The key to treating acute ischemic stroke (AIS) is to start reperfusion therapy as early as possible to rescue the ischemic penumbra. Recombinant tissue plasminogen activator (rt-PA), which dissolves blood fibrous clots and recanalizes occluded vessels, has been approved as a preferred treatment for AIS in many countries and is included in treatment guidelines. With the publication of several relevant clinical research results, the application of thrombolytic therapy has been updated. This article reviews the research progress of hot issues such as green channel for stroke, broadened therapeutic window, new thrombolytic drugs, imaging screening, and cytoprotection for intravenous thrombolytic therapy of AIS, and hope to provide references for clinical decision-making.

Acute basilar artery occlusion (ABAO) is one of the key causes of ischemic strokes in the vertebrobasilar system, with a high disability and mortality of about 90% and therefore a heavy disease burden. Recent studies indicate that the key to successful treatment of ABAO is to start reperfusion therapy as soon as possible and to save the ischemic penumbra by endovascular treatment (EVT). However, EVT for ABAO is still lack of evidence-based medicine. Hence, we summarize the progress in EVT by comparing different EVTs and analyzing the correlation between preoperative imaging elvaluation and clinical outcome, so as to provide reference for clinical EVT of patients.

Acute ischemic stroke is one of the most common diseases in the emergency department. It is characterized by a high fatality rate and high disability rate. In acute ischemic stroke, intravenous thrombolysis is used widely as a first-line treatment. Hemorrhagic transformation is one of the common complications after thrombolysis, and the main risk factors include age, body temperature, hypertension, etc. Currently, based on the risk factors of hemorrhagic transformation after thrombolysis, there are mainly six foreign models of risk warning, including iScore model, SEDAN model, THRIVE model, SITS model, STARTING-SICH model, and SICH SCORE model; and three domestic models, including THRIVE-c model, model of Xu team, and model of Chang Hong team. As a clinician, it is particularly imperative to recognize the relevant risk factors of hemorrhagic transformation after thrombolysis. This review mainly focuses on the recent progress in the risk factors of hemorrhagic transformation after thrombolysis.

Stroke is still characterized by a high incidence, recurrence, disability, and mortality. Effective airway assessment is indispensable in the management of stroke patients. Quickly assessing the airway condition of stroke patients determines the choice of airway ventilation, which improves the prognosis of patients in turn. There are many airway assessment methods for stroke patients, albeit no perfect uniform standard. By summarizing and elaborating the latest airway assessment methods applicable to stroke patients, we aim to make a comprehensive and perfect judgment of patients, individually select the appropriate airway assessment method, improve the difficult airway management of stroke patients through effective airway assessment, and further optimize the treatment.

The epidemiological characteristics of stroke in China from 2007 to 2017 were collected by consulting the global burden of disease research database and reviewing the literature, and descriptive epidemiological methods were used to analyze the characteristics of stroke in China. The results showed that, from 2007 to 2017, the prevalence trend of stroke in China mainly showed that the incidence and prevalence of ischemic stroke continued to increase, while the incidence and prevalence of hemorrhagic stroke showed a decreasing trend, and the overall mortality of stroke showed a decreasing trend. The epidemic characteristics of stroke in China are as follows: the younger-onset tendency; In terms of incidence, prevalence and mortality, more patients in males than that in females, more in rural areas than that in urban areas, and more in northern areas than in southern areas. In the most recent decade, the incidence and prevalence of ischemic stroke in China have increased significantly with lower average age at onset compared with those ten years ago, which were considered to be related to unhealthy lifestyle, such as dietary habits. The government should strongly advocate good lifestyle and dietary habits. In addition, the incidence, prevalence and mortality of stroke were significantly higher in rural areas than that in urban areas. Therefore, strengthening the prevention and control of stroke in rural areas should be the key of future work.

The outcomes of cardiac arrest (CA) patients are still not optimistic. Severe brain damage after resuscitation is the main cause of death and neurological disability. Therefore, reducing brain injury is the key point of treatment in post CA syndrome. Target temperature management (TTM) is proved to be the only intervention that can effectively improve survival and neurological prognosis. However, a investigation published recently showed insufficient understanding and poor practice of TTM in CA patients in China. So it is of great significance to promote TTM awareness and translations of guidelines into standardized clinical practice in pre-hospital emergency medical systems, departments of emergency, intensive care units. We comprehensively interpreted the TTM part in 2020 expert consensus statement on neuroprotection after cardiac arrest in China and other international guidelines, mainly involved the neuroprotective mechanism, timing of initiation, target temperature, duration of the cooling phase, cooling methods and rewarming rate.

Neuroprotection is one of the key measures for successful cardiopulmonary resuscitation with good prognosis for patients with cardiac arrest (CA). Although the success rate of cardiopulmonary resuscitation has increased, the prognosis of patients with CA after cardiopulmonary resuscitation has not been significantly improved due to insufficient follow-up treatment of cardiopulmonary resuscitation. In order to reduce brain damage and improve the survival and neurological prognosis of patients with CA, we interpreted the part of drug treatment in 2020 experts consensus statement on neuroprotection after CA in China, which mainly involved the treatments of brain protection and drug therapy selection .

Stroke is one of the leading causes of mortality and disability in China. Facing the challenge of stroke, China Stroke Prevention Project Committee (CSPPC) was established in April 2011 under the leading of the Ministry of Health. The CSPPC actively promotes and stroke prevention and control in China. In 2021, CSPPC has obtained remarkable achievements as following: high-risk stroke population screening and the relevant intervention, construction of stroke centers, promotion of appropriate stroke treatment technologies, tiered diagnosis and treatment of stroke, and health education. In 2022, CSPPC will mainly carry out the following tasks: strengthening the construction of stroke centers and promote regional collaboration; strengthening appropriate technical training to improve the effectiveness of stroke treatment; carrying out high-quality screening of high-risk stroke populations; continuing to popularize health knowledge; perfroming follow up of patients with stroke and improving the health education in general population.

Neurological prognostication has become a very important part of post-cardiac arrest (CA) care. Early and accurate prediction of neurological should allows optimizing identification of those individuals with no chance of a good recovery and avoid making inappropriate decisions on withdrawal of life support in patients with the potential for recovery which is a frequent cause of death. However, there are still many challenges to address CA as an important public health issue in China, such as insufficient awareness as well as poor and non-standard practice of neurological assessment. To promote standardized neurological assessment after CA, we interpreted the part of neurological assessment in 2020 expert consensus statement on neuroprotection after cardiac arrest in China, which mainly involved the methods and protocols of neurological assessment after cardiopulmonary resuscitation.

Intracerebral hemorrhage is defined as the primary non-traumatic cerebral parenchyma hemorrhage, which is fatal with a poor prognosis and a variety of complications. Sleep disturbance is a common complication in patients with cerebral hemorrhage, and seriously affects the prognosis and quality of life of patients. The manifestation and severity of sleep disturbance after intracerebral hemorrhage are related to the location of hemorrhage, the severity of neurological injury and other factors. The treatment of sleep disorder after cerebral hemorrhage mainly includes medicine, traditional Chinese medicine, psychological intervention, relaxation therapy and so on. Individualized treatment should be applied for patients with different conditions, so as to improve the sleep quality of patients and improve the prognosis of patients.

Cerebral microbleeds (CMBs) are caused by cerebral small vessel diseases with high prevalence. Emerging evidence shows that CMBs are an independent risk factor of intracranial hemorrhage and hemorrhagic transformation after ischemic stroke. Hemorrhage is the biggest concern of antithrombotic therapy. Therefore, antithrombotic therapy is one of the major challenges for atrial fibrillation in patients with CMBs. However, so far there is no high-quality clinical randomized controlled trial to evaluate the benefits and risks of the patients taking antithrombotic therapy. This article reviews the relevant studies to provide evidence for clinicians to antithrombotic strategy according to the clinical characteristics of patients, so as to maximize the benefits of patients.

Stroke severely threatens human health due to its high disability and fatality rate. Active and effective rehabilitation intervention for stroke patients as early as possible can reduce the occurrence of disability and improve patients' life and quality of life. With the development of science and technology, virtual reality, rehabilitation robots, mirror therapy, non-invasive brain stimulation, vagus nerve stimulation, and other technologies continue to emerge in the medical field promoting the development of rehabilitation medicine. This paper reviews the progress of the above techniques in stroke rehabilitation.

Blood pressure (BP) management in acute ischemic stroke is one of the important intervention affecting clinical prognosis. Many factors in patients with ischemic stroke can lead to increased BP in the acute stage, which is relatively common, while few patients may manifest hypotension. BP is a key factor affecting the clinical outcomes according to the previous studies. Too high or too low BP is related to the poor prognosis, but the specific management strategy of BP in the acute stage has not been determined yet. Increased BP during the acute phase of recanalization treatment is associated with an increased risk of symptomatic intracranial hemorrhage. The management of BP needs to be more rigorous, but the need for intensive BP control should be analyzed in light of the individual patient's features.