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Targeted Therapies and Clinical Outcomes for Ischemic Stroke

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

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 4162

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Special Issue Editor

Dr. Farhan Siddiq

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Guest Editor

Division of Neurosurgery, University of Missouri, Columbia, MO 65211, USA
Interests: ischemic stroke; cerebral bleed; cerebrovascular disease; vascular stroke; neurological surgery

Special Issue Information

Dear Colleagues,

Our Special Issue on "Targeted Therapies and Clinical Outcomes for Ischemic Stroke" aims to provide a comprehensive overview of the latest advancements in targeted therapy research. The collection of articles in this Special Issue will focus on areas such as stroke pathogenesis, biomarkers for diagnosis and prognosis purposes, imaging technologies, as well as the development of new drugs and therapeutic approaches for ischemic stroke.

We are seeking original research articles, reviews, and perspectives that showcase innovative techniques and strategies related to the prevention and treatment of ischemic stroke. However, please note that we will not accept mini-reviews or case reports in this Special Issue.

Overall, this Special Issue provides an excellent opportunity for researchers, clinicians, and scholars to present their findings and share their insights on the latest developments in targeted therapy for ischemic stroke. We believe that this Special Issue will play a vital role in promoting progress in this field, and we look forward to receiving contributions from experts around the globe.

Dr. Farhan Siddiq
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

ischemic stroke
neuroprotection
thrombectomy
clinical trials
endovascular treatment
neuroimaging
rehabilitation

Published Papers (5 papers)

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Research

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12 pages, 1326 KiB

Open AccessArticle

The Risk of Venous Thromboembolism and Ischemic Stroke Stratified by VTE Risk Following Multiple Myeloma: A Korean Population-Based Cohort Study

by Hyun Jin Han, Miryoung Kim, Jiyeon Lee and Hae Sun Suh

J. Clin. Med. 2024, 13(10), 2829; https://doi.org/10.3390/jcm13102829 - 11 May 2024

Viewed by 192

Abstract

Background: Multiple myeloma (MM) is associated with high morbidity and mortality, with elevated rates of arterial thrombosis and venous thromboembolism (VTE) and ischemic stroke (IS). We aimed to estimate the incidence of VTE and IS categorized by the VTE risk grade among individuals with MM in Korea. Additionally, we explored the potential of the IMPEDE VTE score as a tool for assessing IS risk in patients with MM. Methods: This retrospective cohort study comprised 37,168 individuals aged ≥ 18 years newly diagnosed with MM between January 2008 and December 2021 using the representative claims database of the Korean population. The risk of the incidence of VTE and IS within 6 months after MM diagnosis was stratified based on high-risk (IMPEDE VTE score ≥ 8) and low-risk (<8) categories. The hazard ratios (HRs) were estimated using Cox proportional hazard models. Results: The VTE incidence was 120.4 per 1000 person-years and IS incidence was 149.3 per 1000 person-years. Statistically significant differences were observed in the cumulative incidence rates of VTE between groups with high and low VTE scores (p < 0.001) and between individuals aged ≤ 65 years (p < 0.001) and those with a Charlson comorbidity index (CCI) ≥ 3 compared to lower scores (p < 0.001). Additionally, the cumulative incidence rate of IS differed significantly across all groups (p < 0.001). The HR for the high-risk group in VTE and IS occurrence was 1.59 (95% CI, 1.26–2.00) and 3.47 (95% CI, 2.99–4.02), respectively. Conclusions: It is important to screen and manage high-risk groups for the early development of VTE or IS in patients with newly diagnosed MM. Full article

(This article belongs to the Special Issue Targeted Therapies and Clinical Outcomes for Ischemic Stroke)

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16 pages, 784 KiB

Open AccessArticle

Outcome of Pulmonary Embolism with and without Ischemic Stroke

by Karsten Keller, Volker H. Schmitt, Omar Hahad and Lukas Hobohm

J. Clin. Med. 2024, 13(10), 2730; https://doi.org/10.3390/jcm13102730 - 7 May 2024

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Abstract

Background: Ischemic stroke is the second, and pulmonary embolism (PE) is the third most common cardiovascular cause of death after myocardial infarction. Data regarding risk factors for ischemic stroke in patients with acute PE are limited. Methods: Patients were selected by screening the German nationwide in-patient sample for PE (ICD-code I26) and were stratified by ischemic stroke (ICD code I63) and compared. Results: The nationwide in-patient sample comprised 346,586 hospitalized PE patients (53.3% females) in Germany from 2011 to 2014; among these, 6704 (1.9%) patients had additionally an ischemic stroke. PE patients with ischemic stroke had a higher in-hospital mortality rate than those without (28.9% vs. 14.5%, p < 0.001). Ischemic stroke was independently associated with in-hospital death (OR 2.424, 95%CI 2.278–2.579, p < 0.001). Deep venous thrombosis and/or thrombophlebitis (DVT) combined with heart septal defect (OR 24.714 [95%CI 20.693–29.517], p < 0.001) as well as atrial fibrillation/flutter (OR 2.060 [95%CI 1.943–2.183], p < 0.001) were independent risk factors for stroke in PE patients. Systemic thrombolysis was associated with a better survival in PE patients with ischemic thrombolysis who underwent cardio-pulmonary resuscitation (CPR, OR 0.55 [95%CI 0.36–0.84], p = 0.006). Conclusions: Ischemic stroke did negatively affect the survival of PE. Combination of DVT and heart septal defect and atrial fibrillation/flutter were strong and independent risk factors for ischemic stroke in PE patients. In PE patients with ischemic stroke, who had to underwent CPR, systemic thrombolysis was associated with improved survival. Full article

(This article belongs to the Special Issue Targeted Therapies and Clinical Outcomes for Ischemic Stroke)

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18 pages, 1707 KiB

Open AccessArticle

Upper-Limb Functional Recovery in Chronic Stroke Patients after COVID-19-Interrupted Rehabilitation: An Observational Study

by Daigo Sakamoto, Toyohiro Hamaguchi, Yasuhide Nakayama, Takuya Hada and Masahiro Abo

J. Clin. Med. 2024, 13(8), 2212; https://doi.org/10.3390/jcm13082212 - 11 Apr 2024

Viewed by 498

Abstract

Background/Objectives: Upper-limb function of chronic stroke patients declined when outpatient rehabilitation was interrupted and outings restricted, owing to the novel coronavirus infection (COVID-19) pandemic. We investigated whether these patients recovered upper-limb function post-resumption of outpatient rehabilitation. Methods: In this observational study, 43 chronic stroke hemiparesis patients with impaired upper extremity function were scored for limb function via the Fugl-Meyer assessment of the upper extremity (FMA-UE) and the Action Research Arm Test (ARAT) after a structured interview, evaluation, and intervention. Scores at 6 and 3 months pre- and 3 months post-rehabilitation interruption were examined retrospectively; scores immediately and at 3 and 6 months post-resumption of care were examined prospectively. The amount of change for each time period and an analysis of covariance were performed with time as a factor, changes in the FMA-UE and the ARAT scores as dependent variables, and statistical significance at 5%. Results: The time of evaluation significantly impacted the total score, as well as part C and part D of FMA-UE and total, pinch, and gross movement of the ARAT. Post-hoc tests showed that the magnitude of change in limb-function scores from immediately to 3 months post-resumption was significantly higher than the change from 3 months pre- to immediately post-interruption for the total score and part D of the FMA-UE, as well as grip and gross movement of the ARAT (p < 0.05). Conclusions: Upper-limb functional decline in chronic stroke patients, caused by the COVID-19 pandemic-related therapy interruption and outing restrictions, was resolved approximately 3 months post-resumption of rehabilitation therapy. Our data can serve as reference standards for planning and evaluating treatment for chronic stroke patients with inactivity-related impaired upper-limb function. Full article

(This article belongs to the Special Issue Targeted Therapies and Clinical Outcomes for Ischemic Stroke)

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Graphical abstract

11 pages, 825 KiB

Open AccessArticle

Frequency, Severity, Risk Factors, and Outcome of Hemorrhagic Transformation in Anterior and Posterior Stroke

by Tanya Ayub, Awini Barwari and Josef Finsterer

J. Clin. Med. 2024, 13(7), 2010; https://doi.org/10.3390/jcm13072010 - 29 Mar 2024

Viewed by 415

Abstract

Background: There are few data on hemorrhagic transformation in posterior circulation strokes (PCS) compared to anterior circulation strokes (ACS). The aim of this study was to retrospectively analyze the incidence of hemorrhagic transformation, its different subtypes, the associations with different risk factors, and the outcome of ACS and PCS patients. Methods: A retrospective analysis of consecutive ischemic stroke patients with hemorrhagic transformation was performed. Clinical and demographic data were collected from electronic patient records. Results: Included were 186 ACS patients and 67 PCS patients. The median age was 77 years, with PCS patients being slightly younger than ACS patients. ACS patients were more likely to be treated with acetylsalicylic acid before stroke. ACS and PCS patients had comparable frequencies and severity of hemorrhagic transformation. After excluding ACS patients who received thrombectomy, PCS patients developed hemorrhagic transformation more frequently compared to ACS patients. Risk factors for hemorrhagic transformation did not differ between ACS and PCS patients and included vitamin K antagonist use before stroke and thrombectomy in ACS patients. There was no correlation between hemorrhagic transformation and stroke outcome. Conclusions: Hemorrhagic transformation occurs with similar frequency in PCS and ACS patients but is more common in PCS patients after the exclusion of ACS patients undergoing thrombectomy. Full article

(This article belongs to the Special Issue Targeted Therapies and Clinical Outcomes for Ischemic Stroke)

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Review

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25 pages, 1138 KiB

Open AccessReview

Targeted Temperature Management for Patients with Acute Ischemic Stroke: A Literature Review

by Dhanesh D. Binda, Maxwell B. Baker, Shama Varghese, Jennifer Wang, Rafael Badenes, Federico Bilotta and Ala Nozari

J. Clin. Med. 2024, 13(2), 586; https://doi.org/10.3390/jcm13020586 - 19 Jan 2024

Viewed by 2259

Abstract

Despite significant advances in medical imaging, thrombolytic therapy, and mechanical thrombectomy, acute ischemic strokes (AIS) remain a major cause of mortality and morbidity globally. Targeted temperature management (TTM) has emerged as a potential therapeutic intervention, aiming to mitigate neuronal damage and improve outcomes. This literature review examines the efficacy and challenges of TTM in the context of an AIS. A comprehensive literature search was conducted using databases such as PubMed, Cochrane, Web of Science, and Google Scholar. Studies were selected based on relevance and quality. We identified key factors influencing the effectiveness of TTM such as its timing, depth and duration, and method of application. The review also highlighted challenges associated with TTM, including increased pneumonia rates. The target temperature range was typically between 32 and 36 °C, with the duration of cooling from 24 to 72 h. Early initiation of TTM was associated with better outcomes, with optimal results observed when TTM was started within the first 6 h post-stroke. Emerging evidence indicates that TTM shows considerable potential as an adjunctive treatment for AIS when implemented promptly and with precision, thereby potentially mitigating neuronal damage and enhancing overall patient outcomes. However, its application is complex and requires the careful consideration of various factors. Full article

(This article belongs to the Special Issue Targeted Therapies and Clinical Outcomes for Ischemic Stroke)

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