缺血性脑卒中是中国致死致残的首要病因之一，其防控体系的建设已成为国家重大公共卫生议题。本文以“疾病负担分析—临床干预优化—风险预测指标评价”为逻辑主线，整合流行病学调查、临床疗效评估及新型生物标志物检测等多维度证据，构建了一个全链条的脑卒中防控策略。研究依托全球疾病负担（Global Burden of Disease, GBD）数据库、本院既往住院病例数据库以及美国国家健康与营养调查数据库，通过大数据分析、回顾性队列研究等方法，深入探讨了缺血性脑卒中在中国的疾病负担演变、关键干预路径及风险评估体系。
本论文主要分为三部分：第一部分基于 GBD 2021 数据，绘制了中国缺血性脑卒中的疾病负担图谱。研究显示，目前中国人群卒中的疾病负担显著高于全球平均水平，且呈现由老龄化主导转向流行病学变化主导的趋势，为后续研究提供了重要背景；第二部分探讨了缺血性脑卒中的二级预防策略。针对颈动脉合并椎动脉狭窄这一高危因素，本文首次比较了同期同侧行外科手术或腔内介入血运重建的临床结局。随访结果表明，两组患者术后 30 天内未发生死亡或卒中事件，且操作相关并发症的差异无统计学意义。术后 6 个月内，所有管腔狭窄且伴有临床症状的患者均实现了 100%的症状缓解，且随访期间未出现动脉再狭窄。该研究为弓上动脉联合狭窄患者提供了有价值的临床治疗策略；第三部分基于既往研究指出，主动脉钙化与脑卒中之间存在独立性关联，进一步评估了肝纤维化指数在腹主动脉钙化风险预测中的应用价值。通过构建多因素回归模型分析，结果表明：在一般人群中，肝纤维化指数与腹主动脉钙化的严重程度未呈现显著的统计学关联。
本论文的创新价值在于：通过构建“疾病负担—治疗路径—风险预警”三级防控体系，实现了群体预防与个体化干预的有机衔接。研究结果为优化医疗资源配置、制定手术策略，以及评估肝纤维化指数在一般人群中预测效力提供了循证依据，对完善中国缺血性脑卒中防治网络具有实践意义。

The Comprehensive Prevention and Control Strategy for Ischemic Stroke: Disease Burden Analysis, Clinical Intervention Optimization, and Risk Prediction Evaluation Ischemic stroke is one of the leading causes of death and disability in China, and the construction of its prevention and control system has become a major public health issue at the national level. This paper follows the logical framework of "disease burden analysis – clinical intervention optimization – risk prediction indicator evaluation," integrating multidimensional evidence from epidemiological surveys, clinical efficacy assessments, and novel biomarker testing to establish a comprehensive stroke prevention and control strategy. The study utilizes data from the Global Burden of Disease (GBD) database, our hospital's historical inpatient case database, and the National Health and Nutrition Examination Survey (NHANES) database from the United States, employing big data analysis, retrospective cohort studies, and other methods to explore in-depth the evolution of ischemic stroke disease burden, key intervention pathways, and risk assessment systems in China. This dissertation is divided into three main parts: The first part uses GBD 2021 data to map the disease burden of ischemic stroke in China. The findings show that the disease burden of stroke in the Chinese population remains significantly higher than the global average and is shifting from being primarily driven by aging to being driven by epidemiological changes. This provides a critical background for subsequent research. The second part explores secondary prevention strategies for ischemic stroke. Focusing on the high-risk factor of carotid artery combined with vertebral artery stenosis, this study is the first to compare the clinical outcomes of concurrent external carotid surgery or endovascular intervention for revascularization on the same side. Follow-up results indicate that no deaths or strokes occurred within 30 days post-operation for both groups, and the differences in procedure-related complications were not statistically significant. Six months post-operation, 100% of patients with symptomatic stenosis experienced symptom relief, and no arterial restenosis occurred during follow-up. This study provides valuable clinical treatment strategies for patients with combined stenosis of the supra-aortic arch branches. The third part builds on previous research that indicates an independent association between aortic calcification and stroke, further evaluating the predictive value of the liver fibrosis index in the risk assessment of abdominal aortic calcification. Multivariate regression analysis reveals that, in the general population, there is no significant statistical association between the liver fibrosis index and the severity of abdominal aortic calcification. The innovation of this dissertation lies in its establishment of a three-tiered prevention and control system, “disease burden – treatment pathway – risk warning,” which effectively bridges population-level prevention with individualized intervention. The results provide evidence-based support for optimizing healthcare resource allocation, developing surgical strategies, and assessing the predictive value of the liver fibrosis index in the general population, contributing to the improvement of China’s ischemic stroke prevention and treatment network. The Comprehensive Prevention and Control Strategy for Ischemic Stroke in China: Advancements in Carotid Stenosis Management and Exosome-Based Therapies for Ischemic Stroke and Myocardial Ischemia-Reperfusion Injury First Part: This section discusses the perioperative brain protection strategies for carotid endarterectomy. Ischemic cerebrovascular disease accounts for more than 75% of the spectrum of cerebrovascular diseases, with carotid stenosis being a major risk factor that plays a key role in the pathogenesis of ischemic stroke. Approximately 60% of ischemic stroke events can be attributed to carotid stenosis. Particularly for patients with severe carotid stenosis (≥70% stenosis) or those with vulnerable plaques, the risk of stroke is significantly increased. Carotid endarterectomy, as a classic vascular surgery technique, has been established as the standardized treatment for secondary prevention of ischemic stroke in patients with carotid stenosis, supported by evidence from clinical studies. In perioperative management, through scientific assessment and the appropriate application of shunting techniques, precise perioperative blood pressure control, goal-directed fluid therapy, standardized drug use, and enhanced smoking cessation interventions, the risk of brain hyperperfusion syndrome can be effectively reduced, while also decreasing postoperative mortality and stroke incidence, thereby maximizing therapeutic outcomes. Second Part: This section describes the therapeutic mechanisms of mesenchymal stem cell-derived exosomes based on their protein components in ischemia-reperfusion injury. In the field of myocardial ischemia-reperfusion injury, significant progress has been made in the proteomic study of exosomes, providing new research directions and theoretical foundations for exploring treatments for ischemic stroke-related reperfusion injury. The protein components in exosomes protect heart function and alleviate ischemia-reperfusion injury by regulating pathways such as energy depletion, oxidative stress imbalance, and the accumulation of misfolded proteins. Myocardial ischemia-reperfusion injury shares significant pathophysiological similarities with ischemic stroke, as both involve critical processes such as oxidative stress, inflammatory responses, and apoptosis. Therefore, the exosome-based therapeutic research in myocardial ischemia-reperfusion injury not only holds significant reference value but also demonstrates potential for clinical translation.