Surgical interventions for patients with spontaneous intracerebral haemorrhage: a systematic review and network meta-analysis

自发性脑出血患者的手术干预措施：系统评价与网络荟萃分析

Intracerebral haemorrhage (ICH) is a critical condition that leads to significant mortality or profound disability. Surgery serves as an important intervention that can save lives; however, the surgical techniques employed globally exhibit considerable variability, and their efficacy remains ambiguous. This systematic review and network meta-analysis found that endoscopic surgery and minimally invasive puncture surgery were associated with lower mortality and better functional outcomes compared with other interventions. However, the certainty of evidence was limited due to heterogeneity in patient populations and treatment protocols. More definitive conclusions will require future large-scale, rigorously designed RCTs that standardise protocols and minimise confounding factors.

脑出血（ICH）是一种危急病症，可导致较高的死亡率或严重残疾。手术是一种重要的救命干预手段；然而，全球采用的手术技术存在显著差异，其疗效也尚不明确。这项系统评价和网络荟萃分析发现，与其他干预措施相比，内镜手术和微创穿刺手术与较低的死亡率和较好的功能结局相关。然而，由于患者群体和治疗方案存在异质性，证据的确定性有限。未来需要开展大规模、设计严谨的随机对照试验（RCT），对方案进行标准化并尽量减少混杂因素，才能得出更明确的结论。

REF: Wang H, Yang Y, Zhao D, et al. Surgical interventions for patients with spontaneous intracerebral haemorrhage: a systematic review and network meta-analysis. Stroke Vasc Neurol. Published online November 25, 2025. doi:10.1136/svn-2024-003942 PMID: 41290409

Safety and Efficacy of Remote Ischaemic Conditioning for Acute Ischaemic Stroke Treated with Mechanical Thrombectomy (RECAST-MT): rationale and design

远程缺血预适应对接受机械取栓治疗的急性缺血性卒中的安全性和有效性研究（RECAST - MT）：研究依据与设计

Adjunctive neuroprotection is a promising strategy for improving functional recovery in patients with acute ischaemic stroke (AIS) treated with mechanical thrombectomy (MT). Remote ischaemic conditioning (RIC) has been shown to be safe and effective in patients with AIS; however, its specific impact on neurological outcomes in patients undergoing MT remains to be established. To evaluate the safety and efficacy of adjunctive RIC in improving 90-day functional outcomes in patients with AIS treated with MT, and to compare two treatment durations (14 days vs 30 days). The RECAST-MT trial will provide phase III evidence on the efficacy of RIC in combination with MT for patients with AIS. If successful, this approach could offer a safe, easy-to-implement and cost-effective neuroprotective therapy in this population.

辅助神经保护是改善接受机械取栓术（MT）治疗的急性缺血性卒中（AIS）患者功能恢复的一种有前景的策略。远程缺血预适应（RIC）已被证明对AIS患者是安全有效的；然而，其对接受MT治疗患者神经功能结局的具体影响仍有待确定。本研究旨在评估辅助RIC改善接受MT治疗的AIS患者90天功能结局的安全性和有效性，并比较两种治疗时长（14天与30天）。RECAST - MT试验将为RIC联合MT治疗AIS患者的有效性提供Ⅲ期研究证据。如果试验成功，这种方法可为该类患者提供一种安全、易于实施且具有成本效益的神经保护疗法。

REF: Wang Y, Huang S, Liu L, et al. Safety and Efficacy of Remote Ischaemic Conditioning for Acute Ischaemic Stroke Treated with Mechanical Thrombectomy (RECAST-MT): rationale and design. Stroke Vasc Neurol. Published online November 25, 2025. doi:10.1136/svn-2025-004591 PMID: 41290408

Loberamisal injection for the treatment of acute ischaemic stroke: a multicentre, randomised, double-blind, placebo-controlled phase II clinical trial

洛贝米萨尔注射液治疗急性缺血性卒中：一项多中心、随机、双盲、安慰剂对照的Ⅱ期临床试验

Loberamisal is a small-molecule agent that inhibits the nNOS-postsynaptic density protein 95 coupling and enhances α2-containing γ-aminobutyric acid type A receptor, which has been shown effective in animal studies. This trial aimed to investigate its safety and therapeutic efficacy in patients with acute ischaemic stroke (AIS) within 48 hours of symptom onset. Loberamisal injection was well tolerated in patients with AIS within 48 hours of symptom onset in China. The efficacy and optimal dosage of loberamisal for AIS need prospective validation.

洛贝米萨尔是一种小分子药物，可抑制神经元型一氧化氮合酶（nNOS）与突触后致密蛋白95的耦合，并增强含α2亚基的γ-氨基丁酸A型受体（GABAA）的功能，动物研究已证实其有效性。本试验旨在探究该药在症状发作48小时内的急性缺血性脑卒中（AIS）患者中的安全性和治疗效果。在中国，症状发作48小时内的AIS患者对洛贝米萨尔注射液耐受性良好。洛贝米萨尔治疗AIS的疗效和最佳剂量尚需前瞻性验证。

REF: Feng B, Li H, Xu S, et al. Loberamisal injection for the treatment of acute ischaemic stroke: a multicentre, randomised, double-blind, placebo-controlled phase II clinical trial. Stroke Vasc Neurol. Published online November 10, 2025. doi:10.1136/svn-2025-004581 PMID: 41218852

Monitoring treatment of delayed cerebral ischaemia in unconscious patients after aneurysmal subarachnoid haemorrhage: a prospective multimodal neuromonitoring study

动脉瘤性蛛网膜下腔出血后昏迷患者延迟性脑缺血的治疗监测：一项前瞻性多模式神经监测研究

Aneurysmal subarachnoid haemorrhage (SAH) is a life-threatening condition with high morbidity. Delayed cerebral ischaemia (DCI) significantly contributes to secondary injury and poor outcomes. While perfusion CT (CTP) aids DCI detection, multimodal neuromonitoring-including brain tissue oxygenation (PtiO2) and cerebral microdialysis-offers superior temporal resolution. Its value in guiding treatment remains underexplored. PRx and LPR reflect meaningful physiological responses to DCI treatment and are associated with 1-year outcomes. Multimodal neuromonitoring may support not only diagnosis but also treatment monitoring and decision-making in unconscious SAH patients.

动脉瘤性蛛网膜下腔出血（SAH）是一种具有高发病率的危及生命的疾病。延迟性脑缺血（DCI）是导致继发性损伤和预后不良的重要原因。虽然灌注 CT（CTP）有助于 DCI 的检测，但包括脑组织氧分压（PtiO2）和脑微透析在内的多模态神经监测具有更优的时间分辨率。其在指导治疗方面的价值仍有待深入研究。压力反应性指数（PRx）和局部压力反应性（LPR）反映了 DCI 治疗过程中有意义的生理反应，且与 1 年预后相关。多模态神经监测不仅可用于无意识 SAH 患者的诊断，还可用于治疗监测和决策制定。

REF: Veldeman M, Bögli SY, Olakorede I, et al. Monitoring treatment of delayed cerebral ischaemia in unconscious patients after aneurysmal subarachnoid haemorrhage: a prospective multimodal neuromonitoring study. Stroke Vasc Neurol. Published online November 4, 2025. doi:10.1136/svn-2025-004642 PMID: 41192974

Reduced endothelial TAK1 impairs vascular integrity in cerebral small vessel disease via the RIPK1-MLKL signalling pathway

内皮细胞TGF-β激活激酶1（TAK1）表达降低通过受体相互作用蛋白激酶1（RIPK1）-混合谱系激酶结构域样蛋白（MLKL）信号通路损害脑小血管病中的血管完整性

Hypertension stands as a major modifiable risk factor for cerebral small vessel disease (CSVD), driving pathological cerebrovascular rarefaction and blood-brain barrier (BBB) compromise through endothelial dysfunction and death. However, the mechanisms regulating cerebral endothelial cell death and endogenous vascular repair pathways remain incompletely characterised. While transforming growth factor-β-activated kinase 1 (TAK1) is recognised as a central regulator of cell survival and homeostasis across multiple tissues, its cerebrovascular-specific functions in hypertension-related CSVD pathogenesis have not been fully delineated. Our results demonstrate that TAK1 downregulation in endothelial cells induces RIPK1-MLKL-mediated necroptosis and downregulation of tight junction protein expression. This coordinated mechanism orchestrates cerebrovascular integrity impairment and subsequent cognitive deterioration. This study positions TAK1 as a promising and potential therapeutic target for the prevention and treatment of hypertension-related CSVD.

高血压是脑小血管病（CSVD）的一个主要可改变风险因素，通过内皮功能障碍和死亡导致病理性脑血管稀疏和血脑屏障（BBB）受损。然而，调控脑内皮细胞死亡和内源性血管修复途径的机制仍未完全明确。虽然转化生长因子 - β激活激酶1（TAK1）被认为是多种组织中细胞存活和体内平衡的关键调节因子，但其在高血压相关CSVD发病机制中的脑血管特异性功能尚未完全阐明。我们的研究结果表明，内皮细胞中TAK1表达下调会诱导受体相互作用蛋白激酶1（RIPK1） - 混合谱系激酶结构域样蛋白（MLKL）介导的坏死性凋亡，并下调紧密连接蛋白的表达。这一协同机制会导致脑血管完整性受损，继而引发认知功能恶化。本研究表明TAK1有望成为预防和治疗高血压相关CSVD的潜在治疗靶点。

REF: Yang J, Xiao C, Yi M, Zhou K, Xu X, Fan Y. Reduced endothelial TAK1 impairs vascular integrity in cerebral small vessel disease via the RIPK1-MLKL signalling pathway. Stroke Vasc Neurol. Published online November 4, 2025. doi:10.1136/svn-2025-004469 PMID: 41151805

Stent angioplasty in patients with vertebral artery ostial stenosis: clinical and angiographic outcomes in 525 patients

椎动脉开口狭窄患者的支架血管成形术：525例患者的临床和血管造影结果

The optimal treatment approach for patients with severe atherosclerotic vertebral artery ostial stenosis (VAOS) is not yet supported by evidence from large-scale studies. Even with optimal medical treatment and effective risk factor management, substantial numbers of patients experience symptoms or recurrent strokes. Endovascular treatment is a potential solution, particularly when medicinal therapy alone is insufficient for symptom and stroke risk reduction. This study was aimed at assessing the safety and effectiveness of stent angioplasty in patients with VAOS. Stent angioplasty was demonstrated to be a safe and feasible option for patients with VAOS, with a low risk of periprocedural stroke and symptom recurrence, and favourable stent patency rates at mid-term and long-term follow-up.

严重动脉粥样硬化性椎动脉开口狭窄（VAOS）患者的最佳治疗方法尚未得到大规模研究证据的支持。即使采用了最佳药物治疗并有效控制了危险因素，仍有相当数量的患者会出现症状或发生复发性卒中。血管内治疗是一种潜在的解决方案，尤其是在单纯药物治疗不足以减轻症状和降低卒中风险的情况下。本研究旨在评估支架血管成形术治疗VAOS患者的安全性和有效性。研究表明，支架血管成形术是治疗VAOS患者的一种安全可行的选择，围手术期卒中风险和症状复发风险较低，且在中长期随访中支架通畅率良好。

REF: Hajiyev K, Khanafer A, von Gottberg P, et al. Stent angioplasty in patients with vertebral artery ostial stenosis: clinical and angiographic outcomes in 525 patients. Stroke Vasc Neurol. Published online November 4, 2025. doi:10.1136/svn-2025-004651 PMID: 41192977

Early blood pressure lowering and cerebral oedema in thrombolysis-treated stroke: secondary analysis of the ENCHANTED trial

接受溶栓治疗的卒中患者早期降压与脑水肿：ENCHANTED试验的二次分析

Controversy persists over the balance of benefits and harms of early intensive blood pressure (BP) lowering in thrombolysis-treated acute ischaemic stroke (AIS) patients. The BP-control arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) (n=2196) showed that compared with guideline-recommended management (systolic BP (SBP)<180 mm Hg), intensive BP lowering did not improve functional outcome despite reducing intracranial haemorrhage. We aimed to evaluate the relationship between the BP parameters and cerebral oedema in ENCHANTED BP-control arm participants. Although the effect size is modest, achieving rapid lowering of SBP within 1 hour and then maintaining stable SBP over 24 hours appears to be associated with less cerebral oedema in thrombolysis-treated AIS patients.

对于接受溶栓治疗的急性缺血性卒中（AIS）患者，早期强化降压的利弊平衡仍存在争议。强化血压控制与溶栓治疗卒中研究（ENCHANTED）的血压控制组（n = 2196）显示，与指南推荐的管理方案（收缩压（SBP）<180 mmHg）相比，强化降压虽能减少颅内出血，但并未改善患者的功能结局。我们旨在评估ENCHANTED血压控制组参与者的血压参数与脑水肿之间的关系。尽管效应量较小，但在接受溶栓治疗的AIS患者中，在1小时内迅速降低收缩压，然后在24小时内维持收缩压稳定，似乎与较轻的脑水肿相关。

REF: Liu F, Ren X, Chen C, et al. Early blood pressure lowering and cerebral oedema in thrombolysis-treated stroke: secondary analysis of the ENCHANTED trial. Stroke Vasc Neurol. Published online November 4, 2025. doi:10.1136/svn-2025-004463 PMID: 41192975

Fibrinogenase for injection in the treatment of acute ischaemic stroke: a randomised clinical trial

注射用纤维蛋白原酶治疗急性缺血性脑卒中的随机临床试验

Fibrinogenase for injection is an effective antithrombotic agent for eligible patients with acute ischaemic stroke (AIS), but evidence regarding its treatment effects remains limited. This study aimed to evaluate the efficacy and safety of fibrinogenase for injection in patients with AIS who did not receive reperfusion therapies. In patients with AIS, treatment with fibrinogenase for injection was associated with improved 90-day functional outcomes compared with placebo. This clinical benefit was particularly evident among those who were randomised within 48 hours of symptom onset and in those with mild to moderate stroke due to large artery atherosclerosis or small artery occlusion.

注射用降纤酶是适合的急性缺血性卒中（AIS）患者有效的抗血栓药物，但有关其治疗效果的证据仍然有限。本研究旨在评估注射用降纤酶对未接受再灌注治疗的AIS患者的有效性和安全性。对于AIS患者，与安慰剂相比，使用注射用降纤酶治疗可改善90天功能结局。这种临床获益在症状发作48小时内随机入组的患者以及由大动脉粥样硬化或小动脉闭塞导致的轻中度卒中患者中尤为明显。

REF: Ma M, Fang J, Jiang X, et al. Fibrinogenase for injection in the treatment of acute ischaemic stroke: a randomised clinical trial. Stroke Vasc Neurol. Published online November 4, 2025. doi:10.1136/svn-2025-004547 PMID: 41192976

Clinical features, treatment and long-term outcomes of hemorrhagic moyamoya disease in children: an extensive follow-up study

儿童出血性烟雾病的临床特征、治疗及长期结局：一项长期随访研究

Paediatric hemorrhagic moyamoya disease (hMMD) is rare, with unclear clinical features and long-term outcomes owing to limited data. We comprehensively evaluated the clinical characteristics, prognosis and optimal treatment strategies for pediatric hMMD. Although rare, paediatric hMMD carries a high rebleeding rate. The second decade of life may represent the peak period for bleeding in paediatric patients with MMD, necessitating close monitoring. Early EDAS reduces rebleeding and postoperative complications in hMMD. Compared with the natural course, EDAS safely reduces paediatric rehemorrhage.

小儿出血型烟雾病（hMMD）较为罕见，由于数据有限，其临床特征和长期预后尚不明确。我们全面评估了小儿hMMD的临床特征、预后和最佳治疗策略。尽管小儿hMMD罕见，但再出血率很高。儿童烟雾病患者的第二个十年可能是出血高峰期，因此需要密切监测。早期行脑 - 硬膜 - 动脉 - 血管融通术（EDAS）可降低hMMD的再出血率和术后并发症。与自然病程相比，EDAS能安全地降低小儿再出血风险。

REF: Chen C, Gao G, Li D, et al. Clinical features, treatment and long-term outcomes of hemorrhagic moyamoya disease in children: an extensive follow-up study. Stroke Vasc Neurol. Published online November 4, 2025. doi:10.1136/svn-2025-004515 PMID: 41093368