A Registry Study of Microcirculation Disorder After Cerebral Small Vessel Disease and Ischemic Stroke

A Registry Study of Microcirculation Disorder After Cerebral Small Vessel Disease and Ischemic Stroke, MODEST, Research Protocol

This study aims to construct a registry platform for microcirculatory disorders in a large sample of Chinese patients with cerebral small vessel disease and ischemic stroke; To explore the role of microcirculatory disorders in different types of cerebral small vessel disease and iachemic stroke, as well as their pathogenesis, severity, and prognosis; And to research on the drug treatment of microcirculatory disorders for cerebral small vessel disease and stroke in the real world.

Cerebral small vessel disease (CSVD) is a clinical syndrome with imaging and pathological changes, which is caused by various structural abnormality or functional dysfunction of small blood vessels including cerebral arterioles, perforating arteries, capillaries, and venules. It is also a common cause of stroke. Among people over 60 years old, the prevalence of CSVD exceeds 80%, and it is speculated that the number of CSVD patients in China exceeds 200 million, far higher than the number of stroke patients. CSVD can cause about 20% of stroke and 50% of dementia, while also doubling the risk of dementia and death, and tripling the risk of stroke. It is an important cause of death and disability in elderly people in China.

Stroke is a kind of cerebrovascular diseases characterized by sudden localized or diffuse neurological deficits caused by cerebral blood circulation disorders, and is the main clinical phenotype of cerebrovascular diseases. Stroke is characterized by high incidence rate, high disability rate, high mortality, high recurrence rate, and high economic burden. It is the first cause of death and disability in adult in China.

Microcirculatory disorders may play an important role in the pathophysiological process of ischemic CSVD. The pathological process of CSVD involves various components of the neurovascular units, including the blood-brain barrier composed of vascular endothelial cells, basement membrane, pericytes, and astrocytes, as well as oligodendrocytes, neurons, and extracellular matrix, etc.Among them, the disruption of the blood-brain barrier and endothelial damage are considered to be the initial stage of the pathological process of CSVD, causing the destruction of various secondary microcirculation structures and functions, namely the occurrence of microcirculatory disorders.

Microcirculatory disorders may also play a major role in the occurrence and development of ischemic cerebrovascular disease. By exploring multiple omics markers such as specific molecular biological markers related to ischemic cerebrovascular disease in the pathophysiological pathways of microcirculatory disorders, traditional risk factors and imaging markers can be combined to create prediction models for ineffective reperfusion of acute ischemic stroke and progression of CSVD, providing scientific evidence for improving the prognosis of acute ischemic stroke and CSVD.

Inclusion Criteria:

Study 1:

1. Age ≥ 18 years old.
2. Acute ischemic stroke within 7 days of onset.
3. Sign an informed consent form.

Study 2:

1. Age ≥ 18 years old.
2. Ischemic stroke during recovery period, within 30 days to 1 year of onset.
3. Sign an informed consent form.

Study 3:

1. Age ≥ 18 years old.

2. Within 3 years, there are characteristic lesions of cerebral small vessel disease on head MRI or CT, and they meet at least one of the following criteria:

   1. Paraventricular or deep white matter hyperintensities, Fazekas total score ≥ 2;
   2. Paraventricular or deep white matter hyperintensities, Fazekas total score=1, and at least two vascular risk factors (hypertension, hyperlipidemia, diabetes, current smoking, obesity, history of coronary heart disease, history of stroke).
   3. Paraventricular or deep white matter hyperintensities, Fazekas total score=1, with ≥ 1 lacune.
   4. New recent subcortical small infarcts.

3. Sign an informed consent form.

Exclusion Criteria:

Study 1:

1. Cerebral hemorrhage and subarachnoid hemorrhage within 3 months of onset.
2. There are untreated cerebral vascular malformations or untreated aneurysms (diameter>3mm).
3. Confirmed neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, Parkinson's syndrome, etc.
4. A mental illness diagnosed according to the DSM-V diagnostic criteria.
5. There are clear diagnoses of non-vascular white matter lesions, such as multiple sclerosis, adult white matter dysplasia, metabolic encephalopathy, etc.
6. Unable to cooperate in completing follow-up visits due to geographical or other reasons.
7. The patient also participated in other clinical trials.

Study 2:

1. Cerebral hemorrhage and subarachnoid hemorrhage within 3 months of onset.
2. There are untreated cerebral vascular malformations or untreated aneurysms (diameter>3mm).
3. Confirmed neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, Parkinson's syndrome, etc.
4. A mental illness diagnosed according to the DSM-V diagnostic criteria.
5. There are clear diagnoses of non-vascular white matter lesions, such as multiple sclerosis, adult white matter dysplasia, metabolic encephalopathy, etc.
6. Unable to cooperate in completing follow-up visits due to geographical or other reasons.
7. The patient also participated in other clinical trials.

Study 3:

1. Cerebral hemorrhage and subarachnoid hemorrhage within 3 months of onset.
2. There are untreated cerebral vascular malformations or untreated aneurysms (diameter>3mm).
3. Confirmed neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, Parkinson's syndrome, etc.
4. A mental illness diagnosed according to the DSM-V diagnostic criteria.
5. There are clear diagnoses of non-vascular white matter lesions, such as multiple sclerosis, adult white matter dysplasia, metabolic encephalopathy, etc.
6. Unable to cooperate in completing follow-up visits due to geographical or other reasons.
7. The patient also participated in other clinical trials.