Intravenous thrombolysis versus early antiplatelet therapy in acute ischaemic stroke with small artery occlusion

小动脉闭塞型急性缺血性卒中静脉溶栓与早期抗血小板治疗的比较

The efficacy of intravenous thrombolysis (IVT) versus early antiplatelet therapy (APT) in small artery occlusion (SAO) stroke remains debated. IVT significantly reduced the likelihood of unfavourable FO at 3 months in SAO patients but did not significantly reduce END. Patients with traditional risk factors may benefit more from IVT than those with elevated inflammatory markers.

在小动脉闭塞（SAO）型卒中中，静脉溶栓（IVT）与早期抗血小板治疗（APT）的疗效仍存在争议。静脉溶栓显著降低了SAO患者3个月时不良功能结局（FO）的可能性，但未显著降低早期神经功能恶化（END）的发生。有传统危险因素的患者可能比炎症标志物升高的患者从静脉溶栓中获益更多。

REF: Zhang K, Liu H, Zong C, et al. Intravenous thrombolysis versus early antiplatelet therapy in acute ischaemic stroke with small artery occlusion. Stroke Vasc Neurol. Published online September 25, 2025. doi:10.1136/svn-2025-004309 PMID: 41005788

Phase I dose-escalation study of tenecteplase, a third-generation fibrinolytic agent, combined with neuronavigation-assisted stereotactic minimally invasive puncture, in patients with acute spontaneous deep cerebral haemorrhage

第三代纤溶药物替奈普酶联合神经导航辅助立体定向微创穿刺治疗急性自发性深部脑出血患者的Ⅰ期剂量递增研究

Tenecteplase (TNK) offers logistical advantages in stroke thrombolytic therapy with its single bolus administration compared with alteplase. Moreover, its high specificity for fibrin may contribute to a reduction in haemorrhage complications. However, the safety, tolerability and efficacy of TNK, combined with neuronavigation-assisted stereotactic minimally invasive puncture, in patients with acute spontaneous deep cerebral haemorrhage remain unknown. TNK is well tolerated with encouraging signs of dissolving blood clots. Further exploration of TNK combined with neuronavigation-assisted stereotactic MIPS in patients with acute spontaneous deep cerebral haemorrhage is warranted.

替奈普酶（TNK）与阿替普酶相比，在中风溶栓治疗中具有给药便利的优势，因为它只需单次静脉推注。此外，其对纤维蛋白的高特异性可能有助于减少出血并发症。然而，TNK联合神经导航辅助立体定向微创穿刺术治疗急性自发性深部脑出血患者的安全性、耐受性和有效性仍不清楚。TNK耐受性良好，在溶解血栓方面有令人鼓舞的表现。有必要进一步探索TNK联合神经导航辅助立体定向微创穿刺术治疗急性自发性深部脑出血患者的应用。

REF: Wu Z, Wang M, Bai X, et al. Phase I dose-escalation study of tenecteplase, a third-generation fibrinolytic agent, combined with neuronavigation-assisted stereotactic minimally invasive puncture, in patients with acute spontaneous deep cerebral haemorrhage. Stroke Vasc Neurol. Published online September 24, 2025. doi:10.1136/svn-2025-004389 PMID: 40992931

Macular choriocapillaris perfusion area: a potential biomarker of mild cognitive impairment in patients with cerebral small vessel disease

黄斑脉络膜毛细血管灌注面积：脑小血管病患者轻度认知障碍的潜在生物标志物

To develop and validate retinal vascular biomarkers for detecting mild cognitive impairment (MCI) in cerebral small vessel disease (CSVD) using swept-source optical coherence tomography angiography (SS-OCTA). SS-OCTA-derived macular CCPA, especially in the 3-6 mm OS region, may serve as a promising and non-invasive biomarker for CSVD-related MCI. Further multicentre studies are needed to establish its clinical applicability.

利用扫频源光学相干断层扫描血管造影（SS - OCTA）开发并验证用于检测脑小血管病（CSVD）中轻度认知障碍（MCI）的视网膜血管生物标志物。基于SS - OCTA得出的黄斑中心凹无血管区周围毛细血管灌注面积（CCPA），尤其是在3 - 6 mm 颞侧区域的CCPA，可能成为检测与CSVD相关的MCI有前景的非侵入性生物标志物。需要开展更多多中心研究来确定其临床适用性。

REF: Yu W, Shen Z, Zhang W, et al. Macular choriocapillaris perfusion area: a potential biomarker of mild cognitive impairment in patients with cerebral small vessel disease. Stroke Vasc Neurol. Published online September 24, 2025. doi:10.1136/svn-2025-004139 PMID: 40992932

Dual versus mono antiplatelet therapy within 72 hours after onset for mild ischaemic stroke or transient ischaemic attack: meta-analysis of randomised controlled trials

轻度缺血性卒中或短暂性脑缺血发作发病后72小时内双联与单联抗血小板治疗：随机对照试验的荟萃分析

Although previous evidence generally agreed on the short-term dual antiplatelet therapy (DAPT) for mild stroke or transient ischaemic attack (TIA), there is no consensus on the optimal threshold for stroke severity and initiation timing of DAPT. We conducted an updated meta-analysis of randomised controlled trials to evaluate early DAPT versus single therapy in mild stroke or TIA. For acute mild stroke (NIHSS ≤5) or patients with TIA within 72 hours of ictus, early DAPT initiation demonstrates net clinical benefit through reducing ischaemic events, despite an increase in bleeding complications, without affecting mortality.

尽管此前的证据普遍支持对轻度卒中或短暂性脑缺血发作（TIA）采用短期双联抗血小板治疗（DAPT），但对于卒中严重程度的最佳阈值以及DAPT的启动时机尚无共识。我们对随机对照试验进行了一项更新的荟萃分析，以评估早期DAPT与单一疗法治疗轻度卒中或TIA的效果。对于急性轻度卒中（美国国立卫生研究院卒中量表评分 ≤ 5分）或发病72小时内的TIA患者，早期启动DAPT可通过减少缺血性事件带来净临床获益，尽管会增加出血并发症，但不影响死亡率。

REF: Yang Y, Zhu J, Gao Y, Pan Y, Wang Y. Dual versus mono antiplatelet therapy within 72 hours after onset for mild ischaemic stroke or transient ischaemic attack: meta-analysis of randomised controlled trials. Stroke Vasc Neurol. Published online September 23, 2025. doi:10.1136/svn-2025-004143 PMID: 40987530

Characteristics of brain structural damage related to cerebral small vessel disease in general population with intracranial artery stenosis

颅内动脉狭窄的普通人群中与脑小血管病相关的脑结构损伤特征

Covert MRI markers of cerebral small vessel disease (CSVD) can coexist with large artery atherosclerosis. We aimed to explore whether the spatial distributions of these markers were diverse in people with or without intracranial artery stenosis (ICAS). Since ICAS may be involved in the upstream pathogenesis of lacunes, white matter lesions and cortical atrophy, the impact of ICAS should not be ignored when evaluating MRI markers of CSVD.

脑小血管病（CSVD）的隐匿性磁共振成像标志物可与大动脉粥样硬化并存。我们旨在探讨在有无颅内动脉狭窄（ICAS）的人群中，这些标志物的空间分布是否存在差异。由于ICAS可能参与了腔隙性梗死、白质病变和皮质萎缩的上游发病机制，因此在评估CSVD的磁共振成像标志物时，不应忽视ICAS的影响。

REF: Pan ZA, Liu ZY, Pan XQ, et al. Characteristics of brain structural damage related to cerebral small vessel disease in general population with intracranial artery stenosis. Stroke Vasc Neurol. Published online September 16, 2025. doi:10.1136/svn-2025-004471 PMID: 40957669

Brain-targeted extracellular vesicles for anti-cuproptosis therapy in subarachnoid haemorrhage

用于蛛网膜下腔出血抗铜死亡治疗的脑靶向细胞外囊泡

Subarachnoid haemorrhage (SAH) is primarily caused by ruptured aneurysms with high mortality worldwide. Cuproptosis is a copper-induced cell death that regulates lipoylated tricarboxylic acid cycle proteins. The link between cuproptosis and SAH is unclear. To inhibit cuproptosis for SAH treatment, we designed brain-targeted delivery of siRNA to inhibit cuproptosis. These findings suggest that cuprotosis is critical for inducing neural injury after SAH. Neuron-targeted RVG-RBCEVs/siRNA treatment attenuated oxidative stress by inhibiting cuproptosis via suppressed LIAS expression. This innovative approach alleviates neurobehavioural impairments and represents a neuroprotective strategy following SAH.

蛛网膜下腔出血（SAH）主要由动脉瘤破裂引起，在全球范围内死亡率很高。铜死亡是一种由铜诱导的细胞死亡方式，可调节脂酰化三羧酸循环蛋白。铜死亡与蛛网膜下腔出血之间的联系尚不清楚。为了抑制铜死亡以治疗蛛网膜下腔出血，我们设计了脑靶向递送小干扰RNA（siRNA）来抑制铜死亡。这些发现表明，铜死亡在蛛网膜下腔出血后诱发神经损伤方面起着关键作用。神经元靶向的狂犬病病毒糖蛋白修饰的红细胞外泌体（RVG - RBCEVs）/siRNA治疗通过抑制脂酰化合成酶（LIAS）的表达来抑制铜死亡，从而减轻氧化应激。这种创新方法可减轻神经行为障碍，是一种蛛网膜下腔出血后的神经保护策略。

REF: Xu P, Fang J, Qin F, et al. Brain-targeted extracellular vesicles for anti-cuproptosis therapy in subarachnoid haemorrhage. Stroke Vasc Neurol. Published online September 15, 2025. doi:10.1136/svn-2025-004248 PMID: 40953925

Tongxinluo capsule in the treatment of cerebral small vessel disease: protocol of a randomised, double-blind, placebo-controlled, multicentre clinical study (TOPS-CSVD)

通心络胶囊治疗脑小血管病：一项随机、双盲、安慰剂对照、多中心临床研究方案（TOPS - CSVD）

Tongxinluo capsule has demonstrated multiple beneficial effects on microcirculation, endothelial cells and inflammation. However, evidence supporting their efficacy in improving vascular cognitive decline is limited. This trial aims to investigate the potential benefits of Tongxinluo capsules in Chinese patients with cerebral small vessel disease (CSVD) who have been diagnosed with mild cognitive impairment. This trial has the potential to offer novel insights into the management of cognitive decline associated with CSVD through the application of traditional Chinese medicine.

通心络胶囊已被证明对微循环、内皮细胞和炎症具有多种有益作用。然而，支持其改善血管性认知衰退疗效的证据有限。本试验旨在研究通心络胶囊对已被诊断为轻度认知障碍的中国脑小血管病（CSVD）患者的潜在益处。本试验有可能通过应用中药为CSVD相关认知衰退的管理提供新的见解。

REF: Wang Y, Xie X, Xu J, et al. Tongxinluo capsule in the treatment of cerebral small vessel disease: protocol of a randomised, double-blind, placebo-controlled, multicentre clinical study (TOPS-CSVD). Stroke Vasc Neurol. Published online September 10, 2025. doi:10.1136/svn-2024-003929 PMID: 40935402

Incidence and impact of brain lesions and cognitive impairment after CABG with moderate or severe cerebral artery stenosis seen on low-field MRI

低场磁共振成像显示的中重度脑动脉狭窄患者冠状动脉搭桥术后脑损伤和认知障碍的发生率及影响

The study aimed to assess the incidence and impact of brain lesions and cognitive impairment after coronary artery bypass grafting (CABG) in patients with moderate-to-severe cerebral artery stenosis using low-field MRI. Low-field MRI has proven effective in detecting new brain lesions after CABG. Both postoperative new brain lesions and CABG operation were significant contributors to cognitive decline.

本研究旨在利用低场强磁共振成像（MRI）评估中重度脑动脉狭窄患者冠状动脉旁路移植术（CABG）后脑损伤和认知障碍的发生率及其影响。低场强MRI已被证明能有效检测CABG术后的新发脑损伤。术后新发脑损伤和CABG手术均是导致认知功能下降的重要因素。

REF: Zhang G, Pei Y, Xu F, et al. Incidence and impact of brain lesions and cognitive impairment after CABG with moderate or severe cerebral artery stenosis seen on low-field MRI. Stroke Vasc Neurol. Published online September 10, 2025. doi:10.1136/svn-2025-004132 PMID: 40935401

Efficacy of Papaverine to Prevent Radial Artery Spasm During Transradial Cerebral Angiography (PASS): rationale and design

罂粟碱在经桡动脉脑动脉造影术中预防桡动脉痉挛的疗效研究（PASS）：原理与设计

Radial artery spasm (RAS) is a common complication during transradial cerebral angiography (TRA), but currently, the optimal prevention strategy is not well established. Papaverine has anti-vasospasm, sedative and analgesic effects. However, the efficacy of papaverine in preventing RAS during TRA remains unknown. The primary outcome is the incidence of RAS during the procedure. The operator assessed RAS based on a questionnaire addressing the following five signs: persistent forearm pain, pain response on catheter manipulation, pain response to introducer withdrawal and difficult catheter manipulation after being 'trapped' by the radial artery with considerable resistance on withdrawal of the introducer. RAS was indicated by the presence of at least two of these five signs or by the presence of just one when the operator considered it necessary to administer other spasmolytic agents.

桡动脉痉挛（RAS）是经桡动脉脑血管造影（TRA）期间常见的并发症，但目前，最佳的预防策略尚未明确。罂粟碱具有抗血管痉挛、镇静和镇痛作用。然而，罂粟碱在TRA期间预防RAS的疗效仍不清楚。主要结局是手术过程中RAS的发生率。术者根据一份调查问卷评估RAS，该问卷涉及以下五种体征：持续性前臂疼痛、导管操作时的疼痛反应、拔出鞘管时的疼痛反应以及导管被桡动脉“卡住”导致操作困难且拔出鞘管时有明显阻力。若出现这五种体征中的至少两种，或仅出现一种但术者认为有必要使用其他解痉药物时，则判定为RAS。

REF: Pan D, Yang J, Liu M, et al. Efficacy of Papaverine to Prevent Radial Artery Spasm During Transradial Cerebral Angiography (PASS): rationale and design. Stroke Vasc Neurol. Published online September 10, 2025. doi:10.1136/svn-2024-003659 PMID: 40930776