Cerebrovascular Diseases最新文献

{"title":"A Bibliometric Analysis of Research on Ischemic Stroke Treatment Based on Chinese Multiethnic Medicine Theories.","authors":"Dula Man, La Na, Qingchun Ling, Xia Chun, Runa A, Hairihan Bao, Xia Li","doi":"10.1159/ced/accag032","DOIUrl":"https://doi.org/10.1159/ced/accag032","url":null,"abstract":"<p><strong>Introduction: </strong>To perform a bibliometric analysis that comprehensively evaluates the status of Chinese multiethnic medicine research, knowledge structure, and the developmental trajectory of ischemic stroke prevention and treatment and provide scientific insights for future advancements.</p><p><strong>Methods: </strong>CiteSpace, VOSviewer, and Scimago Graphica were used to analyze studies retrieved from the Web of Science Core Collection (WoSCC) and China National Knowledge Infrastructure (CNKI) databases. Multidimensional evaluations included keyword co-occurrences, author networks, international and institutional collaborations, and publishing patterns.</p><p><strong>Results: </strong>Publication output exhibited a phased increase, accelerating after 2020, with CNKI publications substantially outnumbering those in WoSCC. China dominated the global collaboration network, led by institutions such as the Beijing University of Chinese Medicine. Research focus has gradually shifted from investigations of pathophysiological mechanisms to clinical applications of integrated Chinese and Western medicine, with increasing attention being paid concurrently to fundamental mechanistic research and clinical translation. Traditional Chinese medicine's \"Qi deficiency, blood stasis, and phlegm-dampness obstructing the orifices\" theory, Mongolian medicine's \"Sa disease\" theory, and Tibetan medicine's \"pathogenic factors related to stars and planets\" theory represent distinct theoretical frameworks and intervention approaches developed within these traditional systems to explain ischemic stroke.</p><p><strong>Conclusion: </strong>Chinese multiethnic medicine shows promise and a developing evidence base for ischemic stroke prevention and treatment; however, challenges include research imbalances, insufficient standardization, and cross-ethnic integration difficulties. Future research should focus on generating high-quality clinical evidence, promoting standardization and normalization, deepening interdisciplinary mechanistic studies, and advancing integration and translational application of multiethnic medicine. Through multidisciplinary collaboration and supportive policy frameworks, a stroke prevention and treatment system with Chinese characteristics should be established, contributing Chinese expertise to global stroke management.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke-Associated Pneumonia: Asia-Pacific Perspective.","authors":"Sarah Syed, Thanh Phan, Henry Ma","doi":"10.1159/ced/accag031","DOIUrl":"https://doi.org/10.1159/ced/accag031","url":null,"abstract":"<p><strong>Background: </strong>Stroke-associated pneumonia (SAP) is a frequent complication of acute ischemic stroke (AIS) and is associated with increased mortality, disability, length of hospital stay, and healthcare costs. Global pooled prevalence estimates of SAP range from 12.3% to 14.3%, but reported rates vary across the APAC region. Given that China alone accounted for 4.1 million incident stroke cases in 2021, representing one-third of the global stroke burden, SAP represents a substantial clinical and health-system challenge across the region.</p><p><strong>Summary: </strong>Reported SAP prevalence varied substantially across APAC cohorts, ranging from 2.6% in Japan, 5.5% in Singapore, 10.4% in the China National Stroke Registry and up to 15.8% in Thailand, reflecting differences in diagnostic criteria, case mix, stroke severity, and care settings. SAP frequently occurs early after stroke; in one Japanese cohort, 77.3% of cases developed within 72 hours. Stroke severity was the most consistently reported risk factor, alongside dysphagia, mechanical ventilation, older age, and comorbid disease. Evidence supports a multifactorial pathogenesis involving stroke-induced immunodepression and gut-brain-lung axis disruption. Large international trials of universal antibiotic prophylaxis have not demonstrated reductions in SAP or improvements in functional outcomes. In APAC, preventive care interventions have produced variable results; notably, a Chinese assessor-blinded randomized controlled trial of tailored oral health care reported SAP in 10.26% of the intervention group compared with 32.43% of controls. Overall, heterogeneity in SAP definitions, study populations, and intervention designs limits direct comparison between studies.</p><p><strong>Key messages: </strong>SAP is a common complication of AIS in the APAC region, although reported prevalence varies considerably between studies and according to diagnostic criteria applied. Stroke severity, dysphagia, mechanical ventilation, older age and comorbidities are frequently reported risk factors. Evidence for preventative interventions remains heterogenous, highlighting the need for standardised diagnostic criteria and further evaluation of risk-stratification tools and multidisciplinary prevention strategies in resource-diverse APAC settings.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Epidemiology of Intracerebral Hemorrhage in Japan: A Population-Based Study from the Shiga Stroke and Heart Attack Registry.","authors":"Satoshi Shitara, Akiko Harada, Sachiko Tanaka-Mizuno, Naoyuki Takashima, Takako Fujii, Hisatomi Arima, Makoto Urushitani, Kazuhiko Nozaki, Katsuyuki Miura, Kazumichi Yoshida","doi":"10.1159/ced/accag017","DOIUrl":"10.1159/ced/accag017","url":null,"abstract":"<p><strong>Introduction: </strong>Intracerebral hemorrhage (ICH) remains a major cause of stroke-related mortality and disability, particularly in East Asian populations. However, contemporary population-based data regarding ICH incidence in Japan are limited. We investigated the incidence and clinical characteristics of ICH using a large population-based registry in Japan.</p><p><strong>Methods: </strong>We analyzed patients with first-ever ICH registered in the Shiga Stroke and Heart Attack Registry between 2011 and 2015. Age- and sex-standardized incidence rates were calculated using the 2015 Japanese Population Census as the standard population.</p><p><strong>Results: </strong>A total of 3,461 patients with first-ever ICH were identified during the study period, representing 7,008,831 person-years of observation and corresponding to a crude incidence rate of 49.4 per 100,000 person-years. Mean age at onset was 72 ± 14 years, and 1,894 (54.7%) patients were men. The age-standardized incidence rate of ICH was 61.2 (95% confidence interval [CI], 60.5-61.8) per 100,000 person-years in men and 49.8 (95% CI, 49.3-50.4) per 100,000 person-years in women. Incidence increased markedly with age in both sexes. Women had more severe neurological status at presentation and worse functional outcomes at discharge, likely reflecting differences in age and baseline characteristics. Putaminal hemorrhage was the most common hemorrhage location in men, whereas subcortical hemorrhage was most common in women.</p><p><strong>Conclusion: </strong>ICH remains a substantial public health burden in Japan, particularly among older individuals. Significant sex differences were observed in incidence, severity, functional outcomes, and hemorrhage location. Continued epidemiological surveillance of ICH is warranted in aging populations.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Disparities in ICH: Presentation, Care, and Outcomes in the TICH-2 Trial.","authors":"Chaamanti S Menon, Michael Desborough, Elinor Mai Greenman, Lisa Woodhouse, Zhe Kang Law, Kailash Krishnan, Rob A Dineen, Philip M Bath, Nikola Sprigg","doi":"10.1159/ced/accag015","DOIUrl":"10.1159/ced/accag015","url":null,"abstract":"<p><strong>Introduction: </strong>Sex-based disparities in ischaemic stroke outcomes are more widely reported than those for intracerebral haemorrhage. This study aims to examine sex differences in baseline characteristics, imaging findings, care processes, and functional outcomes following ICH and to determine whether the treatment effect of tranexamic acid (TXA) differed by sex.</p><p><strong>Methods: </strong>We performed a post hoc analysis of the TICH-2 trial, a multicentre, double-blind, randomised, placebo-controlled study of TXA in spontaneous ICH. Baseline characteristics and care processes were compared between men and women. The primary outcome was functional status at day 90 (modified Rankin Scale, mRS). Regression models were adjusted for prespecified prognostic variables. Odds ratios represent the odds of poor outcome in women compared to men, with men serving as the reference group. Interaction terms were used to test for sex-treatment effects.</p><p><strong>Results: </strong>Of 2,325 patients in TICH-2, 1,024 (44%) were women. Women were older (mean age 72.3 vs. 66.2 years, p < 0.001), had worse pre-stroke function (mRS 0.71 vs. 0.43, p < 0.001), larger haematomas (25.6 mL vs 22.7 mL, p = 0.012), and more lobar bleeds (39.2% vs. 25.9%, p < 0.001). They were also more likely to receive early do-not-attempt-resuscitation (DNAR) orders (22.6% vs. 12.4%, p = 0.003). After adjustment, there were no significant sex differences in functional outcome at 90 days (aOR 1.04, 95% CI 0.88-1.22). There was no evidence of a sex-specific treatment effect with TXA (interaction p > 0.1).</p><p><strong>Conclusion: </strong>Despite older age, poorer pre-stroke function, more severe imaging features, and higher rate of early DNAR status, women had similar adjusted 90-day functional outcomes to men.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Endovascular Thrombectomy Effective for Distal Medium Vessel Occlusion Stroke? A Meta-Analysis of Randomized Controlled Trials and Observational Studies.","authors":"Jian Wu, Fuli Yan, Jiaying Li, Junlong Huang, MingFei Yang, Zhanying Ju","doi":"10.1159/ced/accag029","DOIUrl":"https://doi.org/10.1159/ced/accag029","url":null,"abstract":"<p><strong>Background: </strong>Evidence on endovascular thrombectomy (EVT) for distal medium vessel occlusion (DMVO) stroke remains insufficient, and its efficacy across severity levels is unclear.</p><p><strong>Methods: </strong>Systematic search of databases for RCTs and observational studies comparing EVT versus best medical treatment (BMT) in DMVO patients. Patients were stratified by NIHSS (<6, ≥6, unreported) and occlusion site (MCA, PCA, ACA).</p><p><strong>Primary outcome: </strong>90-day mRS 0-1.</p><p><strong>Secondary outcomes: </strong>mRS 0-2, mortality, and symptomatic intracranial hemorrhage (sICH).</p><p><strong>Results: </strong>3 RCTs (n=1,233) and 39 observational studies (n=11,148) were included. RCTs showed no significant difference between EVT+BMT and BMT alone in mRS 0-1 (RR 0.95, 95% CI 0.82-1.10), mRS 0-2 (RR 0.92, 95% CI 0.80-1.06), or mortality (OR 1.23, 95% CI 0.76-1.99), but EVT significantly increased sICH risk (OR 2.38, 95% CI 1.35-4.20, p=0.003). Observational studies similarly found no differences in functional outcomes or mortality, with elevated sICH in the EVT group (OR 1.69, 95% CI 1.14-2.50, p=0.008). Subgroup analyses suggested a potential gradient effect: in NIHSS ≥6 patients, EVT showed no significant benefit in primary analysis, but a sensitivity analysis excluding heterogeneous studies yielded a potential signal (mRS 0-1: RR 1.18, 95% CI 1.01-1.37, p=0.04). Conversely, in NIHSS <6 patients, BMT alone appeared non-inferior (RR 0.91, 95% CI 0.82-1.00, p=0.05).</p><p><strong>Conclusion: </strong>EVT does not improve functional outcomes in overall DMVO but increases sICH risk. Exploratory analyses suggest EVT may benefit more severe (NIHSS ≥6) or proximal occlusion patients, whereas BMT alone may suffice for milder cases. These findings are hypothesis-generating and require RCT validation.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Prehospital Delay in People with Ischemic Stroke: A Meta-Analysis.","authors":"Yiling Li, Runfang Guo, Hejia Wan, Qiuyue Huang, Jie Jing, Jiajia He","doi":"10.1159/ced/accag027","DOIUrl":"10.1159/ced/accag027","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous thrombolysis for ischemic stroke can significantly improve neurological outcomes. However, prehospital delay is associated with failure to receive timely treatment and poorer patient outcomes.</p><p><strong>Methods: </strong>Nine databases were searched from inception to January 30, 2026. Two researchers independently completed the screening, data extraction, and risk-of-bias assessment. Incidence rates and 95% confidence intervals (CIs) were pooled. Heterogeneity among results was assessed using the I2 statistic. Sensitivity analysis was conducted using the leave-one-out method, and Egger's regression test and funnel plots were used to detect publication bias.</p><p><strong>Results: </strong>A total of 27 studies involving 266,336 participants across 14 countries were included. The overall pooled incidence was 67.7% (95% CI: 59.2%-75.6%). The pooled incidence of prehospital delay was 65.0% (95% CI: 59.8-70.0%) at the 2-h cut-off, 77.2% (95% CI: 70.2-83.5%) at 3 h, 68.6% (95% CI: 56.2-79.9%) at 3.5 h, 73.8% (95% CI: 60.4-85.3%) at 4 h, and 60.6% (95% CI: 42.8-77.1%) at 4.5 h. The 5- and 6-h cut-offs were each reported by only one study, with incidences of 29.7% and 53.1%, respectively. Subgroup analyses revealed significant moderators, including continent, education level, stroke knowledge, stroke symptom recognition, transportation and study quality. The certainty of evidence was low.</p><p><strong>Conclusion: </strong>Prehospital delay was common among patients with ischemic stroke, with an overall pooled incidence of 67.7%. Regional estimates varied, but the limited evidence outside Asia and substantial heterogeneity make these comparisons exploratory. Targeted stroke education and improved emergency medical services (EMS) are needed, together with geographically diverse studies using standardized delay definitions.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Paradigm Shift in the Treatment of Hereditary Hemorrhagic Telangiectasia: A Narrative Review.","authors":"Maya P Haghighi, Hunter Hutchinson, Ohm K Parikh, Danyas Sarathy, Brandon Lucke-Wold, Mehrdad Pahlevani, Michael Karsy","doi":"10.1159/ced/accag030","DOIUrl":"10.1159/ced/accag030","url":null,"abstract":"<p><strong>Background: </strong>Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant, multisystem vascular disorder characterized by mucocutaneous telangiectasias and visceral arteriovenous malformations (AVMs). Pathogenic variants in ENG (endoglin), ACVRL1 (activin receptor-like kinase 1, ALK1), and SMAD4 (SMAD family member 4) disrupt signaling in the bone morphogenetic protein (BMP) 9/10 and transforming growth factor-beta (TGF-β) pathways, resulting in dysregulated angiogenesis and excess vascular endothelial growth factor activity. Clinically, HHT most commonly presents with recurrent epistaxis and chronic gastrointestinal bleeding, frequently leading to iron deficiency anemia and reduced quality of life (QoL). Complications from visceral AVMs involving the lungs, brain, and liver may also occur. Early diagnosis and systematic screening are essential to reduce preventable morbidity.</p><p><strong>Summary: </strong>This narrative review synthesizes current primary literature on the diagnosis, screening, and treatment of HHT, with particular emphasis on evolving systemic therapies, supportive care strategies, and procedural interventions. Evidence from international guidelines, randomized trials, observational cohort studies, and narrowly focused systematic reviews was evaluated to summarize contemporary management approaches. HHT diagnosis is made with the Curaçao clinical criteria, genetic testing, and targeted imaging to identify visceral vascular malformations. Screening recommendations emphasize early detection of pulmonary and cerebral AVMs and ongoing surveillance for anemia and other complications. Therapeutic strategies increasingly prioritize systemic therapy over repeated local procedures. Antiangiogenic agents including intravenous bevacizumab, pomalidomide, thalidomide, and oral pazopanib have demonstrated efficacy in reducing bleeding severity, improving hemoglobin levels, and decreasing transfusion requirements in moderate-to-severe disease. Supportive care remains foundational and includes iron replacement, selective blood transfusion, routine monitoring, and assessment of patient-reported QoL. In patients with refractory epistaxis, surgical interventions such as septodermoplasty or nasal closure may provide durable bleeding control. Endovascular and neurosurgical management may also be required for selected vascular complications.</p><p><strong>Key messages: </strong>Management of HHT is undergoing a paradigm shift toward mechanism-based systemic therapy integrated with multidisciplinary care. Advances in antiangiogenic and precision-medicine approaches are improving bleeding control and long-term outcomes. Early recognition, comprehensive screening, individualized therapy, and coordinated management across specialties are critical for optimizing care in this complex, multisystem disease.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary cerebral small vessel disease: from phenotype to management.","authors":"Trajano Aguiar Pires Gonçalves, Thiago Oscar Goulart, Iago Blanco Bacchiega, Rodrigo Siqueira Soares Frezatti, Tomásia Oliveira de Holanda Monteiro Frezatti, Maria Clara Zanon Zotin, Rui Kleber do Vale Martins Filho, Guilherme Gustavo Riccioppo Rodrigues, Mattia Losa, Wilson Marques, Pedro José Tomaselli, Octavio M Pontes-Neto","doi":"10.1159/ced/accag028","DOIUrl":"https://doi.org/10.1159/ced/accag028","url":null,"abstract":"<p><p>Hereditary cerebral small vessel disease (cSVD) comprises a heterogeneous group of monogenic disorders affecting small cerebral arteries, arterioles, capillaries, and venules, leading to stroke, intracerebral hemorrhage, and vascular cognitive impairment, often at a young age. Despite their rarity, these conditions offer critical insights into the molecular mechanisms underlying microvascular brain injury and are frequently underdiagnosed due to phenotypic overlap with sporadic cSVD. Key diagnostic clues include early onset, disproportionate MRI burden, positive family history, and systemic manifestations. Distinct genetic entities, such as CADASIL, HTRA1-related arteriopathies, COL4A1/2-associated microangiopathies, RVCL-S, Fabry disease, and hereditary cerebral amyloid angiopathies, exhibit characteristic clinical, radiological, and extracerebral features. Accurate recognition is essential to guide genetic testing, avoid inappropriate treatments, enable targeted monitoring, and identify the few conditions with disease-modifying therapies. Early diagnosis also allows appropriate genetic counseling and risk stratification for affected families.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial Atherosclerotic Stenosis: Asian Recommendations on Standardized Definitions, Diagnosis, and Imaging - A Joint WSO, APSO, and PAVIN Consensus Statement.","authors":"Jose C Navarro, Bonifacio C Pedregosa, Craig S Anderson, Jeyaraj D Pandian, Adnan I Qureshi, Juan F Arenillas, David S Liebeskind, Daniel Bos, Nijasri C Suwanwela, Tsong-Hai Lee, Maria Epifania V Collantes, Narayanaswamy Venketasubramanian, Vijay K Sharma, Romulo U Esagunde, Sun U Kwon, Thomas W Leung, Kay Sin Tan, David Bonovich, Monique Therese S Punsalan, Gabriel Alejandro B Baroque, Meliza Angelica J De Leon, Maria Teresa A Cañete, John Harold B Hiyadan, Maria Socorro F Sarfati, Johnny K Lokin, Anna Marie Sage-Nolido, Cyrus G Escabillas, Anne Marie Joyce Tenorio-Javier, Christian Emmanuel T Lim, Melchor R Basalo, Maria Lutgarda M Dorado, Allan A Belen, Robert N Gan","doi":"10.1159/ced/accag025","DOIUrl":"10.1159/ced/accag025","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial atherosclerotic stenosis (ICAS) is a leading cause of ischemic stroke, particularly in Asian populations. Despite its significance, standardized definitions, diagnostic criteria, and imaging protocols remain limited, affecting the validity and interpretability of existing data. We aimed to develop expert consensus recommendations for the standardization of definitions, diagnosis, and imaging of ICAS, taking into account the diversity of healthcare resources and infrastructure across Asia.</p><p><strong>Methods: </strong>An international multidisciplinary expert panel with broad Asian representation was convened to develop regionally relevant evidence-guided consensus recommendations using a modified Delphi process. Statement development was informed by targeted literature reviews undertaken to address prespecified research questions. The consensus process incorporated iterative voting rounds and an interim non-voting consensus meeting held during the 2026 Philippine Academy of Vascular and Interventional Neurology Biennial Conference. Consensus was predefined as ≥80% agreement.</p><p><strong>Results: </strong>Question-specific targeted literature reviews informed the development of 24 candidate statements. The 17-member expert panel completed the Delphi process after 2 voting rounds, yielding 23 final recommendations: 2 on the definitions of intracranial atherosclerotic disease (ICAD) and ICAS (≥50% luminal narrowing); 2 on the definitions of symptomatic and asymptomatic ICAS; 12 on the diagnostic evaluation of ICAS; 2 on the use of transcranial Doppler ultrasound for the screening of intracranial stenosis; 3 on stenosis quantification and severity classification; and 2 on the advanced and investigational assessment of intracranial atherosclerosis.</p><p><strong>Conclusion: </strong>These consensus recommendations provide a standardized framework for the definitions, diagnosis, and imaging of ICAS, intended to guide and align research and clinical practice across Asia while laying the foundation for future international standardization. Periodic review and refinement will be needed in response to emerging evidence, advances in diagnostic technologies, and increasing access to these modalities across healthcare settings.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Surgery for Patients with Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.","authors":"Namrah Aziz, Shafaq Saleem, Saadia Sattar, Syed Hamza Sohail, Syed Roohan Aamir, Muhammad Ibrahim, Ayeesha Kamal","doi":"10.1159/ced/accag026","DOIUrl":"10.1159/ced/accag026","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous supratentorial intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Minimally invasive surgery (MIS) offers a potential alternative to conventional treatments by reducing operative trauma and improving outcomes. Recent large-scale trials have provided critical insights, allowing for a more detailed comparison of MIS techniques against traditional approaches.</p><p><strong>Methods: </strong>We systematically searched PubMed, MEDLINE, CINAHL, Scopus, ScienceDirect, and the Cochrane Library for randomized controlled trials (RCTs) published up to September 2025 involving patients with computed tomography-confirmed supratentorial ICH. We included all types of MIS (stereotactic and neuroendoscopic procedures) and conventional treatments (craniotomy and medical management). The primary outcome was a favorable functional outcome (modified Rankin Scale 0-3 or equivalent) at follow-up. Secondary outcomes included death and adverse events such as rebleeding and infection. Subgroup analyses examined the influence of age, hematoma volume, follow-up duration, functional outcome measurement tool, and timing of surgery on MIS efficacy.</p><p><strong>Results: </strong>Twenty-four high-quality RCTs involving 4,629 patients were included. MIS was associated with significantly improved functional outcomes compared with conventional treatments (odds ratio [OR] 1.88 [95% CI: 1.47-2.41]). When examined separately, MIS demonstrated higher odds of favorable outcomes than conventional craniotomy (OR 2.10 [95% CI: 1.56-2.83]) and medical management (OR 1.66 [95% CI: 1.11-2.50]). Across MIS subtypes, endoscopic surgery (OR 1.94 [95% CI: 1.20-3.15]) and stereotactic aspiration with thrombolysis (OR 1.97 [95% CI: 1.43-2.72]) showed significant functional benefits; however, stereotactic aspiration without thrombolysis did not reach statistical significance (OR 1.55 [95% CI: 0.88-2.73]). For mortality, MIS was associated with reduced odds of death compared with conventional treatments overall (OR 0.70 [95% CI: 0.59-0.84]). MIS also significantly lowered rebleeding risk compared with conventional craniotomy (OR 0.45 [95% CI: 0.28-0.72]), while showing no significant difference compared with medical management (OR 1.46 [95% CI: 0.56-3.84]). Central nervous system infection rates did not differ significantly between MIS and conventional treatments (OR 0.94 [95% CI: 0.55-1.61]), including subgroup comparisons with craniotomy (OR 0.89 [95% CI: 0.50-1.58]) and medical management (OR 1.44 [95% CI: 0.29-7.08]). Substantial to considerable heterogeneity was observed across primary and most secondary analyses (I2 up to 70%).</p><p><strong>Conclusion: </strong>MIS is associated with improved functional outcomes and reduced mortality in patients with supratentorial ICH. Due to heterogeneity in existing studies, further trials are needed to establish the best MIS approaches and algorithms.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}