FLAIR Vascular Hyperintensities/DWI Mismatch Predicts Penumbra in Proximal Middle Cerebral Artery Occlusion FVH/DWI Ratio Predicts Penumbra in MCA Occlusion

液体衰减反转恢复序列血管高信号影/弥散加权成像不匹配可预测大脑中动脉近端闭塞的半暗带；液体衰减反转恢复序列血管高信号影/弥散加权成像比值可预测大脑中动脉闭塞的半暗带

Perfusion imaging used to select patients for extended-window stroke therapy is not widely available. We investigated whether fluid-attenuated inversion recovery vascular hyperintensities (FVHs) on routine magnetic resonance imaging could serve as a reliable surrogate for perfusion imaging by predicting the mismatch between hypoperfused tissue volume (perfusion-weighted imaging [PWI]) and infarct core volume (diffusion-weighted imaging [DWI]) in patients with proximal middle cerebral artery occlusion. The FVH/DWI-c-ASPECTS ratio is a potential surrogate imaging marker of perfusion-diffusion mismatch in patients with proximal middle cerebral artery occlusion. It may offer a practical and widely accessible alternative to perfusion imaging for identifying candidates for reperfusion therapy beyond the standard time window.

用于筛选适合超时间窗卒中治疗患者的灌注成像技术尚未广泛应用。我们研究了常规磁共振成像上的液体衰减反转恢复血管高信号（FVHs）能否通过预测大脑中动脉近端闭塞患者的低灌注组织体积（灌注加权成像[PWI]）与梗死核心体积（弥散加权成像[DWI]）之间的不匹配情况，从而成为灌注成像的可靠替代指标。FVH/DWI - c - ASPECTS比值是大脑中动脉近端闭塞患者灌注 - 弥散不匹配的潜在替代影像标志物。对于识别超出标准时间窗的再灌注治疗候选患者，它可能是一种实用且广泛可及的灌注成像替代方法。

REF: Boullet M, Marnat G, Boyer A, et al. FLAIR Vascular Hyperintensities/DWI Mismatch Predicts Penumbra in Proximal Middle Cerebral Artery Occlusion FVH/DWI Ratio Predicts Penumbra in MCA Occlusion. Stroke. Published online January 29, 2026. doi:10.1161/STROKEAHA.125.053277 PMID: 41608811

Low-Intensity Monitoring for Mild-to-Moderate Acute Ischemic Stroke Is Cost Saving: Economic Evaluation for OPTIMISTmain

轻至中度急性缺血性脑卒中低强度监测可节省成本：OPTIMISTmain研究的经济评估

OPTIMISTmain (Main Optimal Post rtPA-IV Monitoring in Ischemic Stroke Trial) has shown that low-intensity monitoring is feasible and safe compared with standard monitoring in stable patients who receive thrombolysis treatment for acute ischemic stroke of mild-to-moderate neurological impairment. We aimed to estimate the economic benefits of low-intensity care compared with standard care. The low-intensity monitoring protocol was cost saving in countries with high proportions of intensive care resources for postthrombolysis treatment monitoring, such as in the United States.

OPTIMISTmain（主要急性缺血性卒中静脉注射重组组织型纤溶酶原激活剂后最佳监测试验）显示，对于接受溶栓治疗的轻至中度神经功能缺损急性缺血性卒中病情稳定患者，与标准监测相比，低强度监测是可行且安全的。我们旨在评估低强度护理相对于标准护理的经济效益。在溶栓后治疗监测中重症监护资源占比较高的国家，如美国，低强度监测方案可节省成本。

REF: Xu L, Ouyang M, Atkins ER, et al. Low-Intensity Monitoring for Mild-to-Moderate Acute Ischemic Stroke Is Cost Saving: Economic Evaluation for OPTIMISTmain. Stroke. Published online January 29, 2026. doi:10.1161/STROKEAHA.125.053506 PMID: 41608808

Relationship Between Degree of Stenosis and Time-To-Peak Delay in High Grade Asymptomatic Carotid Artery Disease

无症状性高等级颈动脉疾病中狭窄程度与达峰时间延迟的关系

Cerebral hemodynamic impairment in patients with asymptomatic high-grade (>70%) internal carotid artery (ICA) stenosis is associated with risk of stroke and cognitive decline, but correlations between degree of stenosis and hemodynamic impairment are derived from small case series. Using baseline data from 242 participants in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis-Hemodynamics (CREST-H) study, we hypothesized that degree of stenosis in the ICA would correlate with time-to-peak (TTP) delay in ipsilateral cerebral blood flow using MR/CT perfusion scans, adjusting for demographic and cardiovascular risk variables. In this large cohort of patients with high-grade asymptomatic carotid stenosis, higher end-diastolic flow velocities correlated with greater TTP delays, supporting a definition of "hemodynamically significant stenosis." Our findings have implications for management of asymptomatic carotid stenosis which will be tested in the CREST-H study.

无症状性重度（>70%）颈内动脉（ICA）狭窄患者的脑血流动力学损害与中风和认知衰退风险相关，但狭窄程度与血流动力学损害之间的相关性来自小型病例系列研究。利用颈动脉血运重建和药物治疗无症状性颈动脉狭窄血流动力学研究（CREST - H）中242名参与者的基线数据，我们假设通过磁共振/计算机断层扫描灌注成像来评估，在调整人口统计学和心血管风险变量后，颈内动脉狭窄程度与同侧脑血流达峰时间（TTP）延迟相关。在这个由大量无症状性重度颈动脉狭窄患者组成的队列中，较高的舒张末期血流速度与更大的TTP延迟相关，这支持了“血流动力学显著狭窄”的定义。我们的研究结果对无症状性颈动脉狭窄的治疗具有指导意义，相关结论将在CREST - H研究中进一步验证。

REF: Marshall RS, Lal BK, Edwards LJ, et al. Relationship Between of Degree of Stenosis and Time-To-Peak Delay in High Grade Asymptomatic Carotid Artery Disease. Stroke. Published online January 29, 2026. doi:10.1161/STROKEAHA.125.054149 PMID: 41608800

Potential Missed Opportunities to Administer Intravenous Thrombolysis to Patients With Acute Ischemic Stroke

急性缺血性脑卒中患者静脉溶栓潜在的错失机会

Recent years have seen improvements in stroke-care pathways, including mobile stroke units (MSUs), and this may have affected the rate, predictors, and outcomes of patients with acute ischemic stroke who qualify for but do not receive treatment with intravenous thrombolysis (IVT). In the BEST-MSU trial, potential missed IVT opportunities occurred in 1-in-8 patients in the emergency department, and rarely on the MSU. Although often due to early improvement or minor deficits, more than one-third of these patients had poor functional status at 3 months.

近年来，包括移动卒中单元（MSU）在内的卒中诊疗路径有所改善，这可能影响了符合静脉溶栓治疗（IVT）条件但未接受该治疗的急性缺血性卒中患者的比例、预测因素和预后情况。在BEST - MSU试验中，急诊科每8例患者中就有1例存在潜在的错过静脉溶栓治疗的机会，而在移动卒中单元中这种情况很少发生。尽管这些情况通常是由于症状早期改善或症状轻微所致，但超过三分之一的患者在3个月时功能状态不佳。

REF: Navi BB, Wang M, Yamal JM, et al. Potential Missed Opportunities to Administer Intravenous Thrombolysis to Patients With Acute Ischemic Stroke. Stroke. Published online January 29, 2026. doi:10.1161/STROKEAHA.125.054326 PMID: 41608799

Rescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry

急性缺血性卒中取栓术中挽救性与一线颅内支架置入术：RESISTANT 注册研究的倾向加权分析

While rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO), first-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. We conducted a comparative analysis of FLS versus RS using data from a large, multicenter international registry to evaluate their relative safety and effectiveness. In this study, no significant differences in safety or effectiveness were detected between FLS and RS strategies during EVT for AIS. Prospective, randomized trials are needed to better define optimal treatment approaches.

虽然补救性支架置入术（RS）是大血管闭塞性急性缺血性卒中（AIS - LVO）血管内取栓术（EVT）失败后的一种公认挽救策略，但一线支架置入术（FLS）已成为一种潜在的替代方案，可避免血管损伤并改善预后。然而，对这两种策略的直接比较仍然有限。我们利用一个大型国际多中心注册研究的数据，对一线支架置入术与补救性支架置入术进行了对比分析，以评估它们的相对安全性和有效性。在这项研究中，在AIS血管内治疗期间，一线支架置入术和补救性支架置入术策略在安全性或有效性方面未发现显著差异。需要开展前瞻性随机试验来更好地确定最佳治疗方案。

REF: Rodriguez-Calienes A, Yavagal DR, Asdaghi N, et al. Rescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry. Stroke. Published online January 29, 2026. doi:10.1161/STROKEAHA.125.054467 PMID: 41608810

Cerebral Amyloid Angiopathy Imaging Markers, Radiological Boston Criteria, and Thrombolysis Outcomes in Ischemic Stroke

缺血性卒中的脑淀粉样血管病影像学标志物、波士顿放射学标准与溶栓治疗结局

Cerebral amyloid angiopathy (CAA) is thought to increase the risk of post thrombolytic intracranial bleeding, yet CAA neuroimaging markers and MRI criteria have not been systematically evaluated in large acute stroke trials. We therefore examined the association of radiological Boston CAA criteria and their constituent markers with hemorrhagic risks and functional outcomes after intravenous thrombolysis in the Alteplase compared to Tenecteplase (AcT) trial. In thrombolyzed patients with acute ischemic stroke, CSS burden is strongly and consistently associated with higher risk of severe hemorrhage, disability and death, making it a particularly relevant CAA marker when weighing thrombolytic risk vs benefit. Meeting radiological Boston criteria versions 1.0 or 1.5 increases hemorrhagic risk but meeting the latest 2.0 criteria does not.

脑淀粉样血管病（CAA）被认为会增加溶栓后颅内出血的风险，但在大型急性卒中试验中，尚未对CAA神经影像学标志物和磁共振成像（MRI）标准进行系统评估。因此，我们在阿替普酶与替奈普酶对比试验（AcT）中，研究了波士顿CAA影像学标准及其构成标志物与静脉溶栓后出血风险和功能结局的关联。在接受溶栓治疗的急性缺血性卒中患者中，脑微出血（CSS）负荷与严重出血、残疾和死亡的高风险密切且持续相关，这使其在权衡溶栓风险与获益时成为特别重要的CAA标志物。符合波士顿影像学标准1.0版或1.5版会增加出血风险，但符合最新的2.0版标准则不会。

REF: Marzoughi S, Alhabli I, Singh N, et al. Cerebral Amyloid Angiopathy Imaging Markers, Radiological Boston Criteria, and Thrombolysis Outcomes in Ischemic Stroke. Stroke. Published online January 29, 2026. doi:10.1161/STROKEAHA.125.054654 PMID: 41608814

Dissecting Aneurysm in Cervical Artery Dissection: Insights from the STOP-CAD Study

颈动脉硬化夹层中的夹层动脉瘤：来自STOP - CAD研究的见解

Cervical artery dissection (CeAD) may result in dissecting aneurysm (DA) formation. We aimed to characterize risk factors and clinical outcomes associated with DA in a large, international CeAD cohort. DAs are relatively common manifestations of CeAD, typically occurring within six months of CeAD diagnosis. DA was not associated with an increased risk of subsequent ischemic stroke or ICH.

颈动脉夹层（CeAD）可能导致夹层动脉瘤（DA）形成。我们旨在描述一个大型国际CeAD队列中与DA相关的危险因素和临床结局。DA是CeAD相对常见的表现，通常在CeAD诊断后的六个月内出现。DA与后续缺血性卒中或颅内出血风险增加无关。

REF: Khan M, Keser Z, Shu L, et al. Dissecting Aneurysm in Cervical Artery Dissection: Insights from the STOP-CAD Study. Stroke. Published online January 29, 2026. doi:10.1161/STROKEAHA.125.054847 PMID: 41608793

Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association

妊娠期和产后孕产妇中风的预防与治疗：美国心脏协会科学声明

Stroke remains a rare but life-threatening complication of pregnancy, with significant implications for both maternal and fetal health. Current stroke prevention and treatment guidelines offer limited guidance for managing stroke in pregnant and postpartum patients. Despite advances in obstetric and neurological care, the diagnosis and management of pregnancy-associated stroke continue to be challenged by delayed recognition, a lack of tailored clinical guidelines, and persistent disparities in outcomes. This scientific statement represents a multidisciplinary effort to synthesize current knowledge of the risk factors and diverse causes of stroke in pregnancy and to offer consensus-driven suggestions for prevention, acute management, and postpartum recovery.

中风仍是一种罕见但危及生命的妊娠并发症，对孕产妇和胎儿的健康均有重大影响。目前的中风预防和治疗指南对于妊娠和产后患者中风的管理提供的指导有限。尽管产科和神经科护理取得了进展，但妊娠相关中风的诊断和管理仍面临着识别延迟、缺乏针对性临床指南以及结局持续存在差异等挑战。本科学声明是一项多学科的努力，旨在综合目前对妊娠中风危险因素和多种病因的认识，并就预防、急性处理和产后康复提供基于共识的建议。

REF: Miller EC, Bello NA, Chen PR, et al. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association. Stroke. Published online January 28, 2026. doi:10.1161/STR.0000000000000514 PMID: 41603019

2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association

2026年急性缺血性脑卒中患者早期管理指南：美国心脏协会/美国卒中协会指南

The "2026 Guideline for the Early Management of Patients With AIS" replaces the "2018 Guidelines for the Early Management of Patients With AIS" and the 2019 update to reflect recent advances in evidence. This updated guideline is intended to provide a comprehensive, up-to-date, evidence-based set of recommendations, advising management from prehospital evaluation through acute treatment and early in-hospital management of complications and initiation of early secondary prevention measures. The intended audience includes prehospital care professionals, physicians, allied health professionals, and hospital administrators. This guideline represents the most current and comprehensive evidence available in AIS care. Key updates include the incorporation of new evidence related to thrombolytic choice and eligibility, determination of eligibility for endovascular thrombectomy, and management of hyperglycemia and dysphagia; a focused consideration of the pediatric population; and modification of the approach to thrombolysis contraindications. Although this guideline reflects significant advances, it also highlights gaps in knowledge and underscores the urgent need for continued research to further refine and improve treatment strategies.

《2026年急性缺血性卒中（AIS）患者早期管理指南》取代了《2018年急性缺血性卒中患者早期管理指南》及其2019年更新版，以体现近期的证据进展。这份更新后的指南旨在提供一套全面、最新且基于证据的建议，涵盖从院前评估到急性治疗、院内早期并发症管理以及启动早期二级预防措施等方面的管理建议。目标受众包括院前急救专业人员、医生、辅助医疗专业人员和医院管理人员。本指南代表了急性缺血性卒中护理领域当前最全面和最新的证据。主要更新内容包括纳入了与溶栓药物选择和适应证、血管内取栓适应证判定以及高血糖和吞咽困难管理相关的新证据；重点考虑了儿科人群；以及修改了溶栓禁忌证的处理方法。尽管本指南体现了重大进展，但也凸显了知识上的空白，并强调了持续开展研究以进一步完善和改进治疗策略的迫切需求。

REF: Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. Published online January 26, 2026. doi:10.1161/STR.0000000000000513 PMID: 41582814