Mortality from cerebrovascular diseases in China:Exploration of recent and future trends

Background:Cerebrovascular disease(CVD)ranks among the foremost factors responsible for mortality on a global scale.The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated.Methods:We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention’s Disease Surveillance Points(CDC-DSP)system.The mortality of CVD in 2020 was described by age,sex,residence,and region.The temporal trend from 2013 to 2019 was evaluated using joinpoint regression,and estimated rates of decline were extrapolated until 2030 using time series models.Results:In 2019,the age-standardized mortality in China(ASMRC)per 100,000 individuals was 113.2.The ASMRC for males(137.7/10^(5))and rural areas(123.0/10^(5))were both higher when stratified by gender and urban/rural residence.The central region had the highest mortality(126.5/10^(5)),the western region had a slightly lower mortality(123.5/10^(5)),and the eastern region had the lowest mortality(97.3/10^(5)).The age-specific mortality showed an accelerated upward trend from aged 55-59 years,with maximum mortality observed in individuals over 85 years of age.The age-standardized mortality of CVD decreased by 2.43%(95%confidence interval,1.02-3.81%)annually from 2013 to 2019.Notably,the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years.In 2020,both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019.The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030.Conclusion:The heightened focus on the burden of CVD among males,rural areas,the central and western of China,and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities,consequently presenting novel challenges to strategies for disease prevention and control.

Perfusion and plaque evaluation to predict recurrent stroke in symptomatic middle cerebral artery stenosis

Background and purpose We investigated the baseline demographics of patients with severe unilateral atherosclerotic stenosis of the middle cerebral artery(MCA)using multimodal MRI and evaluated the haemodynamic impairments and plaque characteristics of patients who had a recurrent stroke.Materials and methods We retrospectively recruited consecutive patients with severe unilateral atherosclerotic MCA stenosis who underwent arterial spin labelling(ASL)with postlabelling delay(PLD)of 1.5 and 2.5 s,and vessel wall MRI.For each PLD,cerebral blood flow(CBF)maps were generated.Hypoperfusion volume ratio(HVR)from 2 PLD CBF was calculated.An HVR value≥50%was considered as severe HVR.Plaque areas,plaque burden,plaque length and remodelling index were measured.Plaque enhancement at maximal lumen narrowing site were graded.Baseline clinical and imaging characteristics were compared between patients with(event+)and without(event?)1 year ischaemic events.Results Forty-three patients(47.23±12.15 years;28 men)were enrolled in this study.Seven patients had an HVR≥50%.During the 1-year follow-up,7 patients had experienced a recurrent stroke.HVR were significantly higher in the event+than event?(53.17%±29.82%vs 16.9%±15.57%,p=0.0002),whereas no significant difference was detected in plaque areas,plaque burden,remodelling index,plaque length and plaque enhancement grade.The multivariable analysis revealed that a severe HVR was significantly associated with a recurrent stroke(Odds ratio=12.93,95%confidence interval 1.57 to 106.24,p=0.017)after adjusted by hypertension and smoking.Conclusion HVR obtained from two PLD ASL may be a useful imaging predictor of recurrent stroke.

Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion:choice of therapeutic strategy according to underlying aetiological mechanism?

Various mechanisms underlie causative large artery occlusion(LAO)in patients with acute ischaemic stroke.Cardioembolic and atherosclerotic occlusions are the two most common types.The pathophysiological changes and responses to mechanical thrombectomy(MT)and antithrombotic treatments including thrombolysis,antiplatelet and anticoagulation therapy may vary among patients with different aetiological mechanisms of occlusion.Atherosclerotic occlusion is inclined to have relatively abundant collaterals and larger area of penumbra,hence a relatively wider time window for reperfusion therapy,while poor response to medical thrombolysis and MT.Severe residual stenosis and reocclusion occurred frequently after MT in atherosclerotic LAO.Angioplasty and stenting as rescue or the first-line therapy and more intensified antiplatelet therapy beyond related recommendations in the current guidelines are sometimes used in managing acute causative LAO because of poor recanalisation after recommended standard thrombolysis or MT therapy,which are usually based on individual experience.Standard protocol to establish emergent aetiological diagnosis of causative LAO and individualised aetiology-specific treatment strategy is needed.

Association of fluid-attenuated inversion recovery vascular hyperintensity with ischaemic events in internal carotid artery or middle cerebral artery occlusion

Background and purpose Individuals with intracranial artery occlusion have high rates of ischaemic events and recurrence.It has been challenging to identify patients who had high-risk stroke using a simple,valid and non-invasive screening approach.This study aimed to investigate whether fluid-attenuated inversion recovery(FLAIR)vascular hyperintensity(FVH),a specific imaging sign on the FLAIR sequence,could be a predictor of ischaemic events in a population with internal carotid artery(ICA)or middle cerebral artery(MCA)occlusion.Methods We retrospectively analysed 147 patients(mean 60.43±12.83 years)with 149 lesions,including 37 asymptomatic and 112 symptomatic cases of ICA or MCA occlusion.Symptomatic occlusion was considered if ischaemic events were present in the relevant territory within 90 days.FVH Alberta Stroke Program Early Computed Tomography Score(FVH-ASPECTS:0-7,with 0 indicating absence of FVH and 7 suggesting prominent FVH)and collateral circulation grade were assessed for each participant.Multivariable logistic regression analysis was performed to detect independent markers associated with symptomatic status.Results A lower FVH-ASPECTS was associated with a more favourable collateral circulation grade(rho=−0.464,p<0.0001).The FVH-ASPECTS was significantly lower in the asymptomatic occlusion group than in the symptomatic occlusion group(p<0.0001).FVH-ASPECTS(Odd ratio,2.973;95%confidence interval,1.849 to 4.781;p<0.0001)was independently associated with symptomatic status after adjustment for age,sex,lesion location and collateral circulation grade in the multivariate logistic regression.The area under the curve was 0.861 for the use of FVH-ASPECTS to identify symptomatic occlusion.Conclusions The ability to discriminate symptomatic from asymptomatic occlusion suggests that FVH may be a predictor of stroke.As a simple imaging sign,FVH may serve as a surrogate for haemodynamic impairments and can be used to identify high-risk stroke cases early in ICA or MCA occlusion.