Science and Technology Pilot | Create more opportunities for patients with cerebrovascular disease

Common cerebrovascular diseases are generally divided into ischemic and hemorrhagic diseases, of which ischemic cerebrovascular diseases account for 70%~80% and hemorrhagic cerebrovascular diseases account for 20%~30%. The high incidence, recurrence, disability and mortality rates of cerebrovascular diseases pose a serious threat to people's health and safety, and bring a heavy burden to patients and their families. For hundreds of years, doctors around the world have been trying to find the ultimate solution to defeat cerebrovascular disease and create more chances of survival for patients.

On April 1, the fourth session of the "Pilot" series of lectures by Beijing Medical Science and Technology Innovation Academician and Beijing Scholar was held as scheduled. The keynote speakers of this lecture are Wang Yongjun, a Beijing scholar and president of Beijing Tiantan Hospital affiliated to Capital Medical University, and Cao Yong, a Beijing scholar and deputy director of the Department of Neurosurgery of Beijing Tiantan Hospital. They are all explorers of the ultimate solution to defeat cerebrovascular disease.

Breakthrough Forbidden Zone

The "China Plan" solves the world's problems

Ischemic stroke, commonly known as cerebral infarction, has a mortality rate of 5%~15% in the acute stage, and a disability rate of 50% in surviving patients, and symptoms such as paralysis, aphasia, and blindness can occur. Wang Yongjun introduced that before the two outcomes of death and disability, there was a contributing factor - recurrence. Each recurrence will increase the disability rate of the patient and push the patient to the brink of death. Therefore, reducing the recurrence rate is the core link in the treatment of ischemic stroke, and it is also the focus of Wang Yongjun's team.

According to reports, in the 90s of the 20th century, scientists confirmed that the early use of a single antiplatelet drug aspirin can reduce the risk of stroke recurrence, but the recurrence rate in 3 months is still more than 10%. The drug clopidogrel and aspirin also have the same platelet-inhibiting effect, and the mechanism of action is different. Theoretically, the combination of "bispecific antibodies" can further reduce the risk of stroke recurrence. In order to test this theory, scientists from various countries have conducted three large-scale international clinical trials. However, the discouraging conclusion is that the combination of aspirin and clopidogrel does not reduce the risk of ischemic stroke recurrence, but instead increases the likelihood of serious bleeding, including intracerebral hemorrhage, which also makes the "bispecific antibody" treatment a no-go area in stroke research.

In order to make China's cerebrovascular disease research among the world's cerebrovascular disease research, in 2000, Wang Yongjun, who was studying abroad, returned to China to carry out a series of cohort studies in the field of stroke. In 2008, the mainland launched a major national science and technology project for the creation of new drugs, which gave Wang Yongjun an opportunity. He chose to attack the forbidden area and carried out a "study on the efficacy of clopidogrel in people at high risk of acute non-disabling cerebrovascular disease". The English abbreviation of this study is "CHANCE", which happens to translate as "opportunity" in Chinese. Wang Yongjun and his team hope to provide more chances of survival for stroke patients through research.

Wang Yongjun's team boldly innovated and used big data technology, which was still an emerging thing at that time. After 8 months of designing, calculating, and overturning, the team finally designed the protocol and model of the "opportunity" study, that is, for patients with a severity score of 3 or less, aspirin and clopidogrel should be given in combination therapy within 24 hours of onset and no more than 21 days.

In order to confirm the effectiveness and safety of the research protocol, Wang Yongjun's team carried out a large-scale clinical study across the country. A total of 5,170 patients were enrolled in 114 sub-centers across the country, half of whom were treated with traditional aspirin alone and the other half with newly developed treatment regimens. After repeated validation, it was finally proved that the "chance" study could reduce the 90-day recurrence risk of patients with cerebrovascular disease by 32% without increasing bleeding side effects. The forbidden area of "double antibodies" that has plagued the clinical and research field of cerebrovascular diseases for decades has finally been broken by the Chinese. In 2013, the New England Journal of Medicine published an article entitled "Chances."

The "China Plan" produced by the "Opportunity" study reduced the recurrence rate of ischemic cerebrovascular disease from 11% to 8.2%. In 2021, the "Opportunity 2" program reduced the recurrence rate of ischemic cerebrovascular disease from 8.2% to 6%, which can reduce the recurrence of about 114,000 people per year on the basis of "opportunity" and save about 2.28 billion yuan in hospitalization costs every year.

At present, the "Opportunity 3" study has been completed, and the protocol will bring new hope to patients with ischemic cerebrovascular disease. "For every patient, the recurrence rate is not only a number, but every percentage point reduction can be the aftermath of the life of thousands of families. Wang Yongjun said.

Accurate assessments

Look for a safe distance from surgery

Cerebrovascular malformation is the main cause of cerebral hemorrhage in adolescents, which not only brings life-threatening to patients, but also produces serious sequelae, including epilepsy, hemiplegia, aphasia and other neurological deficits. The treatment of cerebrovascular malformations is Cao Yong's main research direction.

"At present, the treatment modalities for cerebrovascular malformations include craniotomy resection, interventional embolization and stereotactic radiosurgery. Among them, surgery is the most important treatment. Cao Yong introduced.

Cao Yong introduced that Zhao Jizong, academician of the Chinese Academy of Sciences, chief physician and professor of the Neurosurgery Center of Beijing Tiantan Hospital, and Wang Shuo, chief physician and professor of neurosurgery of Beijing Tiantan Hospital, started the research on giant cerebral arteriovenous malformations around 2001, and won the second prize of the National Science and Technology Progress Award in 2005 for the topic "Surgical treatment of cerebrovascular malformations and their formation and rupture bleeding mechanism". As a result, the huge cerebrovascular malformation problem has been basically solved, and the results have been good in both comprehensive treatment and simple surgical treatment. The next step is to solve the problem of cerebrovascular malformation in the functional area.

Cao Yong introduced that the cerebral cortex was generally considered to be a functional area, but now it is more believed that conduction tracts are more important. Nowadays, compound surgery is used for patients with cerebrovascular malformations, and preoperative evaluation links are added to facilitate understanding of whether the cerebrovascular malformations and conduction tracts and functional areas are invasive or pushing.

"Some cerebrovascular malformations are compact, and the relationship between the conduction tract and the functional area is pushing, and the safety distance to protect the conduction tract during surgery should be judged, and the current distance is 5 mm. Some cerebrovascular malformations are diffuse, like gliomas, which grow into the functional area and invade the functional area or conduction tract. For such patients, surgery is the option, either by embolizing a part of the body before surgery, or by other treatments. Cao Yong said.

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Editor: Guo Lei, Yang Shijia

Review: Pan Huahong, Yan Yan