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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of the management of high-risk population

Yilong Wang, Shangrong Han, Haiqiang Qin, Huaguang Zheng, Bin Jiang, Yong Cao, Yuan Gao, Ling Guan, Qian Jia, Yong Jiang, Yuming Jiao, Shuya Li, Yapeng Li, Zixiao Li, Wei Liu, Xiaojuan Ru, Dongling Sun, Haixin Sun, Penglian Wang, Tingting Wang, Lixia Zong, Lei Guo, Xuewei Xie, Yuming Xu, Yuyuan Xu, Xiaomeng Yang, Yingying Yang, Mengyuan Zhou, Wenzhi Wang
DOI: 10.1136/svn-2020-000385 Published 13 August 2020
Yilong Wang
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Shangrong Han
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Haiqiang Qin
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Huaguang Zheng
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Bin Jiang
3Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
4Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Yong Cao
2China National Clinical Research Center for Neurological Diseases, Beijing, China
5Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yuan Gao
6Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
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Ling Guan
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Qian Jia
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yong Jiang
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yuming Jiao
2China National Clinical Research Center for Neurological Diseases, Beijing, China
5Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Shuya Li
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yapeng Li
6Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
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Zixiao Li
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Wei Liu
7Department of Neurology, Beijing Haidian Hospital, Beijing, China
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Xiaojuan Ru
3Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
4Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Dongling Sun
3Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
4Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Haixin Sun
3Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
4Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Penglian Wang
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Tingting Wang
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Lixia Zong
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Lei Guo
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Xuewei Xie
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yuming Xu
6Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
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Yuyuan Xu
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Xiaomeng Yang
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yingying Yang
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Mengyuan Zhou
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2China National Clinical Research Center for Neurological Diseases, Beijing, China
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Wenzhi Wang
3Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
4Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Article Figures & Data

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  • Figure 1
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    Figure 1

    Flow chart for the management of patients with hypertension hypertension is defined as an average SBP ≥135 mm Hg or DBP ≥85 mm Hg during the day, SBP ≥120 mm Hg or DBP ≥70 mm Hg during the night or SBP ≥130 mm Hg or DBP ≥80 mm Hg in 24 hours by ambulatory blood pressure (BP) monitoring; or SBP ≥135 mm Hg or DBP ≥85 mm Hg by self-monitoring. details about risk factors and target organ damage is described on the publication: Prevention and Treatment of Cardio_Cerebral_Vascular Disease Jan 2018. Vol 19. No 1, DOI: 10.3969/j.issn.1007–5410.2019.01.002. CKD, chronic kidney disease. SBP, systolic blood pressure, DBP, diastolic blood pressure.

  • Figure 2
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    Figure 2

    Flow chart for the management of patients with diabetes or pre-diabetes. BP, blood pressure; OGTT, oral glucose tolerance test.

  • Figure 3
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    Figure 3

    Flow chart for the management of patients with dyslipidaemia.*Very-high-risk patients diagnosed with acute cardiovascular syndrome, stable coronary artery disease, postpercutaneous coronary intervention, ischaemic cardiomyopathy and peripheral artery diseases. **High risk: (1) LDL-C ≥4.9 mmol/L or TC ≥7.2 mmol/L; (2) patients with diabetes aged over 40 with LDL-C 1.8–4.9 mmol/L, or TC 3.1–7.2 mmol/L. ***Low risk and moderate risk: TC 3.1–7.2 mmol/L or LDL-C 1.8–4.9 mmol/L.

  • Figure 4
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    Figure 4

    Flow chart for the management of patients with asymptomatic carotid stenosis.*Risk factors include hypertension, dyslipidaemia, diabetes, atrial fibrillation, smoking, obesity, lack of physical activity and stroke family history. DSA, Digital Subtraction Angiography. CTA; CT Angiography; CEA, carotid endarterectomy;,CAS, carotid artery stenting.

  • Figure 5
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    Figure 5

    Flow chart for the management of patients with unruptured intracranial aneurysms.*Symptomatic aneurysm: patients show symptoms related to the aneurysm, such as ptosis, severe headache, vomiting, neck stiffness, drowsiness, enlarged pupils, disorder of consciousness and so on. MRA, MR Angiography; CTA, CT Angiography; BP, blood pressure.

  • Figure 6
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    Figure 6

    Flow chart for evaluating first stroke.*Major risk factor includes: age, gender, hypertension, diabetes, dyslipidaemia, atrial fibrillation, cigarette smoking, cerebrovascular or cardiovascular disease family history, BMI. BMI, body mass imdex; TIA, transient ischaemic attack.

Tables

  • Figures
  • Table 1

    CHA2DS2-VASc Score

    CHA2DS2-VAScScore
    Heart failure1
    Hypertension1
    Age ≥75 years2
    Diabetes mellitus1
    Prior stroke/TIA2
    Peripheral vascular disease1
    Age 65−74 years1
    Female sex1
    • TIA, transient ischaemic attack.

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Vol 10 Issue 1 Table of Contents
Stroke and Vascular Neurology: 10 (1)
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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of the management of high-risk population
Yilong Wang, Shangrong Han, Haiqiang Qin, Huaguang Zheng, Bin Jiang, Yong Cao, Yuan Gao, Ling Guan, Qian Jia, Yong Jiang, Yuming Jiao, Shuya Li, Yapeng Li, Zixiao Li, Wei Liu, Xiaojuan Ru, Dongling Sun, Haixin Sun, Penglian Wang, Tingting Wang, Lixia Zong, Lei Guo, Xuewei Xie, Yuming Xu, Yuyuan Xu, Xiaomeng Yang, Yingying Yang, Mengyuan Zhou, Wenzhi Wang
Stroke and Vascular Neurology Aug 2020, svn-2020-000385; DOI: 10.1136/svn-2020-000385

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of the management of high-risk population
Yilong Wang, Shangrong Han, Haiqiang Qin, Huaguang Zheng, Bin Jiang, Yong Cao, Yuan Gao, Ling Guan, Qian Jia, Yong Jiang, Yuming Jiao, Shuya Li, Yapeng Li, Zixiao Li, Wei Liu, Xiaojuan Ru, Dongling Sun, Haixin Sun, Penglian Wang, Tingting Wang, Lixia Zong, Lei Guo, Xuewei Xie, Yuming Xu, Yuyuan Xu, Xiaomeng Yang, Yingying Yang, Mengyuan Zhou, Wenzhi Wang
Stroke and Vascular Neurology Aug 2020, svn-2020-000385; DOI: 10.1136/svn-2020-000385
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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of the management of high-risk population
Yilong Wang, Shangrong Han, Haiqiang Qin, Huaguang Zheng, Bin Jiang, Yong Cao, Yuan Gao, Ling Guan, Qian Jia, Yong Jiang, Yuming Jiao, Shuya Li, Yapeng Li, Zixiao Li, Wei Liu, Xiaojuan Ru, Dongling Sun, Haixin Sun, Penglian Wang, Tingting Wang, Lixia Zong, Lei Guo, Xuewei Xie, Yuming Xu, Yuyuan Xu, Xiaomeng Yang, Yingying Yang, Mengyuan Zhou, Wenzhi Wang
Stroke and Vascular Neurology Aug 2020, svn-2020-000385; DOI: 10.1136/svn-2020-000385
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    • Abstract
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    • Controlling the risk factors of stroke
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