The Association of Lipoprotein(a) and Stroke Recurrence: A Systematic Review and Meta-Analysis

脂蛋白(a)与卒中复发的关联：系统评价与Meta分析

Lipoprotein(a) [Lp(a)] is a lipoprotein structurally similar to low-density lipoprotein and is considered a genetically determined risk factor for cardiovascular disease. Although Lp(a) has been linked to ischemic stroke, its role in secondary stroke prevention, particularly in stroke recurrence, remains unclear. Elevated Lp(a) levels are linked to increased stroke recurrence and poor functional outcome in stroke patients. Lp(a) may represent a novel therapeutic target in secondary stroke prevention in addition to a promising biomarker.

脂蛋白(a) [Lp(a)] 是一种在结构上与低密度脂蛋白相似的脂蛋白，被认为是心血管疾病的一种由遗传决定的危险因素。尽管Lp(a)与缺血性中风有关，但其在中风二级预防中的作用，尤其是在中风复发方面的作用仍不清楚。Lp(a)水平升高与中风患者中风复发增加和功能预后不良有关。除了是一种有前景的生物标志物外，Lp(a)可能是中风二级预防中的一个新的治疗靶点。

REF: Palaiodimou L, Melanis K, Stefanou MI, et al. The Association of Lipoprotein(a) and Stroke Recurrence: A Systematic Review and Meta-Analysis. J Stroke. 2025;27(2):161-168. doi:10.5853/jos.2024.04623 PMID: 40494575

Tenecteplase Beyond 4.5 Hours in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

急性缺血性卒中发病4.5小时后应用替奈普酶的系统评价与随机临床试验的Meta分析

Acute ischemic stroke (AIS) is a leading cause of disability worldwide. While intravenous thrombolysis is recommended within 4.5 hours of last known well (LKW) time, many patients present beyond this window. This meta-analysis suggests TNK might be safe and effective for selected AIS patients in the 4.5- to 24-hour time window, offering improved functional outcomes without a significant increase in hemorrhagic complications.

急性缺血性卒中（AIS）是全球范围内导致残疾的主要原因。虽然推荐在最后已知健康时间（LKW）后的4.5小时内进行静脉溶栓治疗，但许多患者就诊时已超出这一时间窗。这项荟萃分析表明，对于4.5至24小时时间窗内的部分急性缺血性卒中患者，替奈普酶（TNK）可能安全有效，能改善功能结局，且不会显著增加出血性并发症。

REF: Aladawi M, Abuawwad MT, Taha MJJ, et al. Tenecteplase Beyond 4.5 Hours in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Stroke. 2025;27(2):184-194. doi:10.5853/jos.2024.05715 PMID: 40494577

Carotid Web: An Update Focusing on Its Relationship With Fibromuscular Dysplasia and Therapeutic Strategy

颈动脉嵴：聚焦其与纤维肌发育不良的关系及治疗策略的最新进展

Carotid web was described more than 50 years ago as an atypical fibromuscular dysplasia (FMD) subtype with highly supporting pathological evidence as intimal FMD. In the following decades, the transition from catheter angiography or digital subtraction angiography (DSA) to non-invasive imaging techniques and the dramatic decrease in pathological procedures contributed to the gradual loss of this information. Currently, attention on the carotid web has increased due to its association with cryptogenic ischemic stroke. In fact, the underlying hypothesis is that the morphological features of the carotid web may determine a thrombogenic potential with artery-to-artery embolism. The pathology of the carotid web allowed identification of small thrombi embedded in the web pouch, and the features of thrombi endovascularly retrieved from intracranial arteries are very similar. The diagnosis of carotid web is usually made by non-invasive techniques, such as computed tomography angiography, ultrasound, and magnetic resonance imaging, requiring the concordance of two different techniques for confirming the diagnosis. DSA is usually considered in cases of diagnostic uncertainty and when interventional treatment of ischemic stroke or carotid web is considered. Treatment options in symptomatic cases include medical therapy (single or dual antiplatelets) or interventional approach (surgery or stenting), but there are no randomized controlled trials about therapy. The main aim of this review is to present the current knowledge on carotid web, retrieving historical data and angiographic classifications of FMD, as well as to discuss the biological plausibility of the association with stroke in symptomatic cases and the need for an updated classification of FMD, together with prospective data.

颈动脉嵴在50多年前被描述为一种非典型纤维肌发育不良（FMD）亚型，有充分的病理证据表明其为内膜型FMD。在随后的几十年里，从导管血管造影或数字减影血管造影（DSA）向非侵入性成像技术的转变，以及病理检查操作的大幅减少，导致这一信息逐渐被遗忘。目前，由于颈动脉嵴与隐源性缺血性卒中相关，人们对其关注度有所增加。实际上，潜在的假设是，颈动脉嵴的形态特征可能导致具有动脉 - 动脉栓塞风险的血栓形成。颈动脉嵴的病理检查可发现嵌于嵴袋内的小血栓，从颅内动脉血管内取出的血栓特征与之非常相似。颈动脉嵴的诊断通常通过非侵入性技术进行，如计算机断层血管造影、超声和磁共振成像，确诊需要两种不同技术的结果一致。在诊断不明确以及考虑对缺血性卒中或颈动脉嵴进行介入治疗时，通常会考虑采用DSA检查。有症状病例的治疗选择包括药物治疗（单药或双联抗血小板治疗）或介入治疗（手术或支架置入），但目前尚无关于治疗的随机对照试验。本综述的主要目的是介绍目前关于颈动脉嵴的知识，回顾FMD的历史数据和血管造影分类，讨论有症状病例中颈动脉嵴与卒中关联的生物学合理性，以及结合前瞻性数据探讨更新FMD分类的必要性。

REF: Zedde M, Stoenoiu MS, Persu A, Pascarella R. Carotid Web: An Update Focusing on Its Relationship With Fibromuscular Dysplasia and Therapeutic Strategy. J Stroke. 2025;27(2):169-183. doi:10.5853/jos.2025.00626 PMID: 40494576

Anticoagulation Failure in Stroke: Causes, Risk Factors, and Treatment

卒中抗凝治疗失败：原因、危险因素与治疗

Anticoagulation is crucial to reducing the risk of cardioembolic strokes, particularly in vulnerable populations such as patients with atrial fibrillation, artificial heart valves, or left ventricular thrombus. Though successful, anticoagulation failure (the occurrence of an ischemic stroke or systemic embolism while receiving therapy) remains a major stroke-care issue. The reason for anticoagulation failure can be below the required threshold, inability to follow up, drug-drug interactions, preexisting hypercoagulable states, or anticoagulant resistance. This failure undermines stroke prevention and requires tailored management, often requiring more drastic or alternative interventions. This review examines what drives anticoagulation failure and explores predictors of this failure in clinical, imaging, and laboratory data. It also discusses current management techniques for improving control and points to new treatments and possible futures, such as high-resolution imaging and personalized medicine based on biomarkers, to help tackle this critical clinical problem.

抗凝治疗对于降低心源性栓塞性中风的风险至关重要，尤其是对于心房颤动患者、人工心脏瓣膜患者或左心室血栓患者等脆弱人群。尽管抗凝治疗取得了一定成效，但抗凝失败（即在接受治疗期间发生缺血性中风或全身性栓塞）仍是中风护理的一个主要问题。抗凝失败的原因可能是抗凝水平低于所需阈值、无法进行随访、药物相互作用、既往存在高凝状态或对抗凝剂产生抵抗。这种失败会影响中风的预防效果，需要进行针对性管理，通常需要采取更激进或替代性的干预措施。本综述探讨了导致抗凝失败的因素，并分析了临床、影像学和实验室数据中可预测抗凝失败的指标。此外，还讨论了当前用于改善抗凝控制的管理技术，并指出了新的治疗方法和可能的发展方向，如高分辨率成像和基于生物标志物的个性化医疗，以帮助解决这一关键的临床问题。

REF: Choi Y, Kim JS. Anticoagulation Failure in Stroke: Causes, Risk Factors, and Treatment. J Stroke. 2025;27(2):195-206. doi:10.5853/jos.2025.00206 PMID: 40494578

Residual Inflammatory Risk and Intracranial Atherosclerosis Plaque Vulnerability: Insights From High-Resolution Magnetic Resonance Imaging

残余炎症风险与颅内动脉粥样硬化斑块易损性：来自高分辨率磁共振成像的见解

This study aimed to investigate the association between residual inflammatory risk (RIR) and vulnerable plaques using high-resolution magnetic resonance imaging (HRMRI) in symptomatic intracranial atherosclerotic stenosis (ICAS). In patients with symptomatic ICAS, RIR is associated with a higher risk of intraplaque hemorrhage and strong enhancement, indicating an increased vulnerability to atherosclerotic plaques.

本研究旨在利用高分辨率磁共振成像（HRMRI）探究症状性颅内动脉粥样硬化性狭窄（ICAS）患者残余炎症风险（RIR）与易损斑块之间的关联。在症状性ICAS患者中，RIR与斑块内出血和明显强化的高风险相关，提示动脉粥样硬化斑块的易损性增加。

REF: Yu Y, Cui R, He X, et al. Residual Inflammatory Risk and Intracranial Atherosclerosis Plaque Vulnerability: Insights From High-Resolution Magnetic Resonance Imaging. J Stroke. 2025;27(2):207-216. doi:10.5853/jos.2024.03251 PMID: 40494579

Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis

心房颤动相关缺血性卒中患者启动抗凝治疗前的抗血小板药物使用：ELAN试验分析

Antiplatelets are often used before direct oral anticoagulant (DOACs) initiation after an acute ischemic stroke related to atrial fibrillation (AF), but the evidence is weak. Here, we explored the risks and benefits of this approach. Following an AF-associated ischemic stroke, we found a lower risk of recurrence and no signs of net harm with antiplatelet use before DOAC initiation, despite an increased risk of bleeding.

在与心房颤动（AF）相关的急性缺血性中风后开始使用直接口服抗凝剂（DOACs）之前，通常会使用抗血小板药物，但相关证据不足。在此，我们探讨了这种治疗方法的风险和益处。我们发现，在与房颤相关的缺血性中风后，在开始使用DOAC之前使用抗血小板药物虽会增加出血风险，但可降低中风复发风险，且无明显净危害迹象。

REF: Polymeris AA, Koga M, Strbian D, et al. Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis. J Stroke. 2025;27(2):217-227. doi:10.5853/jos.2024.04322 PMID: 40494580

Low-Density Lipoprotein Cholesterol Level, the Lower the Better? Analysis of Korean Patients in the Treat Stroke to Target Trial

低密度脂蛋白胆固醇水平，是否越低越好？治疗性卒中达标试验中韩国患者的分析

The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90-110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

“按目标治疗卒中”（TST）是一项涉及法国和韩国患者的随机临床试验，该试验表明，低密度脂蛋白胆固醇（LDL - C，<70 mg/dL）较低目标组（LT）发生心脑血管事件的情况少于较高目标组（90 - 110 mg/dL，HT）。然而，这些结果是否适用于不同缺血性卒中亚型的亚洲患者仍不清楚。与法国TST研究不同，韩国患者的研究结果呈中性。虽然LT在预防心血管疾病方面更有效，但在预防卒中方面并非如此，这可能归因于卒中亚型的差异。需要进一步研究来阐明他汀类药物对亚洲卒中患者的疗效以及合适的LDL - C目标值。

REF: Kwon H, Ryu JC, Cha JK, et al. Low-Density Lipoprotein Cholesterol Level, the Lower the Better? Analysis of Korean Patients in the Treat Stroke to Target Trial. J Stroke. 2025;27(2):228-236. doi:10.5853/jos.2025.00409 PMID: 40494581

Aldehyde Dehydrogenase 2 Gene Mutation May Reduce the Risk of Rupture of Intracranial Aneurysm in Chinese Han Population

乙醛脱氢酶2基因突变可能降低中国汉族人群颅内动脉瘤破裂风险

Ruptured intracranial aneurysms (RIA) are associated with a mortality rate of up to 40% in the Chinese population, highlighting the critical need for targeted treatment interventions for at-risk individuals. Although the impact of aldehyde dehydrogenase 2 (ALDH2) gene mutations on susceptibility to intracranial aneurysms (IA) is well documented, the potential connection between ALDH2 rs671 single-nucleotide polymorphism (SNP) and RIA remains unexplored. Given the increased prevalence of ALDH2 gene mutations among Chinese Han individuals, it is clinically relevant to investigate the link between ALDH2 rs671 SNP and IA rupture. The incidence of RIA was significantly higher in individuals with a normal ALDH2 gene (ALDH2*1/*1) than in those with an ALDH2 rs671 SNP (ALDH2*1/*2 or ALDH2*2/*2). ALDH2 rs671 SNP may serve as a protective factor against RIA in the Chinese Han population.

在中国人群中，颅内动脉瘤破裂（RIA）的死亡率高达 40%，这凸显了针对高危个体进行针对性治疗干预的迫切需求。尽管乙醛脱氢酶 2（ALDH2）基因突变对颅内动脉瘤（IA）易感性的影响已有充分记录，但 ALDH2 rs671 单核苷酸多态性（SNP）与颅内动脉瘤破裂之间的潜在联系仍未被探索。鉴于中国汉族人群中 ALDH2 基因突变的患病率较高，研究 ALDH2 rs671 单核苷酸多态性与颅内动脉瘤破裂之间的关联具有临床意义。正常 ALDH2 基因（ALDH2*1/*1）个体的颅内动脉瘤破裂发生率显著高于携带 ALDH2 rs671 单核苷酸多态性（ALDH2*1/*2 或 ALDH2*2/*2）的个体。ALDH2 rs671 单核苷酸多态性可能是中国汉族人群颅内动脉瘤破裂的一个保护因素。

REF: Chen X, Gui S, Wei D, et al. Aldehyde Dehydrogenase 2 Gene Mutation May Reduce the Risk of Rupture of Intracranial Aneurysm in Chinese Han Population. J Stroke. 2025;27(2):237-249. doi:10.5853/jos.2024.04098 PMID: 40494582