Mechanical circulatory assist devices stroke subtype classification: a novel stroke classification system in patients with ventricular assist devices

机械循环辅助装置相关卒中亚型分类：心室辅助装置患者的一种新型卒中分类系统

Stroke is a frequent complication of left ventricular assist devices (LVADs) yet remains without a unified etiologic framework to guide evaluation and management. To address this, we developed a novel mechanical circulatory assist device stroke classification system with four etiologic categories: Management-related (M)-events driven by anticoagulation/antiplatelet strategy or perioperative management; Clinically related (C)-events attributable to conventional vascular risk factors; Acquired (A)-events resulting from LVAD-associated complications such as infection or coagulopathy; and Device-related (D)-events linked to pump- or graft-specific pathology or parameter abnormalities. We aimed to describe stroke subtype patterns and evaluate interrater reliability of this classification in LVAD patients. This novel MCAD stroke classification demonstrated excellent interrater reliability in a single-center LVAD retrospective cohort and provides a structured framework for categorizing etiologic contributors. Future prospective multicenter studies are needed to assess its clinical utility.

中风是左心室辅助装置（LVAD）常见的并发症，但目前仍缺乏统一的病因学框架来指导评估和管理。为解决这一问题，我们开发了一种新型的机械循环辅助装置中风分类系统，该系统包含四个病因类别：管理相关（M）事件，由抗凝/抗血小板策略或围手术期管理引发；临床相关（C）事件，归因于传统血管危险因素；获得性（A）事件，由LVAD相关并发症（如感染或凝血功能障碍）导致；装置相关（D）事件，与泵或移植物特定的病理或参数异常有关。我们旨在描述LVAD患者中风亚型模式，并评估该分类的评级者间信度。这种新型的MCAD中风分类在单中心LVAD回顾性队列中显示出了出色的评级者间信度，并为病因因素的分类提供了一个结构化框架。未来需要进行前瞻性多中心研究来评估其临床实用性。

REF: Pinto CB, Owens CD, Alvarado-Dyer R, et al. Mechanical circulatory assist devices stroke subtype classification: a novel stroke classification system in patients with ventricular assist devices. J Stroke Cerebrovasc Dis. 2026;35(5):108605. doi:10.1016/j.jstrokecerebrovasdis.2026.108605 PMID: 41812735

Metabolomic analysis of arterial blood near intracranial occlusions reveals biochemical signatures of acute ischemic stroke

颅内闭塞附近动脉血的代谢组学分析揭示了急性缺血性卒中的生化特征

Acute ischemic stroke is a major cause of death and disability, and timely assessment of symptom onset is essential for appropriate treatment. Conventional imaging often lacks accuracy in estimating the timing of ischemic injury, especially in patients with unclear or unwitnessed onset. Metabolomic profiling may provide biochemical information reflecting tissue damage, collateral circulation, and clinical progression. Arterial blood metabolomics reveals metabolic reprogramming associated with acute ischemic injury and compensatory responses. These findings support the potential use of metabolomic profiling for patient stratification and therapeutic decision-making, which requires validation in independent cohorts.

急性缺血性卒中是导致死亡和残疾的主要原因，及时评估症状发作时间对于恰当治疗至关重要。传统影像学在估算缺血性损伤时间方面往往缺乏准确性，尤其是对于发病情况不明确或无人见证发病的患者。代谢组学分析可能提供反映组织损伤、侧支循环和临床进展的生化信息。动脉血代谢组学揭示了与急性缺血性损伤及代偿反应相关的代谢重编程。这些发现支持将代谢组学分析用于患者分层和治疗决策的潜在价值，但这需要在独立队列中进行验证。

REF: Troisi J, Lombardi M, Abenante V, et al. Metabolomic analysis of arterial blood near intracranial occlusions reveals biochemical signatures of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2026;35(5):108608. doi:10.1016/j.jstrokecerebrovasdis.2026.108608 PMID: 41825659

Prevalence and risk factors associated with anxiety and depression in patients with acute ischemic stroke who receive mechanical thrombectomy

接受机械取栓术的急性缺血性脑卒中患者焦虑和抑郁的患病率及相关危险因素

Studies on poststroke anxiety and depression in patients with acute ischemic stroke (AIS) who received mechanical thrombectomy remain scarce. This study aimed to evaluate the prevalence and risk factors associated with poststroke anxiety and depression. Poststroke anxiety and depression are prevalent issues in patients with AIS who receive mechanical thrombectomy. Meanwhile, younger age, lower BMI, and hypertension were independently associated with poststroke anxiety.

关于接受机械取栓治疗的急性缺血性卒中（AIS）患者卒中后焦虑和抑郁的研究仍然匮乏。本研究旨在评估卒中后焦虑和抑郁的患病率及相关危险因素。卒中后焦虑和抑郁在接受机械取栓治疗的AIS患者中是普遍存在的问题。同时，年龄较小、体重指数较低和高血压与卒中后焦虑独立相关。

REF: Liu X, Xu A, Zhu Y, Pan Q, Wang H, Zhang G. Prevalence and risk factors associated with anxiety and depression in patients with acute ischemic stroke who receive mechanical thrombectomy. J Stroke Cerebrovasc Dis. 2026;35(5):108609. doi:10.1016/j.jstrokecerebrovasdis.2026.108609 PMID: 41831582

Carotid revascularization and hemispheric white matter disease progression

颈动脉血运重建与半球白质病变进展

Carotid revascularization prevents ipsilateral ischemic stroke in high-grade stenosis, but its effect on hemispheric white matter disease (WMD) progression is not known. Carotid revascularization was associated with numerically slower ipsilateral WMD progression (∼50% relative difference) and attenuation of hemispheric asymmetry over a median 5-year follow-up. Given the modest statistical signal and correction for multiple comparisons, these findings should be interpreted as observational and hypothesis-generating. Prospective studies should evaluate whether modulation of WMD progression translates into meaningful cognitive benefit.

颈动脉血运重建术可预防重度狭窄患者的同侧缺血性卒中，但它对大脑半球白质病变（WMD）进展的影响尚不清楚。在中位5年的随访中，颈动脉血运重建术与同侧WMD进展速度在数值上较慢（相对差异约50%）以及大脑半球不对称性减弱相关。鉴于统计学信号较弱且进行了多重比较校正，这些发现应被视为观察性结果并用于提出假设。前瞻性研究应评估调节WMD进展是否能带来有意义的认知益处。

REF: Ramadan DQ, Craver EC, Demirer M, et al. Carotid revascularization and hemispheric white matter disease progression. J Stroke Cerebrovasc Dis. 2026;35(5):108611. doi:10.1016/j.jstrokecerebrovasdis.2026.108611 PMID: 41856222

Toxic effects of herbal supplements on endothelial and vascular system among rural Thai patients: A multicenter cohort study

泰国农村患者中草药补充剂对内皮和血管系统的毒性作用：一项多中心队列研究

The use of herbal supplements among elderly Thais has increased from 65.7% to 73.9% (2022-2024). Evidence regarding cardiovascular safety remains limited, particularly regarding interactions with potentially inappropriate medications (PIMs) in patients with multimorbidity and polypharmacy. This study investigated the association and incidences between herbal supplement use and vascular as well as endovascular diseases (VEDs) among elderly Thai patients. Herbal supplement use was associated with substantially increased cardiovascular risk among elderly Thais through dose-dependent and synergistic mechanisms. These findings necessitate the urgent integration of herbal use assessment into routine geriatric care as well as the development of evidence-based safety guidelines.

泰国老年人使用草药补充剂的比例从2022年的65.7%上升到2024年的73.9%。关于心血管安全性的证据仍然有限，特别是在患有多种疾病且使用多种药物的患者中，草药补充剂与潜在不适当药物（PIMs）相互作用方面的证据。本研究调查了泰国老年患者使用草药补充剂与血管及血管内疾病（VEDs）之间的关联和发生率。通过剂量依赖和协同机制，泰国老年人使用草药补充剂与心血管风险大幅增加有关。这些研究结果迫切需要将草药使用评估纳入常规老年护理，并制定基于证据的安全指南。

REF: Dorlohtahe S, Kedthongma W, Phakdeekul W. Toxic effects of herbal supplements on endothelial and vascular system among rural Thai patients: A multicenter cohort study. J Stroke Cerebrovasc Dis. 2026;35(5):108610. doi:10.1016/j.jstrokecerebrovasdis.2026.108610 PMID: 41839245

Mapping within-country disparities in Ischemic stroke burden and trends by human development index, age and sex

按人类发展指数、年龄和性别绘制国家内部缺血性卒中负担及趋势的差异图

Growing concern exists over stalled declines in acute ischemic stroke (AIS) incidence; understanding health determinants is key to addressing stroke burden. Therefore, we aimed to determine the burden of AIS and transient ischemic stroke attack (TIA) in 2021, and their trends from 2010 to 2021 at the national and subnational levels, disaggregated by age and sex, and examining the relationship with the regional Human Development Index (HDI). These analyses revealed within-country disparities in AIS/TIA burden in a high-HDI country. These findings are crucial to address the rising ASIR among young people, especially females and people in regions with low-HDI.

人们日益担忧急性缺血性卒中（AIS）发病率下降趋势停滞；了解健康决定因素是应对卒中负担的关键。因此，我们旨在确定2021年AIS和短暂性脑缺血发作（TIA）的负担，以及2010年至2021年全国和各省级层面按年龄和性别分类的发病趋势，并研究其与区域人类发展指数（HDI）的关系。这些分析揭示了一个高HDI国家内AIS/TIA负担的地区差异。这些发现对于应对年轻人，尤其是女性和低HDI地区人群中AIS发病率上升的问题至关重要。

REF: Nuñez M, Delgado I, Venegas Peña A, Lavados PM, Anderson CS, Muñoz Venturelli P. Mapping within-country disparities in Ischemic stroke burden and trends by human development index, age and sex. J Stroke Cerebrovasc Dis. 2026;35(5):108614. doi:10.1016/j.jstrokecerebrovasdis.2026.108614 PMID: 41866102

Temporal association between NRF2/HO-1 activation, endogenous BDNF up-regulation, and motor recovery in a male mouse MCAO model

雄性小鼠大脑中动脉阻塞（MCAO）模型中NRF2/HO - 1激活、内源性脑源性神经营养因子（BDNF）上调与运动功能恢复之间的时间关联

Stroke induces severe neurological impairment, however, there is limited understanding of the mechanisms underlying post-stroke recovery. Nuclear factor erythroid 2-related factor 2 (NRF2) and brain-derived neurotrophic factor (BDNF) have been implicated in tissue responses to ischemic injury; however, their temporal interactions in middle cerebral artery occlusion (MCAO) models are not fully understood. These findings indicate that activation of the NRF2/HO-1 pathway is temporally associated with increased expression of endogenous BDNF and recovery of motor function following ischemic injury in male mice.

中风会导致严重的神经功能损伤，然而，人们对中风后恢复的潜在机制了解有限。核因子红细胞2相关因子2（NRF2）和脑源性神经营养因子（BDNF）与组织对缺血性损伤的反应有关；然而，在大脑中动脉阻塞（MCAO）模型中，它们的时间相互作用尚未完全明确。这些研究结果表明，在雄性小鼠缺血性损伤后，NRF2/HO - 1通路的激活在时间上与内源性BDNF表达增加和运动功能恢复相关。

REF: Park J, Hwang H, Shin H, Chung Y, Kim D, Jun Y. Temporal association between NRF2/HO-1 activation, endogenous BDNF up-regulation, and motor recovery in a male mouse MCAO model. J Stroke Cerebrovasc Dis. 2026;35(5):108616. doi:10.1016/j.jstrokecerebrovasdis.2026.108616 PMID: 41876036

Sex differences in the incidence of composite ischemic and bleeding events in ischemic stroke patients with nonvalvular atrial fibrillation and atherosclerosis

非瓣膜性心房颤动合并动脉粥样硬化的缺血性脑卒中患者复合缺血和出血事件发生率的性别差异

Nonvalvular atrial fibrillation (NVAF) and atherosclerotic cardiovascular disease (ASCVD) frequently coexist, but whether clinical outcomes differ by sex in this population remains unclear. We evaluated sex differences in a post hoc analysis of the Optimal Antithrombotic Therapy in Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation and Atherothrombosis (ATIS-NVAF) trial, a randomized study of patients with recent ischemic stroke or transient ischemic attack (TIA), NVAF, and concomitant ASCVD. In this post hoc analysis of the ATIS-NVAF trial, no significant sex differences were observed in the 2-year composite of cardiovascular and bleeding events among patients with recent ischemic stroke or TIA and concomitant NVAF and ASCVD. Appropriate medical management may attenuate the influence of biological sex on the risk of cardiovascular and bleeding events.

非瓣膜性心房颤动（NVAF）和动脉粥样硬化性心血管疾病（ASCVD）常同时存在，但在这一人群中临床结局是否存在性别差异尚不清楚。我们在非瓣膜性心房颤动合并动脉粥样硬化性血栓形成的缺血性卒中患者最佳抗栓治疗（ATIS - NVAF）试验的事后分析中评估了性别差异，该试验是一项针对近期发生缺血性卒中或短暂性脑缺血发作（TIA）、NVAF 且合并 ASCVD 患者的随机研究。在 ATIS - NVAF 试验的这项事后分析中，近期发生缺血性卒中或 TIA 且合并 NVAF 和 ASCVD 的患者在心血管和出血事件的 2 年复合结局方面未观察到显著的性别差异。适当的医疗管理可能会减弱生物学性别对心血管和出血事件风险的影响。

REF: Morishita M, Uchida K, Yoshimura S, et al. Sex differences in the incidence of composite ischemic and bleeding events in ischemic stroke patients with nonvalvular atrial fibrillation and atherosclerosis. J Stroke Cerebrovasc Dis. 2026;35(5):108615. doi:10.1016/j.jstrokecerebrovasdis.2026.108615 PMID: 41871638

Risk of dementia following retinal vascular occlusions: A propensity-score matched cohort study using a global federated database

视网膜血管阻塞后发生痴呆的风险：一项使用全球联合数据库的倾向评分匹配队列研究

Retinal vascular occlusions (RVaO), including retinal artery occlusion (RAO) and retinal vein occlusion (RVO), are common retinal vascular disorders that may indicate systemic vascular disease and cerebral microvascular pathology. This study investigated the association between RVaO and incident dementia, including all-cause, degenerative, and vascular dementia, and explored differences across RVaO subtypes. RVaO is associated with an increased dementia risk, particularly vascular dementia, with RVO showing more consistent associations than RAO. Although the associations were statistically significant, the effect size was small, and the results should be viewed as associative rather than causal.

视网膜血管阻塞（RVaO），包括视网膜动脉阻塞（RAO）和视网膜静脉阻塞（RVO），是常见的视网膜血管疾病，可能提示全身性血管疾病和脑微血管病变。本研究探讨了RVaO与新发痴呆（包括全因性、退行性和血管性痴呆）之间的关联，并探究了不同RVaO亚型之间的差异。RVaO与痴呆风险增加相关，尤其是血管性痴呆，RVO比RAO显示出更一致的关联性。尽管这些关联具有统计学意义，但效应量较小，研究结果应被视为相关性而非因果关系。

REF: Hsieh CY, Sung SF. Risk of dementia following retinal vascular occlusions: A propensity-score matched cohort study using a global federated database. J Stroke Cerebrovasc Dis. 2026;35(5):108622. doi:10.1016/j.jstrokecerebrovasdis.2026.108622 PMID: 41903870