Endovascular treatment has been fundamentally transformed the management of acute ischemic stroke (AIS). However, a prominent clinical challenge persists: almost half of the patients who have achieved successful recanalization of the occluded vessel fail to achieve the expected neurological improvement, a phenomenon termed "futile recanalization". In recent years, the combination of neuroprotective drugs with recanalization therapy has offered some new hope for this issue. Notably, combining immunomodulators with revascularization has shown potential to mitigate ischemia-reperfusion injury and reduce the risk of futile recanalization, providing novel clinical intervention strategies. Therefore, this review synthesizes the basic mechanisms of futile recanalization and new progress in this field. By employing a "vascular-immune-neural network" model to integrate various neuroprotective therapies, we aim to provide theoretical support for overcoming this challenge of AIS and improving the long-term prognosis of AIS patients.

In 2026, the American Heart Association/American Stroke Association issued the "2026 guideline for the early management of patients with acute ischemic stroke" (referred to as the "2026 guideline"). This update revises the 2018 guideline and its 2019 addendum, incorporating the latest advances in the field. Key updates of the 2026 guideline 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 for the pediatric population; and an optimized strategy for assessing contraindications to thrombolysis. In order to facilitate the in-depth understanding and better application of the guidelines by medical staff, update points of the 2026 guideline are summarized.

To explore the predictive value of the cholesterol-high density lipoprotein cholesterol-glucose (CHG) index for outcomes in patients with acute basilar artery occlusion (aBAO) undergoing endovascular treatment (EVT).

Data were derived from the prospective BASILAR registry study. Patients were stratified into quartiles (Q1-Q4) based on the admission CHG index: Q1 (-0.25 to 3.68), Q2 (＞3.68 to 4.25), Q3 (＞4.25 to 4.82), and Q4 (＞4.82 to 7.91). The follow-up period was 1 year post-EVT. The primary outcome was favorable functional outcome at 1 year post-EVT, defined as a modified Rankin scale (mRS) score ≤3. Secondary outcomes included favorable functional outcome at 90-day after EVT. Safety endpoints comprised 90-day all-cause mortality, symptomatic intracranial hemorrhage within 48 hours, and procedure-related complications. Normally distributed continuous data were compared across groups using one-way ANOVA, whereas non-normally distributed data were analyzed using the Kruskal-Wallis H test. Categorical variables were compared using the χ² test or Fisher's exact test. Multivariate Logistic regression was used to analyze the association between the CHG index and poor functional outcome (mRS score ＞3) by odds ratios (OR) with 95% confidence intervals (CI).

A total of 396 aBAO patients treated with EVT were included, with 99 patients in each quartile. Significant differences were observed among the quartiles in age, smoking history, hypertension, type 2 diabetes, hyperlipidemia, uric acid, lipid profile, blood glucose, glycated hemoglobin, and coagulation indicators (all P＜0.05). Regarding clinical outcomes, both the successful recanalization rate [modified thrombolysis in cerebral infarction (mTICI) scale 2c-3: 68.69%, 68.69%, 57.58%, and 48.48% for Q1-Q4, respectively; χ²=11.905, P=0.008] and the rate of favorable functional outcome at 1 year (48.48%, 44.44%, 32.32%, and 31.31%; χ²=9.276, P=0.026) exhibited a significant decreasing trend with increasing CHG index. Multivariate logistic regression showed that each 1-standard-deviation increase in the CHG index was associated with a 41% increased risk of poor outcome (OR=1.41, 95%CI: 1.13-1.76, P=0.002).

An elevated CHG index may serve as an independent predictor of poor 1-year functional outcomes in aBAO patients undergoing EVT. Preoperative assessment of the CHG index might facilitate clinical risk stratification.

To investigate the association between peripheral blood inflammatory biomarkers and 90-day functional outcomes in patients with acute ischemic stroke (AIS) with large ischemic cores versus non-large ischemic cores undergoing endovascular therapy (EVT).

This retrospective study consecutively enrolled patients with anterior circulation AIS who underwent EVT at the First Affiliated Hospital of Nanchang University between November 2019 and January 2025. According to ischemic core volume, patients were categorized into the large ischemic core group (ischemic core volume ≥50 mL) and the non-large ischemic core group (ischemic core volume ＜50 mL). Furthermore, based on the 90-day modified Rankin scale (mRS) scores, each group was subdivided into a functionally independent group (mRS score 0 to 2) and a non-functionally independent group (mRS score ＞2). Demographic characteristics, medical history, clinical data, neuroimaging findings, laboratory parameters—including inflammatory biomarkers [neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammatory response index (SIRI)], and follow-up data were compared between groups. Continuous variables were analyzed using the student's t-test or the Mann-Whitney U test, while categorical variables were compared using the Chi-square test or Fisher's exact test. Univariate and multivariate Logistic regression analyses were performed to identify independent predictors of 90-day functional independence.

A total of 913 patients with anterior circulation AIS who underwent EVT were included in the final analysis. Among them, 270 patients had large ischemic cores, including 73 patients with functional independence and 197 patients without functional independence; 643 patients had non-large ischemic cores, including 335 patients with functional independence and 308 patients without functional independence. In the large ischemic core group, the median NLR values were 4.63 (2.85, 7.60) in the functional independence group and 5.89 (3.99, 10.00) in the non-functional independence group, with a significant difference between groups (Z=-2.518, P=0.012). However, no significant differences were observed for LMR [3.25 (2.16, 5.24) vs 3.17 (2.22, 4.26), Z=-0.575, P=0.565] or SIRI [1.93 (0.92, 3.61) vs 2.38 (1.35, 3.84), Z=-1.584, P=0.113]. In the non-large ischemic core group, significant differences were observed between the functional independence and non-functional independence groups in NLR [4.63 (3.07, 6.86) vs 5.27 (4.02, 8.93), Z=-3.521, P＜0.001], LMR [3.50 (2.74, 4.45) vs 3.32 (2.27, 4.24), Z=-2.806, P=0.005], and SIRI [1.88 (1.09, 2.65) vs 2.00 (1.34, 3.39), Z=-3.153, P=0.002]. Multivariate Logistic regression analysis demonstrated that NLR, LMR, and SIRI were not significantly associated with 90-day functional independence in patients with large ischemic cores undergoing EVT (all P＞0.05). In contrast, NLR, LMR, and SIRI were independent predictors of 90-day functional independence in patients with non-large ischemic cores undergoing EVT (all P＜0.05).

NLR, LMR, and SIRI are independent predictors of 90-day functional independence in patients with anterior circulation AIS and non-large ischemic cores undergoing EVT. However, these inflammatory biomarkers lack significant predictive value in patients with large ischemic cores.

To compare the diagnostic and predictive performance of different clinical scales for anterior circulation large vessel occlusion (LVO) stroke.

Patients with acute ischemic stroke admitted to Beijing Tsinghua Changgung Hospital between March 2021 and January 2024 within 24 hours of onset were prospectively enrolled. Clinical data and neurological function scores were collected, including the National Institutes of Health stroke scale (NIHSS), field assessment stroke triage for emergency destination (FAST-ED), rapid arterial occlusion evaluation (RACE), Cincinnati prehospital stroke severity scale (CPSSS), and emergency medical stroke assessment (EMSA). All patients underwent vascular imaging and were categorized based on infarct lesions and occluded vessels. The diagnostic and predictive performance of each scale for detecting new-onset LVO stroke, especially anterior circulation LVO stroke, was analyzed using receiver operating characteristic (ROC) curves.

A total of 735 patients were enrolled, including 167 with new-onset LVO and 568 with non-LVO strokes. Among new-onset LVO stroke patients, 137 had anterior circulation LVO and 30 had posterior circulation LVO. For new-onset LVO stroke, the areas under the ROC curve (AUC) of FAST-ED, RACE, CPSSS, and EMSA were 0.821, 0.795, 0.778, and 0.776, respectively. For anterior circulation LVO stroke, the corresponding AUCs were 0.844, 0.836, 0.806, and 0.806, respectively. FAST-ED and RACE showed superior predictive performance for anterior circulation LVO stroke compared with CPSSS and EMSA. A FAST-ED score ≥2 yielded optimal diagnostic performance for anterior circulation LVO stroke, with a specificity of 81.4% and a sensitivity of 80.3%. A RACE score ≥3 also showed favorable performance, with a specificity of 85.5% and a sensitivity of 70.3%.

FAST-ED and RACE can accurately identify new-onset anterior circulation LVO stroke, which is helpful for the early prehospital triage of anterior circulation LVO stroke patients.

To investigate the value of atherogenic index of plasma (AIP) and programmed cell death 4 (PDCD4) in predicting neurological deficits and prognosis in patients with acute ischemic stroke (AIS).

This study retrospectively analyzed general data and laboratory parameters from 136 AIS patients admitted to the Department of Neurology at Yan'an People's Hospital from February 2021 to September 2024. Based on the National Institutes of Health stroke scale (NIHSS) score, the AIS patients were divided into mild group (1 to 6 points, 47 cases), moderate group (7 to 15 points, 59 cases), and severe group (＞15 points, 30 cases). Kruskal-Wallis H test was used to compare AIP and PDCD4 levels among the three groups. Spearman's rank correlation coefficient analysis was employed to examine the relationship between AIP, PDCD4, and NIHSS scores. According to the modified Rankin scale (mRS) score at 3 months post-discharge, the AIS patients were categorized into the favorable prognosis group (＜3 points, 81 cases) and the unfavorable prognosis group (≥3 points, 55 cases). Independent sample t-test, Mann-Whitney U test, and Chi-square test were used to compare demographic and laboratory parameters between the two groups. Logistic regression was performed to identify independent risk factors for poor prognosis. The predictive value of AIP and PDCD4 was evaluated using receiver operating characteristic (ROC) curve analysis, and the DeLong test was used to compare areas under the curve (AUC).

AIP of patients in the mild, moderate, and severe groups were 2.06 (1.88, 2.20), 2.20 (2.09, 2.35) and 2.45 (2.37, 2.53), PDCD4 levels were 1.43 (1.18, 1.82), 3.26 (2.35, 3.98) and 4.27 (3.27, 5.05) ng/mL, respectively, with significant differences among groups (H=51.118, 62.184, both P＜0.001). The Spearman correlation analysis results showed that the NIHSS scores were positively correlated with AIP (r=0.545, P＜0.001) and PDCD4 (r=0.646, P＜0.001). The high-density lipoprotein cholesterol [(1.12±0.16) mmol/L vs (1.05±0.14) mmol/L, t=2.721, P=0.007], AIP (2.15±0.24 vs 2.32±0.22, t=4.076, P＜0.001), PDCD4 [1.72 (1.26, 3.07) ng/mL vs 3.88 (2.87, 4.84) ng/mL, Z=-6.844, P＜0.001], and high-sensitivity C-reactive protein (hs-CRP) [4.22 (1.40, 9.91) vs 11.91 (4.15, 44.54) mg/L, Z=-4.753, P＜0.001] in the favorable prognosis group and the poor prognosis group were statistically significant. Binary Logistic regression analysis showed that elevated AIP, hs-CRP, and PDCD4 were independent risk factors for unfavorable prognosis (all P＜0.05). The DeLong test showed that the AUC of PDCD4 alone or combined with AIP in predicting the prognosis of AIS were significantly better than that of AIP alone ( AUC: 0.846, 0.849 vs 0.697; Z=-3.351, -3.422, both P＜0.001). However, no statistically significant difference​ was found between the AUC of the combination and that of PDCD4 alone (Z=-0.197, P=0.844).

AIP and PDCD4 are correlated with the severity of neurological deficits in AIS patients. PDCD4 alone or combined with AIP has a good predictive performance for the prognosis of AIS patients, with comparable diagnostic accuracy between the two approaches.

To analyze the relationship between the stress hyperglycemia ratio (SHR) and the prognosis of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT).

This retrospective study included 158 AIS patients who underwent IVT at the First Affiliated Hospital of the University of Science and Technology of China between January 2022 and December 2023. Baseline clinical data were collected via the hospital's electronic medical record system. Patients were divided into a favorable- [modified Rankin scale (mRS) score ≤3] and a poor-prognosis (mRS score ＞3) groups based on neurological recovery at 90 days. Univariate analysis (t-test, Mann-Whitney U test, or χ² test) compared general clinical data and laboratory indicators between the two groups. Univariate Logistic regression identified factors associated with poor prognosis, while multivariate Logistic regression (adjusted for confounders) analyzed the independent association between SHR and IVT outcomes. Restricted cubic spline models further assessed nonlinear associations between SHR and prognosis.

Among 158 AIS patients, 135 (85.4%) had favorable IVT outcomes and 23 (14.6%) had poor outcomes. Compared with the poor-prognosis group, the favorable-prognosis group showed significantly higher levels of albumin [(44.20±4.66) g/L vs (40.24±5.43) g/L, t=3.672, P＜0.001], uric acid [(348.89±95.39) μmol/L vs (305.54±86.36) μmol/L, t=2.041, P=0.043], LDL-C [(2.76±0.89) mmol/L vs (2.35±0.56) mmol/L, t=2.091, P=0.038], total cholesterol [(4.69±1.12) mmol/L vs (4.00±0.70) mmol/L, t=2.780, P=0.006], and aspartate aminotransferase [22.00 (18.00, 28.30) U/L vs 19.00 (15.00, 24.80) U/L, Z=-2.096, P=0.036]. Conversely, the favorable-prognosis group had significantly lower NIHSS scores before thrombolysis [6.00 (3.00, 11.00) vs 16.00 (11.00, 20.00), Z=-4.915, P＜0.001], direct bilirubin [3.20 (2.10, 4.60) μmol/L vs 4.20 (2.90, 5.60) μmol/L, Z=-2.695, P=0.007], and SHR [1.02 (0.89, 1.18) vs 1.19 (1.02, 1.46), Z=-2.576, P=0.010]. Univariate Logistic regression identified SHR (OR=5.184, 95%CI: 1.202 - 22.360), NIHSS score before thrombolysis (OR=1.189, 95%CI: 1.101 - 1.283), albumin (OR=0.830, 95%CI: 0.749 - 0.920), uric acid (OR=0.994, 95%CI: 0.989 - 1.000), LDL-C (OR=0.515, 95%CI: 0.273 - 0.971), total cholesterol (OR=0.467, 95%CI: 0.266 - 0.820), and direct bilirubin (OR=1.483, 95%CI: 1.154 - 1.906) as factors associated with poor prognosis (all P＜0.05). Multivariate analysis confirmed SHR as an independent predictor of poor IVT outcomes after adjusting for confounders. Restricted cubic spline models revealed a nonlinear relationship: when SHR was ＜1.03, the risk of poor prognosis increased slowly with rising SHR; when SHR was ≥1.03, the risk escalated rapidly.

In AIS patients receiving IVT, elevated SHR is independently associated with poor 90-day outcomes.

To explore the predictive value of Alberta stroke program early CT scores (ASPECTS) combined with 3.0T high-resolution magnetic resonance imaging (MRI) parameters for prognosis in patients with acute ischemic stroke (AIS) following intravenous thrombolysis.

This study enrolled 152 patients with AIS admitted to Xuzhou No.1 People's Hospital from January 2022 to June 2023. According to scores of the modified Rankin scale (mRS) at 90-day after treatment, they were categorized into a poor prognosis group (mRS score ＞2, n=43) and a favorable prognosis group (mRS score ≤2, n=109). At admission, all patients underwent 3.0T high-resolution MRI and dynamic CT angiography (CTA), and received intravenous thrombolysis within 6 h after onset in the hospital. The clinical data, ASPECTS and apparent diffusion coefficient (ADC) of infarction area in the two groups were compared by t-test, Mann-Whitney U test, or χ² test. The influencing factors of prognosis in AIS patients were analyzed by Logistic regression analysis. The evaluation value of dynamic CTA and 3.0T high-resolution MRI in prognosis of AIS patients was analyzed by receiver operating characteristic (ROC) curves.

After propensity score matching, 38 cases in each group were analyzed. The infarction volume [(6.28±0.75) cm³vs (5.15±0.58) cm³, t=7.347, P＜0.001] and National Institutes of Health stroke scale (NIHSS) score at admission (10.25±0.78 vs 7.55±0.45, t=18.483, P＜0.001) in the poor prognosis group were significantly higher than those in the favorable prognosis group, while the proportion of occlusive vessel recanalization [39.47% (15/38) vs 65.79% (25/38), χ²=5.278, P=0.022], ASPECTS (1.20±0.06 vs 2.49±0.18, t=41.119, P＜0.001) and ADC of infarction area [(0.38±0.07)×10^-3 mm²/s vs (0.58±0.11)×10^-3 mm²/s, t=9.456, P＜0.001] were significantly lower than those in the favorable prognosis group. Lower ASPECTS and reduced ADC values were independently associated with poor prognosis (both P<0.05). The combination of ASPECTS and ADC yielded an area under the ROC curve (AUC) of 0.918 (95.35% sensitivity, 65.14% specificity) for predicting poor prognosis.

ASPECTS combined with 3.0T high-resolution MRI parameters (ADC of infarction area) demonstrates robust predictive performance for functional outcomes in AIS patients, providing valuable imaging biomarkers support for individualized treatment decisions.

To investigate the value of mismatch negativity (MMN) latency, and amplitude combined with full outline of unresponsiveness scale (FOUR) score in the prognosis of elderly patients with hypertensive intracerebral hemorrhage (HICH).

This prospective study enrolled 155 elderly patients with HICH admitted to Handan Central Hospital from January 2022 to August 2024. Patients were followed up for 3 months post-discharge and stratified into a favorable prognosis group [modified Rankin scale (mRS) ≤2] and a poor prognosis group (mRS ＞2). All patients underwent MMN latency and amplitude measurements and were assessed using the FOUR score. The clinical data were collected and compared between groups. Multivariate Logistic regression was performed to identify independent predictors of poor prognosis. The predictive performance of MMN latency, MMN amplitude, FOUR score, and Glasgow coma scale (GCS) was evaluated using receiver operating characteristic (ROC) curve analysis, and DeLong tests were used to compare areas under the curve (AUC).

Of the 155 patients, 104 had favorable outcomes and 51 had poor outcomes. Compared with the favorable prognosis group, the poor prognosis group showed a prolonged MMN latency [(275.69±19.85) ms vs (240.71±28.66) ms, t=7.837, P＜0.001], decreased MMN amplitude [(0.85±0.36) μV vs (1.49±0.57) μV, t=8.503, P＜0.001], lower FOUR scores (5.96±1.76 vs 9.35±2.24, t=9.464, P＜0.001), and lower GCS (7.54±3.03 vs 10.75±3.87, t=5.191, P＜0.001). Multivariate Logistic regression analysis showed that a prolonged MMN latency was a risk factor for poor prognosis in elderly HICH patients (OR=1.664, 95%CI: 1.267 - 2.185, P＜0.001), while elevated GCS (OR=0.805, 95%CI: 0.680 - 0.953, P=0.011), high MMN amplitude (OR=0.513, 95%CI: 0.315 - 0.836, P=0.007), and high FOUR score (OR=0.682, 95%CI: 0.550 - 0.846, P＜0.001) were independent protective factors. The combined model of MMN latency, amplitude, FOUR score, and GCS yielded an AUC of 0.903 (sensitivity 90.2%, specificity 85.7%) for predicting poor prognosis, which was significantly higher than any single parameter (AUCs: 0.712, 0.725, 0.773, and 0.660, respectively).

Prolonged MMN latency, decreased MMN amplitude, decreased FOUR score, and decreased GCS are significantly associated with poor prognosis in elderly HICH patients. The combination of these four parameters has high predictive value for identifying patients at risk for poor outcomes.

To explore the application effect of health management led by brain and heart health managers based on capability, opportunity, motivation behavior (COM-B) model in stroke patients.

A total of 113 stroke patients hospitalized in the Neurology Department of Qingdao Municipal Hospital from December 2023 to March 2024 were enrolled. Using time-segmented allocation, they were assigned to a control group (admitted from December 2023 to January 2024) and an intervention group (admitted from February 2024 to March 2024). The control group received routine nursing care, while the intervention group received an additional structured health management program led by brain-heart health managers based on COM-B model. Outcomes, including the Barthel Index (BI), modified Rankin Scale (mRS)​ score, stroke prevention knowledge, self-efficacy, and health behavior scores, were assessed at baseline and at 1, 3, and 6 months post-discharge. Repeated-measures analysis of variance (ANOVA) and independent t-tests were used to evaluate time effects, group effects, and interaction effects.

In the intervention group, 4 cases were excluded, resulting in the final inclusion of 56 patients; in the control group, 3 cases were excluded, resulting in the final inclusion of 57 patients. Significant time, group, and interaction effects were observed for BI, mRS score, knowledge of stroke prevention and treatment, self-efficacy and stroke health behavior between the two groups (all P＜0.05). Comparisons between the intervention and control groups revealed statistically significant differences across all outcome measures at 1, 3, and 6 months post-discharge. For the BI, significant between-group differences were observed at each time point (80.18±20.14 vs 71.23±20.47, t=2.343, P=0.021; 84.37±15.70 vs 77.11±17.32, t=2.337, P=0.021; 91.52±11.52 vs 82.46±14.49, t=3.676, P＜0.001). Similarly, mRS scores differed significantly between groups at 1, 3, and 6 months (1.59±1.50 vs 2.16±1.12, t=2.291, P=0.024; 1.25±1.24 vs 1.79±1.10, t=2.450, P=0.016; 0.82±0.79 vs 1.49±1.02, t=3.901, P＜0.001). Self-efficacy scores were also significantly higher in the intervention group across all follow-up points (46.16±11.70 vs 40.09±13.29, t=2.577, P=0.011; 50.41±9.39 vs 42.93±13.14, t=3.477, P=0.001; 53.02±8.26 vs 46.70±12.06, t=3.243, P=0.002). Moreover, prevention and treatment knowledge scores showed marked between-group differences at 1, 3, and 6 months (22.25±1.39 vs 16.18±1.55, t=21.922, P＜0.001; 28.29±1.58 vs 22.60±1.55, t=19.347, P＜0.001; 31.20±1.81 vs 27.09±2.52, t=9.925, P＜0.001). Finally, healthy behavior scores were significantly different between groups at all three follow-up assessments (74.23±7.95 vs 70.28±8.61, t=2.534, P=0.013; 78.30±7.75 vs 73.14±7.86, t=3.516, P=0.001; 83.64±5.72 vs 77.89±7.04, t=4.758, P＜0.001).

The health management based on COM-B model led by brain and heart health managers can improve the neurological function and activities of daily living of stroke patients, enhancec stroke prevention knowledge and self-efficacy, and promote the formation and maintenance of patients' healthy behaviors.

To establish a rat model of subarachnoid hemorrhage (SAH) using an internal carotid artery (ICA) puncture technique that is technically straightforward and clinically relevant.

Forty 7-8-week-old Sprague Dawley (SD) rats were randomly allocated to a model group and a sham-operated group, with 20 rats in each group. After 1 week of adaptive feeding, surgical procedures were performed. In the model group, the SAH model was constructed via endovascular ICA puncture. Under anesthesia, the common carotid artery, ICA, and external carotid artery were exposed. A pre-prepared 4-0 polypropylene suture was inserted through the stump of the external carotid artery to the bifurcation of the ICA. The suture tip was then advanced to pierce the arterial wall​ at the bifurcation, held for 3 seconds, and this puncture process was repeated 2–3 times. Hemostasis was achieved by electrocoagulation, followed by incision suturing. In the sham-operated group, the suture was immediately withdrawn after reaching the bifurcation, and all other steps were identical to those of the model group. The modified Sugawara scoring system was used to evaluate the severity of hemorrhage at 72 hours after modeling. The modified Garcia scoring system was applied to assess the neurological function of rats in both groups at the same time points. Independent sample t-test was used for intergroup comparison.

Eighteen rats survived in the model group, with a survival rate of 90.0%. Among the survivors, 17 rats (94.4%) achieved a modified Sugawara score ≥8, comprising 11 cases of severe hemorrhage and 6 cases of moderate hemorrhage. Compared with the sham-operated group, the model group showed significant neurological impairment at all time points (24 hours: 14.40±1.43 vs 16.20±1.23, t=3.019, P=0.007; 48 hours: 12.40±0.97 vs 16.60±1.18, t=8.737, P＜0.001; 72 hours: 7.80±1.81 vs 17.20±1.14, t=13.890, P＜0.001), with the most severe neurological impairment observed at 72 hours after modeling.

The modified ICA puncture technique for establishing the SAH model in this study demonstrates high reproducibility, technical simplicity, and a high success rate. This model effectively mimics the pathophysiology of aneurysmal SAH.

To investigate the causal relationship between thyroid function and ischemic stroke using a two-sample Mendelian randomization (MR) approach.

Genetic instruments in the form of single-nucleotide polymorphisms (SNP) strongly associated with exposures—hyperthyroidism, hypothyroidism, thyroid-stimulating hormone (TSH), and free thyroxine (FT4)—were selected from publicly available genome-wide association study (GWAS) databases. Outcomes comprised ischemic stroke and its three etiological subtypes according to the trial of Org 10172 in acute stroke treatment (TOAST) classification: large-artery atherosclerotic stroke, cardioembolic stroke, and small-artery occlusion stroke. A two-sample MR analysis was performed to assess causal associations between thyroid function traits and ischemic stroke outcomes.

Genetically predicted hyperthyroidism was potentially causally associated with an increased risk of small-artery occlusion stroke (OR=1.09, 95%CI: 1.02 – 1.18, P=0.016). Conversely, genetically predicted hypothyroidism was linked to a reduced overall risk of ischemic stroke (OR=0.96, 95%CI: 0.93 – 0.99, P=0.007). Additionally, higher genetically determined TSH levels were associated with a lower risk of cardioembolic stroke (OR=0.87, 95%CI: 0.79 – 0.95, P=0.004). Sensitivity analyses supported the robustness of these findings.

Hyperthyroidism may represent a potential risk factor for small-artery occlusion stroke, whereas hypothyroidism and elevated TSH levels might exert protective effects against specific ischemic stroke subtypes.

To evaluate the instructional efficacy of the national continuing medical education program, the "Cerebrovascular Ultrasound Training Course".

A cross-sectional questionnaire survey was conducted among trainees who attended the course from 2021 to 2025. The questionnaire covered demographic information, perceived teaching effectiveness, self-assessed competency before and after training, clinical application of acquired knowledge, and suggestions for improvement. A five-point Likert scale was used for scoring. Paired-samples t test was used to compare changes in self-assessed core competencies before and after training. Independent-samples t test and one-way analysis of variance (ANOVA) were used to analyze differences in training effectiveness among trainees according to hospital level, professional title, and occupational category, respectively.

Of the 127 questionnaires distributed 126 were valid, with an effective response rate of 99.2%. Among the 126 trainees, 99 were female (78.6%), 102 were aged 35–54 years (81.0%), 65 were clinicians (51.6%), and 98 had attended the course within the past three years (77.8%). Teaching effectiveness was evaluated across five domains: (1) improvement in the ultrasound diagnosis and clinical analysis of cerebrovascular diseases (4.54±0.57); (2) enhancement of standardized operation and result interpretation for transcranial Doppler (4.57±0.53); (3) increased confidence in technology promotion dissemination (4.49±0.59); (4) expanded understanding of clinical application scenarios (4.52±0.56); (5) broadened academic perspectives, with scores 4.49±0.58. Post-training self-assessed scores for all core competencies were significantly higher than pre-training scores (all P＜0.05). Furthermore, 95.2% of the trainees had applied the training content to clinical practice to varying degrees; 57.1% reported that existing programs in their institutions had become more standardized, and 19.8% had newly initiated related programs. No significant differences in training effectiveness were observed among trainees from different hospital levels, professional titles, or occupational categories (all P＞0.05).

The "Cerebrovascular Ultrasound Training Course" has demonstrated significant positive impact on improving trainees' cerebrovascular ultrasound-related competencies, promoting clinical application and technology dissemination, and broadening academic perspectives. This program represents a high-value continuing medical education initiative with broad applicability across diverse clinical settings.

To explore the determinants and potential interventions for pre-hospital delay in patients with acute ischemic stroke (AIS) from the perspective of frontline clinical healthcare professionals.

A descriptive qualitative study was conducted using purposive sampling to recruit 12 clinical healthcare professionals for semi-structured, in-depth interviews. Data were analyzed using thematic analysis, facilitated by NVivo 14 qualitative analysis software.

The causes of and strategies to address delays in seeking medical care among patients with acute ischemic stroke are summarized under four themes:core causes and misconceptions regarding pre-hospital delays (insufficient awareness is the most prominent factor contributing to delays); key factors in in-hospital delays (risk concerns and time-consuming communication during thrombolysis decision-making are the primary causes of in-hospital delays); the effectiveness of public health education and digital tools (in-hospital education is most effective, while digital tools integrate multidimensional modules and cover the entire process); and intervention promotion strategies (differentiated, tiered outreach strategies tailored to specific populations).

Pre-hospital delay in AIS is a multifactorial issue resulting from the interplay of cognitive, behavioral, economic, social support, and healthcare system factors. Targeted, precision interventions tailored to specific population subgroups are essential to effectively reduce delays and improve patient outcomes.

Acute ischemic stroke (AIS) remains a leading cause of long-term disability and mortality. The pathophysiological process of AIS is driven by a complex, intertwined ischemic cascade encompassing oxidative stress, neuroinflammation, excitatory amino acid toxicity, and blood-brain barrier damage. Though intravenous thrombolysis and endovascular therapy have dramatically improved the prognosis of patients with AIS, the narrow therapeutic window and ischemia-reperfusion injury still limit the benefits for a considerable proportion of patients. Edaravone dexborneol is a compound neuroprotective agent, composed of edaravone and dexborneol in a 4∶1 ratio, exerting cerebral protection through a synchronized dual-target mechanism of antioxidation and anti-inflammation. In this review, the pharmacological mechanism, clinical research results (including clinical randomized controlled trial studies and real-world studies), combination treatment strategies, applications in special stroke subtypes, and future research directions of edaravone dexborneol are summarized. Furthermore, we explore the potential for individualized precision therapy to guide the rational clinical use of this agent.

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive stenosis of the terminal portion of the internal carotid artery and proximal middle cerebral artery, along with the formation of abnormal compensatory collateral vessels at the base of the brain. It confers dual risks of both ischemic and hemorrhagic stroke, making the formulation of clinical treatment strategies highly challenging. Antiplatelet therapy serves as the cornerstone of medical treatment for ischemic MMD. However, its exact efficacy in improving cerebral hemodynamics remains unclear. Furthermore, due to the potential risk of hemorrhagic transformation, its clinical application remains controversial. Although antiplatelet therapy holds theoretical promise for secondary stroke prevention in MMD, findings from studies in Asian populations have been inconsistent, particularly regarding the benefits of primary stroke prevention after a radiological diagnosis of asymptomatic MMD. This review synthesizes current evidence on the pathophysiological basis, current clinical status, safety controversies, and pharmacological selection strategies of antiplatelet therapy for MMD. Its aim is to provide a theoretical foundation to guide precision clinical decision-making and inform the design of future.