Updates on Stroke: Diagnosis and Management

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 30 November 2025 | Viewed by 3867

Special Issue Editor


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Guest Editor
Department of Diagnostic Imaging and Interventional Radiology, Azienda Ospedale Università di Padova, University of Padua, 35128 Padua, Italy
Interests: neurovascular diseases; stroke; thrombectomy; neuroradiology

Special Issue Information

Dear Colleagues,

Ischemic stroke is one of the leading causes of death and disability in the world, accounting for about 60 million disability-adjusted life years (DALYs) and 3 million deaths each year. These statistics underscore the profound impact this condition has on our society.

Knowledge regarding diagnosis and therapy is constantly evolving, allowing us to intervene in more cases and thus combat the aforementioned statistics.

However, not all ischemic strokes are the same, both pathophysiologically and prognostically speaking; in this context, we aim to compile a comprehensive resource to aid neuroradiologists in navigating the latest developments in this field, thus treating topics of great interest such as the following:

  • Neurovascular anatomy in relation to imaging findings and clinical presentation in ischemic stroke.
  • Thrombolysis before mechanical thrombectomy within the time window: is it always a good idea?
  • Tandem lesions.
  • Thrombectomy of posterior circulation stroke.
  • Reshaping the ASPECT score over the years: qualitative beyond quantitative.
  • Management of atheromatous disease of large intracranial vessels in acute settings.
  • Carotid web and stroke: is preventive treatment an option?
  • Machine learning support in ischemic stroke: where are we?

Dr. Joseph Domenico Gabrieli
Guest Editor

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Keywords

  • ischemic stroke
  • atheromatous disease
  • thrombolysis
  • machine learning
  • neurovascular anatomy
  • imaging
  • thrombectomy
  • diagnosis and management
  • prognosis

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Published Papers (2 papers)

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Research

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13 pages, 730 KiB  
Article
Predictive Value of Clinical and Dual-Energy Computed Tomography Parameters for Hemorrhagic Transformation and Long-Term Outcomes Following Endovascular Thrombectomy
by Shiu-Yuan Huang, Nien-Chen Liao, Jin-An Huang, Wen-Hsien Chen and Hung-Chieh Chen
Diagnostics 2024, 14(22), 2598; https://doi.org/10.3390/diagnostics14222598 - 19 Nov 2024
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Abstract
Objective: This study’s objective was to explore whether certain parameters measurable by dual-energy computed tomography (DECT) performed 24 h after endovascular thrombectomy (EVT) can predict subsequent hemorrhagic transformation. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke (AIS) managed with EVT [...] Read more.
Objective: This study’s objective was to explore whether certain parameters measurable by dual-energy computed tomography (DECT) performed 24 h after endovascular thrombectomy (EVT) can predict subsequent hemorrhagic transformation. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke (AIS) managed with EVT who had follow-up DECT within 24 h post-EVT between January 2019 and December 2023. Clinical and image parameters were recorded for predictive factor analysis. The primary outcome was hemorrhagic transformation, which was determined by using follow-up computed tomography (CT) or magnetic resonance imaging (MRI). The secondary outcomes were in-hospital mortality and 3-month post-EVT favorable functional outcome, as defined by a modified ranking scale (mRS) score of ≤2. Results: A total of 152 patients were included in this study. Multivariable analysis showed that the VNC-ASPECT score (p = 0.002) and superior sagittal sinus density (p = 0.01) were significantly associated with hemorrhagic transformation. For in-hospital survival rate analysis, post-EVT NIHSS measured 24 h post-EVT was an effective predictor, with a cutoff value of 23 (≤23: 88% vs. >23: 52.1%; p < 0.001). For functional outcome analysis, age (p < 0.001), tPA prior to EVT (p = 0.017), NIHSS 24 h post-EVT (p = 0.001), and VNC-ASPECT score (p < 0.003) were associated with a favorable functional outcome 3 months after EVT. Conclusions: The VNC-ASPECT score was associated with both hemorrhagic transformation and a 3-month post-EVT favorable functional outcome, and could therefore be an useful predictor for the development of hemorrhagic transformation. Full article
(This article belongs to the Special Issue Updates on Stroke: Diagnosis and Management)
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Review

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13 pages, 724 KiB  
Review
Anesthetic Management of Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: An Overview
by Alessandro De Cassai, Nicolò Sella, Tommaso Pettenuzzo, Annalisa Boscolo, Veronica Busetto, Burhan Dost, Serkan Tulgar, Giacomo Cester, Nicola Scotti, Alessandro di Paola, Paolo Navalesi and Marina Munari
Diagnostics 2024, 14(19), 2113; https://doi.org/10.3390/diagnostics14192113 - 24 Sep 2024
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Abstract
Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review [...] Read more.
Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents—such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine—depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period. Full article
(This article belongs to the Special Issue Updates on Stroke: Diagnosis and Management)
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