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Acute Ischemic Stroke: Current Status and Future Challenges
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Acute Ischemic Stroke: Current Status and Future Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 31 August 2024 | Viewed by 675

Special Issue Editor

Dr. Lucio D'Anna

E-Mail Website
Guest Editor
1. Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London W6 8RF, UK
2. Department of Brain Sciences, Imperial College London, London SW7 2AZ, UK
Interests: stroke; cryptogenetic stroke; atrial fibrillation

Special Issue Information

Dear Colleagues,

Stroke is a leading cause of mortality and the primary cause of disability worldwide, with ischemic stroke accounting for approximately 70% of all cases globally. Acute stroke treatment has enjoyed two major successes over the past 30 years, both involving the early reperfusion of the ischemic brain. Both thrombolytic drug treatment and endovascular thrombectomy, after some initial stutters, hit upon successful strategies for patient selection and trial design that yielded a large treatment effect when compared with that of control groups. Recent advancements in brain imaging techniques have significantly expanded the treatment window for reperfusion therapies in carefully selected patients, resulting in improved functional outcomes in the short and long term. Despite significant advancements, several controversies persist in the field of ischemic stroke management. These controversies encompass various topics, including determining the actual effectiveness of endovascular thrombectomy in patients with large ischemic core, distal vessel occlusion, mild stroke syndromes, or high baseline disability. Additionally, the safety of intravenous thrombolysis was determined in patients with a recent ingestion of direct oral anticoagulants. Moreover, these controversies include various topics, including the determination of the optimal secondary prevention strategies. By examining the latest evidence in ischemic stroke management, this Special Issue aims to explore recent advancements, challenges, and ongoing debates throughout the entire spectrum of ischemic stroke management, including prevention strategies, diagnostic techniques, and acute treatment approaches. The studies included in this Special Issue will endeavor to contribute to the ongoing efforts for enhancing the clinical practice, improving patient outcomes, and guiding the future direction of stroke care.

This Special Issue welcomes original research articles and reviews.

Dr. Lucio D'Anna
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute ischemic stroke
  • atrial fibrillation
  • endovascular thrombectomy
  • intravenous thrombolysis
  • direct oral anticoagulants

Published Papers (1 paper)

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Research

10 pages, 391 KiB  
Article
Age and Stroke Severity Matter Most for Clinical Outcome in Acute Arteriosclerotic Tandem Lesions
by Cyrill Huber, Jatta Berberat, Renske Sassenburg, Stefanie Pflugi, Javier Anon, Michael Diepers, Lukas Andereggen, Timo Kahles, Andreas R. Luft, Krassen Nedeltchev, Luca Remonda and Philipp Gruber
J. Clin. Med. 2024, 13(8), 2315; https://doi.org/10.3390/jcm13082315 - 17 Apr 2024
Viewed by 462
Abstract
Background: Tandem lesions (TLs) cause up to 15–30% of all acute ischemic strokes (AISs). Endovascular treatment (EVT) is regarded as the first-line treatment; however, uncertainties remain with respect to the treatment and predictive outcome parameters. Here, we aimed to identify the clinical [...] Read more.
Background: Tandem lesions (TLs) cause up to 15–30% of all acute ischemic strokes (AISs). Endovascular treatment (EVT) is regarded as the first-line treatment; however, uncertainties remain with respect to the treatment and predictive outcome parameters. Here, we aimed to identify the clinical and demographic factors associated with functional short- and long-term outcomes in AIS patients with arteriosclerotic TLs undergoing EVT. Methods: This was a retrospective, mono-centric cohort study of 116 consecutive AIS patients with arteriosclerotic TLs who were endovascularly treated at a stroke center, with analysis of the relevant demographic, procedural, and imaging data. Results: A total of 116 patients were included in this study, with a median age of 72 years (IQR 63–80), 31% of whom were female (n = 36). The median NIHSS on admission was 14 (IQR 7–19), with a median ASPECT score of 9 (IQR 8–10) and median NASCET score of 99% (IQR 88–100%). A total of 52% of the patients received intravenous thrombolysis. In 77% (n = 89) of the patients, an antegrade EVT approach was used, with a good recanalization (mTICI2b3) achieved in 83% of patients (n = 96). Symptomatic intracerebral hemorrhage occurred in 12.7% (n = 15) of patients. A favorable outcome (mRS0–2) and mortality at 3 months were obtained for 40% (n = 47) and 28% of patients (n = 32), respectively. Age and NIHSS on admission were strongly associated with outcome parameters. Diabetes mellitus and previous neurological disorders were independently associated with long-term mortality (median 11 months, IQR 0–42). Conclusions: Younger age, lower stroke severity, and good recanalization were found to be independently associated with a favorable outcome. In contrast, older age, higher stroke severity, previous neurological disorders, and diabetes were correlated with mortality. The endovascular treatment of acute arteriosclerotic tandem lesions is feasible and relatively safe. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke: Current Status and Future Challenges)
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