Improving Access to Stroke Rehabilitation and Recovery: A Policy Statement From the American Heart Association/American Stroke Association

改善卒中康复与恢复的可及性：美国心脏协会/美国卒中协会政策声明

Stroke rehabilitation is an integral component of comprehensive stroke care. Inequities in access to stroke rehabilitation can further widen the disability gap and disproportionately affect underinsured patients, patients living in rural areas, and patients from underrepresented races and ethnicities. However, even insured patients face obstacles to receiving stroke rehabilitation. The prior authorization process, peer-to-peer reviews, and subsequent appeals to health care insurers for the provision of postacute rehabilitation increase length of the acute care stay, placing pressure on health systems to expedite the transition of care, to the detriment of appropriate postacute rehabilitation placement. This policy statement focuses on (1) the provision of quality stroke rehabilitation to prevent complications, facilitate recovery, and limit disability, (2) the creation of evidence-based policies to improve equitable access, effectiveness, and efficiency of postacute care, (3) the development and use of performance measures that are aligned with the American Heart Association/American Stroke Association Guidelines for Adult Stroke Rehabilitation and Recovery to incentivize optimal patient care, and (4) identification of research priorities targeted to improve stroke rehabilitation access. This policy statement is a call for positive and sustained action. Stroke rehabilitation is the lifeline of hope for survivors, their caregivers, and their communities in the days, months, and years after stroke. It is imperative that governments and other funding agencies balance the support needed for acute stroke and stroke rehabilitation treatment, and that organizations, including the American Heart Association/American Stroke Association-an unrelenting advocate for improved brain health-advance the importance of stroke rehabilitation throughout the continuum of care.

中风康复是全面中风护理不可或缺的组成部分。在获取中风康复服务方面存在的不平等现象会进一步拉大残疾差距，并对保险不足的患者、农村地区的患者以及代表性不足的种族和族裔患者造成不成比例的影响。然而，即使是有保险的患者在接受中风康复治疗时也面临障碍。预先授权流程、同行评审以及随后向医疗保险公司就急性后期康复服务提供问题提出的申诉，会延长急性护理住院时间，给医疗系统带来加快护理过渡的压力，从而不利于患者获得合适的急性后期康复安置。本政策声明着重关注以下方面：（1）提供高质量的中风康复服务，以预防并发症、促进康复并减少残疾；（2）制定基于证据的政策，以提高急性后期护理的公平可及性、有效性和效率；（3）制定并采用与美国心脏协会/美国中风协会《成人中风康复与恢复指南》相一致的绩效指标，以激励提供最优的患者护理；（4）确定旨在改善中风康复可及性的研究重点。本政策声明呼吁采取积极且持续的行动。中风康复是中风患者及其护理人员和所在社区在中风发生后的数天、数月乃至数年中的希望之光。政府和其他资助机构必须平衡急性中风治疗和中风康复治疗所需的支持，包括美国心脏协会/美国中风协会（一个不懈倡导改善大脑健康的组织）在内的各组织必须在整个护理连续过程中强调中风康复的重要性。

REF: Ifejika NL, Awosika OO, Black T, et al. Improving Access to Stroke Rehabilitation and Recovery: A Policy Statement From the American Heart Association/American Stroke Association. Stroke. Published online July 31, 2025. doi:10.1161/STR.0000000000000493 PMID: 40740119

Association Between Schizophrenia and Adherence to Medications for Secondary Stroke Prevention

精神分裂症与二级卒中预防药物治疗依从性的关联

Schizophrenia is associated with an increased risk of stroke and under-treatment of vascular risk factors, but less is known about adherence to medications for secondary stroke prevention. We sought to understand current rates of adherence to secondary stroke prevention therapies among elderly ischemic stroke survivors with and without schizophrenia. Schizophrenia is associated with poor adherence to medications for secondary stroke prevention. Future work should focus on developing individual- and system-level interventions to improve vascular risk factor management in this population.

精神分裂症与中风风险增加以及血管危险因素治疗不足有关，但对于中风二级预防药物的依从性情况了解较少。我们旨在了解有和没有精神分裂症的老年缺血性中风幸存者目前对中风二级预防疗法的依从率。精神分裂症与中风二级预防药物的依从性差有关。未来的工作应侧重于制定个体和系统层面的干预措施，以改善这一人群的血管危险因素管理。

REF: Kapoor E, Sheehan KA, Yu AYX, et al. Association Between Schizophrenia and Adherence to Medications for Secondary Stroke Prevention. Stroke. Published online July 30, 2025. doi:10.1161/STROKEAHA.125.051100 PMID: 40735774

Tadalafil Treatment in Patients With Cerebral Small Vessel Disease: The ETLAS-2 Randomized Clinical Trial

他达拉非治疗脑小血管病患者：ETLAS - 2 随机临床试验

White matter hyperintensities and reduced cerebral blood flow are hallmarks of cerebral small vessel disease (CSVD). We tested the feasibility of daily treatment with the vasoactive drug tadalafil in patients with CSVD and its effects on cognition and imaging markers of CSVD. In participants with CSVD, adherence to tadalafil was significantly lower than to placebo and did not meet the prespecified compliance threshold. We observed a nonsignificant reduction in white matter hyperintensity volume after tadalafil, which warrants larger and prolonged studies with reduced tadalafil doses to explore potential benefits in CSVD.

脑白质高信号和脑血流量减少是脑小血管病（CSVD）的标志。我们测试了对CSVD患者每日使用血管活性药物他达拉非治疗的可行性，以及其对CSVD认知和影像学标志物的影响。在CSVD参与者中，他达拉非的依从性显著低于安慰剂，且未达到预先设定的依从性阈值。我们观察到使用他达拉非后脑白质高信号体积有不显著的减小，这需要开展更大规模、更长时间且降低他达拉非剂量的研究，以探索其对CSVD的潜在益处。

REF: Ölmestig J, Mortensen KN, Thomas MB, et al. Tadalafil Treatment in Patients With Cerebral Small Vessel Disease: The ETLAS-2 Randomized Clinical Trial. Stroke. Published online July 28, 2025. doi:10.1161/STROKEAHA.125.051602 PMID: 40718899

Accuracy of Large Language Models to Identify Stroke Subtypes Within Unstructured Electronic Health Record Data

大语言模型在非结构化电子健康记录数据中识别卒中亚型的准确性

While International Classification of Diseases, Tenth Revision codes suffice for identifying stroke events in surveillance, accurately classifying stroke types and subtypes using electronic health records remains challenging due to limitations in structured data. This often necessitates manual review of clinical documentation. This study evaluated whether a large language model, GPT-4o, can accurately identify stroke types and subtypes from unstructured clinical notes. GPT-4o demonstrated strong accuracy in classifying stroke types but faced challenges with ischemic subtypes.

虽然《国际疾病分类第十版》编码足以在监测中识别中风事件，但由于结构化数据存在局限性，利用电子健康记录准确分类中风类型和亚型仍然具有挑战性。这通常需要人工审查临床文档。本研究评估了大型语言模型GPT - 4o能否从非结构化临床笔记中准确识别中风类型和亚型。GPT - 4o在分类中风类型方面表现出较高的准确性，但在缺血性亚型分类方面面临挑战。

REF: Owens D, Nguyen DQ, Dohopolski M, Rousseau JF, Peterson ED, Navar AM. Accuracy of Large Language Models to Identify Stroke Subtypes Within Unstructured Electronic Health Record Data. Stroke. Published online July 25, 2025. doi:10.1161/STROKEAHA.125.051993 PMID: 40709446 PMCID: PMC12313299

Hypertension Is Associated With Earlier Onset of Nontraumatic Subarachnoid Hemorrhage in Women: A Mendelian Randomization Study

高血压与女性非创伤性蛛网膜下腔出血的早发相关：一项孟德尔随机化研究

Nontraumatic subarachnoid hemorrhage (SAH) is linked to hypertension, a condition highly influenced by common genetic variants. For complex diseases affected by genetic and environmental factors, genetic predisposition plays a key role in early onset. We hypothesize that elevated polygenic susceptibility to hypertension is associated with a younger age of onset in SAH. Polygenic susceptibility to hypertension is associated with earlier onset of nontraumatic SAH in women. Further studies are needed to replicate these findings in non-European individuals. Genetic predisposition to hypertension could be used for screening and early identification of individuals at risk of SAH.

非创伤性蛛网膜下腔出血（SAH）与高血压有关，而高血压这种状况深受常见基因变异的影响。对于受遗传和环境因素影响的复杂疾病，遗传易感性在疾病早发中起着关键作用。我们推测，高血压的多基因易感性升高与SAH发病年龄年轻化有关。女性高血压的多基因易感性与非创伤性SAH的早发有关。需要进一步的研究在非欧洲人群中验证这些发现。高血压的遗传易感性可用于筛查和早期识别有SAH风险的个体。

REF: Vanent KN, Leslie-Mazwi TM, Matouk CC, Sheth KN, Levitt MR, Falcone GJ. Hypertension Is Associated With Earlier Onset of Nontraumatic Subarachnoid Hemorrhage in Women: A Mendelian Randomization Study. Stroke. Published online July 23, 2025. doi:10.1161/STROKEAHA.124.047631 PMID: 40698383

Intravenous Thrombolysis in Patients With Recent Intake of Direct Oral Anticoagulants: A Target Trial Analysis and Comparison With Reversal Agent Use

近期服用直接口服抗凝药患者的静脉溶栓治疗：一项目标试验分析及与使用逆转剂的比较

Intravenous thrombolysis (IVT) in patients with recent ingestion of direct oral anticoagulants (DOACs) is a frequent challenge and remains controversial. The benefit of DOAC reversal before IVT is uncertain. This target trial confirms previous observational data regarding the safety of off-label IVT in patients with recent DOAC intake. More data and dedicated trials are needed for patients with confirmed high DOAC plasma levels and regarding the efficacy and safety of DOAC reversal before IVT.

近期服用直接口服抗凝药（DOACs）的患者进行静脉溶栓治疗（IVT）是常见挑战，且仍存在争议。在静脉溶栓前逆转DOACs的益处尚不明确。这项目标试验证实了此前关于近期服用DOACs的患者超说明书使用静脉溶栓治疗安全性的观察性数据。对于已确认DOACs血浆水平较高的患者，以及静脉溶栓前逆转DOACs的有效性和安全性，还需要更多数据和专门的试验。

REF: Meinel TR, Bücke P, D'Anna L, et al. Intravenous Thrombolysis in Patients With Recent Intake of Direct Oral Anticoagulants: A Target Trial Analysis and Comparison With Reversal Agent Use. Stroke. Published online July 22, 2025. doi:10.1161/STROKEAHA.125.051384 PMID: 40693390

Could the Early Disinhibition of the Unaffected Motor Cortex Predict Motor Recovery After Stroke?

未受损运动皮层的早期去抑制能否预测卒中后的运动恢复情况？

Whether intracortical inhibition in the unaffected hemisphere is related to motor recovery after stroke may depend on the status of corticospinal excitability in the affected hemisphere. The aims are (1) to identify the presence of short-latency intracortical inhibition (SICI) in the acute phase according to the motor-evoked potential (MEP) status of the patients and (2) to investigate whether unaffected hemisphere SICI is associated with motor recovery at 3 months in subgroups of patients (with or without an MEP). Implementing intracortical inhibition could improve prediction models in future studies for severe patients without an MEP whose recovery trajectories are hard to predict and for whom clinical rehabilitation decisions are difficult to make.

健侧半球的皮质内抑制是否与卒中后运动功能恢复相关，可能取决于患侧半球皮质脊髓束兴奋性状态。研究目的如下：（1）根据患者运动诱发电位（MEP）状态，确定急性期短潜伏期皮质内抑制（SICI）的存在情况；（2）探究在不同亚组患者（有或无MEP）中，健侧半球SICI是否与3个月时的运动功能恢复相关。在未来研究中，对无MEP、恢复进程难以预测且临床康复决策困难的重症患者，引入皮质内抑制指标可能会改进预测模型。

REF: Rosso C, Daghsen L, Bouvier J, et al. Could the Early Disinhibition of the Unaffected Motor Cortex Predict Motor Recovery After Stroke?. Stroke. Published online July 22, 2025. doi:10.1161/STROKEAHA.125.051614 PMID: 40693370

Aging and Gender Modify the Risk of Carotid Plaque Thrombosis Related to Dyslipidemic Profile

衰老和性别会改变与血脂异常相关的颈动脉斑块血栓形成风险

Dyslipidemia plays a critical role in carotid plaque instability and related cerebrovascular events. Reduction of low-density lipoprotein cholesterol (LDL-C) levels decreases ischemic stroke risk; however, a residual cardiovascular risk persists. Starting from this evidence, this study evaluated the impact of dyslipidemia on carotid plaque instability while also considering age and gender. The data reported here highlight the importance of a personalized medicine approach to lipid management, addressing not only LDL-C but also remnant cholesterol and triglycerides. Tailored interventions targeting specific dyslipidemic profiles could more effectively reduce the risk of carotid plaque rupture and cerebrovascular events, particularly in women and patients aged <70 years.

血脂异常在颈动脉斑块不稳定及相关脑血管事件中起着关键作用。降低低密度脂蛋白胆固醇（LDL - C）水平可降低缺血性中风风险；然而，仍存在残余心血管风险。基于这一证据，本研究评估了血脂异常对颈动脉斑块不稳定的影响，同时考虑了年龄和性别因素。此处报告的数据强调了采用个性化药物治疗方法进行血脂管理的重要性，不仅要关注LDL - C，还要关注残余胆固醇和甘油三酯。针对特定血脂异常特征制定的干预措施，能更有效地降低颈动脉斑块破裂和脑血管事件的风险，尤其适用于女性和年龄小于70岁的患者。

REF: Servadei F, Scimeca M, Palumbo V, et al. Aging and Gender Modify the Risk of Carotid Plaque Thrombosis Related to Dyslipidemic Profile. Stroke. Published online July 22, 2025. doi:10.1161/STROKEAHA.125.051754 PMID: 40693375

Rural and Urban Disparities in Access to Endovascular Thrombectomy for Large Vessel Occlusions in Colorado

科罗拉多州大血管闭塞患者在接受血管内血栓切除术方面的城乡差异

Rural-urban disparities in access to acute stroke care exist and have widened over time. We sought to quantify the rural-urban disparities that may exist in access to endovascular thrombectomy (EVT) for patients experiencing strokes with large vessel occlusions in Colorado. Rural patients experienced longer time to intervention and had worse outcomes after a stroke with large vessel occlusions. Each rural patient with large vessel occlusions lost ≈1.7 years of disability-free life compared with an urban patient with the same severity stroke. More work needs to be done to identify and quantify the sources of delay for rural patients.

在获得急性中风治疗方面存在城乡差异，且这种差异随着时间的推移而扩大。我们试图量化科罗拉多州大血管闭塞性中风患者在获得血管内血栓切除术（EVT）方面可能存在的城乡差异。农村患者从发病到接受干预的时间更长，大血管闭塞性中风后的预后更差。与同等严重程度的城市中风患者相比，每位大血管闭塞的农村患者丧失了约1.7年的无残疾生活时间。需要做更多工作来确定并量化导致农村患者治疗延迟的因素。

REF: Hagedorn D, Whaley M, Zuelke K, et al. Rural and Urban Disparities in Access to Endovascular Thrombectomy for Large Vessel Occlusions in Colorado. Stroke. Published online July 21, 2025. doi:10.1161/STROKEAHA.125.051542 PMID: 40686202