Postthrombectomy Flat-Panel CT Contrast Staining ASPECTS and Functional Outcome Prediction

取栓术后平板 CT 造影剂染色的阿尔伯塔卒中项目早期 CT 评分及功能预后预测

As indications for and utilization of mechanical thrombectomy continue to expand, there has been an increasing focus on developing improved tools for functional outcome prediction. We aim to evaluate the reliability of utilizing the areas of contrast staining for the Alberta Stroke Program Early Computed Tomography Score (s-ASPECTS) rating in immediate postthrombectomy flat-panel computed tomography and investigate its outcome predictive performance. s-ASPECTS was reliably reported and found to be a stronger predictor of outcome compared with baseline Alberta Stroke Program Early Computed Tomography Score, characterizing it as an important prognostic tool for evaluating functional outcomes of patients following mechanical thrombectomy. Further studies are warranted.

随着机械取栓术的适应证和应用范围不断扩大，人们越来越关注开发更完善的工具来预测功能预后。我们旨在评估在取栓术后即刻平板 CT 中利用造影剂染色区域进行阿尔伯塔卒中项目早期 CT 评分（s - ASPECTS）评定的可靠性，并探讨其预后预测性能。研究发现，s - ASPECTS 评定可靠，与基线阿尔伯塔卒中项目早期 CT 评分相比，它能更有力地预测预后，这表明其是评估机械取栓术后患者功能预后的重要工具。有必要开展进一步研究。

REF: Poggi J, Martins PN, A Tarek M, et al. Postthrombectomy Flat-Panel CT Contrast Staining ASPECTS and Functional Outcome Prediction. Stroke. Published online June 30, 2025. doi:10.1161/STROKEAHA.124.049494 PMID: 40583760

Association of Covert Cerebrovascular Disease With Falls Requiring Medical Attention

隐匿性脑血管疾病与需要医疗干预的跌倒的关联

The impact of covert cerebrovascular disease on falls in the general population is not well-known. Here, we determine the time to a first fall following incidentally detected covert cerebrovascular disease during a clinical neuroimaging episode. In a large population with neuroimaging, CBI and WMH are independently associated with greater risks of an index fall. Increasing severities of WMH are associated incrementally with fall risk across imaging modalities.

隐匿性脑血管疾病对普通人群跌倒的影响尚不明确。在此，我们确定了在临床神经影像学检查中偶然发现隐匿性脑血管疾病后首次跌倒的时间。在大量接受神经影像学检查的人群中，脑微出血（CBI）和脑白质高信号（WMH）分别与首次跌倒的更高风险相关。在不同的影像学检查方式中，脑白质高信号严重程度的增加与跌倒风险的增加呈渐进性关联。

REF: Clancy Ú, Puttock EJ, Chen W, et al. Association of Covert Cerebrovascular Disease With Falls Requiring Medical Attention. Stroke. Published online June 27, 2025. doi:10.1161/STROKEAHA.124.050137 PMID: 40575848

Familial Hypercholesterolemia, as an Independent Risk of Cerebral Small Vessel Disease

家族性高胆固醇血症：作为脑小血管病的独立危险因素

Familial hypercholesterolemia (FH) is characterized by elevated levels of LDL-C (low-density lipoprotein cholesterol) since birth. However, the association between FH and cerebrovascular diseases, including cerebral small vessel disease (CSVD), is controversial. To investigate the association between FH and CSVD, we compared the prevalence and severity of CSVD neuroradiological findings between patients with FH and control participants. The association of FH with lacunes and cerebral microbleeds may warrant routine brain imaging for primary prevention of symptomatic stroke in patients with FH.

家族性高胆固醇血症（FH）的特征是自出生起低密度脂蛋白胆固醇（LDL - C）水平就升高。然而，FH与包括脑小血管病（CSVD）在内的脑血管疾病之间的关联存在争议。为了研究FH与CSVD之间的关联，我们比较了FH患者和对照参与者CSVD神经影像学表现的患病率和严重程度。FH与腔隙性梗死和脑微出血的关联可能需要对FH患者进行常规脑部成像，以进行症状性卒中的一级预防。

REF: Murata H, Hattori Y, Noda K, et al. Familial Hypercholesterolemia, as an Independent Risk of Cerebral Small Vessel Disease. Stroke. Published online June 26, 2025. doi:10.1161/STROKEAHA.124.050070 PMID: 40567231

Large-Core Paradox

大核心悖论

Recently, 6 randomized controlled trials of endovascular treatment (EVT) versus medical management in anterior circulation large vessel occlusion with large-core documented significant benefit of EVT on functional outcome. Moreover, one trial reported the benefit of EVT in the large-core category (Alberta Stroke Program Early Computed Tomography Score, 0-2). The results are considered paradoxical by some as they contradict the prevailing view that the presence of a large core precludes the possibility of good outcomes following reperfusion...

最近，有6项关于血管内治疗（EVT）与药物治疗对比的随机对照试验，针对存在大面积梗死核心的前循环大血管闭塞患者，结果显示EVT在改善功能结局方面有显著益处。此外，有一项试验报告了EVT在大面积梗死核心类别（阿尔伯塔卒中项目早期计算机断层扫描评分0 - 2分）中的益处。一些人认为这些结果有悖常理，因为它们与普遍观点相矛盾，即大面积梗死核心的存在排除了再灌注后获得良好结局的可能性……

REF: Ter Schiphorst A, Seners P, Arquizan C, et al. Large-Core Paradox. Stroke. Published online June 26, 2025. doi:10.1161/STROKEAHA.125.050397 PMID: 40567239

Postacute Discharge Destination and Major Adverse Cardiovascular Events Among Patients With Intracerebral Hemorrhage

脑出血患者急性后期出院去向与主要心血管不良事件

Studies evaluating health system factors associated with major adverse cardiovascular events (MACE) among intracerebral hemorrhage (ICH) survivors are lacking. We evaluate differences in MACE incidence across postacute ICH care settings-inpatient rehabilitation facilities (IRF), home, or skilled nursing facilities (SNF). IRF care (versus SNF and home) was associated with lower odds of MACE. Further research is needed to determine specific components of IRF care contributing to better outcomes.

目前缺乏评估与脑出血（ICH）幸存者发生主要不良心血管事件（MACE）相关的卫生系统因素的研究。我们评估了急性脑出血后不同护理环境（住院康复机构[IRF]、居家或专业护理机构[SNF]）中MACE发生率的差异。与SNF和居家护理相比，接受IRF护理的患者发生MACE的几率更低。需要进一步研究以确定IRF护理中有助于改善预后的具体因素。

REF: Bako AT, Potter T, Pan A, et al. Postacute Discharge Destination and Major Adverse Cardiovascular Events Among Patients With Intracerebral Hemorrhage. Stroke. Published online June 26, 2025. doi:10.1161/STROKEAHA.125.050620 PMID: 40567223

White Matter Hyperintensity Multispot Pattern Lesions and Cerebrovascular Amyloid Burden in Cerebral Amyloid Angiopathy

脑淀粉样血管病中白质高信号多灶性病变模式与脑血管淀粉样物质负荷

We investigated the relationship between white matter hyperintensity (WMH) multispot pattern lesions, a supporting magnetic resonance imaging marker of cerebral amyloid angiopathy (CAA), and positron emission tomography-based amyloid-β burden across a range of cerebrovascular amyloid deposition. This pilot study suggests a positive association between cerebrovascular amyloid deposition and WMH multispot lesions in CAA, with potential pathophysiological and clinical implications. These exploratory observations require confirmation in larger studies.

我们研究了白质高信号（WMH）多灶性模式病变（一种支持性的脑淀粉样血管病（CAA）磁共振成像标志物）与基于正电子发射断层扫描的不同程度脑血管淀粉样蛋白沉积的β-淀粉样蛋白负荷之间的关系。这项初步研究表明，在CAA中，脑血管淀粉样蛋白沉积与WMH多灶性病变呈正相关，这具有潜在的病理生理学和临床意义。这些探索性观察结果需要在更大规模的研究中得到证实。

REF: Charidimou A, Baron JC. White Matter Hyperintensity Multispot Pattern Lesions and Cerebrovascular Amyloid Burden in Cerebral Amyloid Angiopathy. Stroke. Published online June 26, 2025. doi:10.1161/STROKEAHA.125.051482 PMID: 40567241

Regional Differences in Presentation, Cause, and Outcome of Reversible Cerebral Vasoconstriction Syndrome

可逆性脑血管收缩综合征临床表现、病因及预后的区域差异

National studies on reversible cerebral vasoconstriction syndrome (RCVS) point to differences between Asian and European patients. We investigated geographic variations in neurological complications, outcomes, and causes. RCVS presentations vary across regions, with higher lesion rates, more secondary forms, and worse outcomes in European patients. While these exploratory results may reflect selection bias from differing health care structures, further research is needed to determine the contribution of genetic, environmental, and societal factors.

关于可逆性脑血管收缩综合征（RCVS）的全国性研究指出，亚洲患者和欧洲患者存在差异。我们对神经并发症、预后和病因的地域差异进行了研究。RCVS的临床表现存在地区差异，欧洲患者的病变发生率更高、继发性病例更多、预后更差。虽然这些探索性结果可能反映了不同医疗保健结构导致的选择偏倚，但仍需进一步研究以确定遗传、环境和社会因素的影响。

REF: Lange KS, Wang SJ, Pezzini A, et al. Regional Differences in Presentation, Cause, and Outcome of Reversible Cerebral Vasoconstriction Syndrome. Stroke. Published online June 26, 2025. doi:10.1161/STROKEAHA.125.051733 PMID: 40567225

Hypodensity Beyond the Ischemic Core: Penumbral Changes Detected With Relative Noncontrast Computed Tomography

缺血核心区以外的低密度影：通过相对非增强计算机断层扫描检测到的半暗带变化

In acute ischemic stroke, infarcted tissue gradually becomes detectable on noncontrast computed tomography (NCCT) as a hypodensity representing vasogenic edema. We studied whether subtle NCCT density changes are also present in penumbral tissue. In patients with anterior circulation acute ischemic stroke, we identified relative hypodensity in penumbral tissue on NCCT with potential clinical relevance on 90-day functional outcomes. The hypodensity was more pronounced with increasing hypoperfusion severity.

在急性缺血性卒中中，梗死组织在非对比计算机断层扫描（NCCT）上逐渐表现为代表血管源性水肿的低密度影而可被检测到。我们研究了半暗带组织中是否也存在细微的NCCT密度变化。在患有前循环急性缺血性卒中的患者中，我们在NCCT上发现半暗带组织存在相对低密度影，这对90天功能结局可能具有临床相关性。随着低灌注严重程度的增加，这种低密度影更为明显。

REF: Vandewalle L, Konduri PR, Christensen S, et al. Hypodensity Beyond the Ischemic Core: Penumbral Changes Detected With Relative Noncontrast Computed Tomography. Stroke. Published online June 25, 2025. doi:10.1161/STROKEAHA.124.050317 PMID: 40557487 PMCID: PMC12243634

Thrombectomy Versus Medical Management for Pediatric Arterial Ischemic Stroke With Large Baseline Infarct

基线大面积梗死的儿童动脉缺血性卒中：血栓切除术与药物治疗对比研究

Multiple recent randomized trials have demonstrated the benefit of thrombectomy over medical management alone in adult patients with large vessel occlusion (LVO) stroke and large infarct on baseline imaging. Cohort studies have also identified improved functional outcomes in pediatric patients who received thrombectomy. However, the role of thrombectomy in pediatric stroke with large baseline infarct remains uncertain. In this multicentre case-control study, pediatric patients (age, 1-18 years) with anterior circulation LVO stroke and low Alberta Stroke Program Early CT Score who received thrombectomy had significantly better functional outcomes than those treated with medical management alone. Exclusion of pediatric patients from thrombectomy based on low Alberta Stroke Program Early CT Score alone may not be appropriate.

近期多项随机试验表明，对于大血管闭塞（LVO）性卒中且基线影像学显示有大面积梗死的成年患者，血栓切除术优于单纯药物治疗。队列研究也发现，接受血栓切除术的儿科患者功能结局有所改善。然而，在基线大面积梗死的儿科卒中患者中，血栓切除术的作用仍不确定。在这项多中心病例对照研究中，患有前循环大血管闭塞性卒中且阿尔伯塔卒中项目早期CT评分较低的儿科患者（年龄1 - 18岁），接受血栓切除术的功能结局明显优于单纯接受药物治疗的患者。仅基于阿尔伯塔卒中项目早期CT评分较低就排除儿科患者接受血栓切除术可能并不合适。

REF: Bhatia KD, Muthusami P, Parra-Farinas C, et al. Thrombectomy Versus Medical Management for Pediatric Arterial Ischemic Stroke With Large Baseline Infarct. Stroke. Published online June 25, 2025. doi:10.1161/STROKEAHA.125.050993 PMID: 40557480