Global burden of cerebral small vessel disease determined from large MRI studies: A systematic review and meta-analysis

基于大型磁共振成像研究确定的脑小血管病全球负担：一项系统评价和荟萃分析

Cerebral small vessel disease (SVD) is a major cause of ischemic stroke, intracerebral hemorrhage, and dementia. Despite its importance, there are few studies of its prevalence and how cerebral SVD varies across the world, different age ranges, sexes, and magnetic resonance imaging (MRI) parameters. SVD can be estimated using MRI neuroimaging markers, including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and perivascular spaces (PVS). This systematic review and meta-analysis based on large MRI studies demonstrated that SVD is a common health problem affecting about one-fifth of the adult population. SVD prevalence differs in regions separated by geographical regions. SVD prevalence is higher with increasing age. There is an overall trend of more lacunes and CMBs in males. WMH volume and CMB are SVD markers prone to the variability of MRI acquisition parameters, and a harmonised SVD scanning protocol should be used. More studies from middle- and low-income regions would benefit the estimation of a truly global prevalence of SVD.

脑小血管病（SVD）是缺血性卒中、脑出血和痴呆的主要原因。尽管其十分重要，但关于其患病率以及脑小血管病在全球不同地区、不同年龄范围、不同性别和磁共振成像（MRI）参数下的差异情况的研究却很少。可以使用MRI神经影像学标志物来评估脑小血管病，这些标志物包括白质高信号（WMHs）、腔隙灶、脑微出血（CMBs）和血管周围间隙（PVS）。这项基于大型MRI研究的系统评价和Meta分析表明，脑小血管病是一种常见的健康问题，约影响五分之一的成年人群。脑小血管病的患病率在不同地理区域存在差异。随着年龄的增长，脑小血管病的患病率更高。总体而言，男性的腔隙灶和脑微出血更多。白质高信号体积和脑微出血是容易受MRI采集参数变化影响的脑小血管病标志物，应采用统一的脑小血管病扫描方案。来自中低收入地区的更多研究将有助于准确评估脑小血管病在全球的真实患病率。

REF: Lam BYK, Cai Y, Zheng H, et al. Global burden of cerebral small vessel disease determined from large MRI studies: A systematic review and meta-analysis. Int J Stroke. Published online April 4, 2026. doi:10.1177/17474930261441916 PMID: 41934293

The importance of advocacy in advancing stroke care: The global stroke action coalition

宣传倡导在推动卒中护理发展中的重要性：全球卒中行动联盟

Stroke represents one of the most significant global health challenges of the 21st century, with 11.9 million people experiencing stroke annually and a disproportionate burden falling on low- and middle-income countries, where 87% of stroke deaths and 89% of disability occur. Despite stroke being highly preventable-with 84% of the burden attributable to modifiable risk factors-and the availability of treatments that have proven to reduce the rate of death or disability, including stroke units, thrombolysis, and thrombectomy, these interventions remain inaccessible to most of the world's population. Advocacy-systematic efforts to influence policy, practice, and resource allocation through evidence-based engagement with decision-makers-has achieved notable successes such as establishing stroke units globally. However, individual advocacy efforts face structural limitations in addressing global stroke challenges. The Global Stroke Action Coalition (GSAC) was formed in 2024 as a coordinated, multi-sectoral initiative convened by the World Stroke Organization, uniting scientific, civil societies, and industry partners to transcend these limitations. The Coalition leverages established infrastructure and expertise to create a unified advocacy force capable of commanding attention from global health leaders. Centered around five strategic priorities-integrating stroke into national non-communicable disease (NCD) strategies, developing National Stroke Action Plans, securing funding commitments, implementing monitoring systems, and including survivors in policy development-the Coalition successfully utilized the 2025 UN High-Level Meeting on Non-Communicable Diseases to further elevate the position of stroke on the global agenda. Key achievements include securing ministerial commitments from 10 countries and launching the "Every Minute Counts" campaign. The Coalition's coordinated approach demonstrates that systematic, evidence-based advocacy can transform stroke care delivery globally, providing a framework for sustained collaboration across sectors and regions essential for meeting Sustainable Development Goal targets and reducing the devastating burden of stroke worldwide.

中风是21世纪全球最重大的健康挑战之一，每年有1190万人中风，且低收入和中等收入国家承受的负担尤为沉重，全球87%的中风死亡病例和89%的残疾病例都发生在这些国家。尽管中风在很大程度上是可以预防的（84%的中风负担归因于可改变的风险因素），并且有已被证实可降低死亡或残疾率的治疗方法，如中风单元、溶栓治疗和取栓术，但世界上大多数人仍然无法获得这些干预措施。倡导——通过与决策者进行基于证据的互动来系统地影响政策、实践和资源分配的努力——已经取得了显著成效，例如在全球范围内设立中风单元。然而，个体的倡导努力在应对全球中风挑战方面存在结构性局限。全球中风行动联盟（GSAC）于2024年成立，它是由世界中风组织发起的一项协调的多部门倡议，联合了科学界、民间社会和行业伙伴，以突破这些局限。该联盟利用现有的基础设施和专业知识，形成了一股统一的倡导力量，能够引起全球卫生领导人的关注。该联盟围绕五大战略重点开展工作——将中风纳入国家非传染性疾病（NCD）战略、制定国家中风行动计划、争取资金承诺、实施监测系统，以及让中风幸存者参与政策制定——并成功借助2025年联合国非传染性疾病问题高级别会议，进一步提升了中风问题在全球议程中的地位。主要成就包括获得了10个国家部长级的承诺，并发起了“分秒必争”运动。该联盟的协调行动表明，基于证据的系统性倡导能够改变全球中风护理服务的提供方式，为跨部门和跨地区的持续合作提供了框架，这对于实现可持续发展目标和减轻全球中风的沉重负担至关重要。

REF: Nelson M, Grupper M, van der Worp HB, et al. The importance of advocacy in advancing stroke care: The global stroke action coalition. Int J Stroke. Published online April 4, 2026. doi:10.1177/17474930261428056 PMID: 41934286

Infarct growth rate and tenecteplase benefit in ischemic stroke at 4.5 to 24 h without thrombectomy—A secondary analysis of the TRACE-III randomized trial

4.5至24小时未行血栓切除术的缺血性卒中患者梗死增长速率与替奈普酶治疗获益——TRACE - III随机试验的一项二次分析

We aimed to explore whether the benefits of tenecteplase within 4.5 to 24 h would be modified by the infarct growth rate (IGR). Patients with late-window ischemic stroke who are not eligible for endovascular thrombectomy may derive greater benefit from tenecteplase compared with standard medical treatment among those with relatively faster infarct growth, although this finding should be considered exploratory.

我们旨在探讨在4.5至24小时内使用替奈普酶的获益是否会受到梗死生长率（IGR）的影响。对于不符合血管内血栓切除术条件的晚期窗缺血性卒中患者，在梗死生长相对较快的患者中，与标准药物治疗相比，替奈普酶可能带来更大获益，不过这一发现应视为探索性结果。

REF: Wang L, Zhou L, Yin J, et al. Infarct growth rate and tenecteplase benefit in ischemic stroke at 4.5 to 24 h without thrombectomy-A secondary analysis of the TRACE-III randomized trial. Int J Stroke. Published online April 7, 2026. doi:10.1177/17474930261443408 PMID: 41944559

Antithrombotic strategies targeting the coagulation pathway and incident covert brain infarction: A systematic review and meta-analysis of randomized trials

针对凝血途径的抗血栓策略与新发隐匿性脑梗死：一项随机试验的系统评价和荟萃分析

Covert brain infarction is a common neuroimaging-defined manifestation of covert cerebrovascular disease and is associated with increased risks of future stroke and cognitive decline. Covert brain infarction has been included as an outcome in randomized trials evaluating coagulation-pathway-targeting strategies. However, whether these strategies consistently reduce incident covert brain infarction and whether treatment effects on covert brain infarction parallel those for acute ischemic stroke remain uncertain. In clinical settings without a mandatory indication for anticoagulation, coagulation-pathway strategies were not associated with reduced incident covert brain infarction compared with antiplatelet therapy. Although effect estimates for covert brain infarction and acute ischemic stroke were broadly similar, uncertainty remains. Composite endpoints predominantly driven by covert brain infarction warrant cautious interpretation when inferring treatment effects on clinically manifest ischemic stroke.

隐匿性脑梗死是隐匿性脑血管病一种常见的神经影像学定义表现，与未来发生卒中及认知功能下降的风险增加相关。隐匿性脑梗死已被纳入评估靶向凝血途径策略的随机试验结果指标。然而，这些策略是否能持续降低隐匿性脑梗死的发生，以及对隐匿性脑梗死的治疗效果是否与对急性缺血性卒中的治疗效果一致，仍不确定。在无抗凝治疗强制指征的临床环境中，与抗血小板治疗相比，凝血途径策略并未降低隐匿性脑梗死的发生。尽管对隐匿性脑梗死和急性缺血性卒中的效应估计大致相似，但仍存在不确定性。当推断对临床显性缺血性卒中的治疗效果时，以隐匿性脑梗死为主导的复合终点需要谨慎解读。

REF: Yang F, Wang L, Wu X, et al. Antithrombotic strategies targeting the coagulation pathway and incident covert brain infarction: A systematic review and meta-analysis of randomized trials. Int J Stroke. Published online April 17, 2026. doi:10.1177/17474930261446363 PMID: 41999065