加轻度非致残性急性缺血性卒中患者在90天时获得良好功能结局的可能性。因此，对已发表研究的轻度卒中患者溶栓治疗的叙述性综述可能有助于临床医生的实践。

REF: Wang X, Dong Y, Dong Q, Wang D. Should patients with minor strokes be given thrombolytics?. Stroke Vasc Neurol. Published online December 31, 2024. doi:10.1136/svn-2024-003451 PMID: 39097332