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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 36449

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Dr. Claudia Altamura

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Department of Clinical Neurology, Campus Bio-Medico University, 00128 Rome, Italy
Interests: prevention and treatment of cerebrovascular diseases; neurosonology; headaches
Special Issues, Collections and Topics in MDPI journals

Dr. Riccardo Altavilla

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Stroke Unit and Neurology division, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, via di Rudinì 8, 20142 Milan, Italy
Interests: prevention and acute treatment of cerebrovascular diseases; neurosonology

Dr. Paola Maggio

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UOC Neurologia Asst Bergamo Est Via Paderno 21, 24068 Seriate BG, Italy
Interests: neurosonology; cerebral blood flow; carotid diseases

Dr. Paola Palazzo

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Department of Neurology, Poitiers University Hospital and University of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
Interests: prevention and acute treatment of cerebrovascular diseases; neurosonology

Special Issue Information

Dear Colleagues,

Over the last decades, the world’s population has been growing older, with an increased prevalence of age-related diseases. Cerebrovascular diseases are the main cause of chronic disability worldwide and are associated with high mortality. Although reperfusion therapies are increasingly available for acute ischemic stroke, most patients even today are not eligible. Besides, the treatment of acute intracerebral hemorrhage remains challenging. In this light, preventive strategies represent a milestone in counteracting the cognitive, physical, and emotional impact of cerebrovascular diseases. The aim of this Special Issue “Prevention and Treatment of Cerebrovascular Diseases” is to offer a novel updated view on strategies for the primary and secondary prevention and treatment of cerebrovascular diseases, with a particular focus on strategies applicable in large populations. Studies evaluating risk conditions in the young will also be welcome. We would like different types of manuscript submissions, including original preclinical and clinical research articles and up-to-date reviews (narrative and systematic reviews, as well as meta-analyses).

Dr. Claudia Altamura
Dr. Riccardo Altavilla
Dr. Paola Maggio
Dr. Paola Palazzo
Guest Editors

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Keywords

Stroke
Cerebrovascular diseases
Vascular dementia
Vascular risk factors
Prevention
Treatment
Rehabilitation

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Published Papers (10 papers)

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Research

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10 pages, 611 KiB

Open AccessArticle

Cerebral Hemodynamics, Right-to-Left Shunt and White Matter Hyperintensities in Patients with Migraine with Aura, Young Stroke Patients and Controls

by Nicoletta Brunelli, Claudia Altamura, Carlo A. Mallio, Gianguido Lo Vullo, Marilena Marcosano, Marcel Bach-Pages, Bruno Beomonte Zobel, Carlo Cosimo Quattrocchi and Fabrizio Vernieri

Int. J. Environ. Res. Public Health 2022, 19(14), 8575; https://doi.org/10.3390/ijerph19148575 - 14 Jul 2022

Cited by 7 | Viewed by 2337

Abstract

Background: Migraine with aura (MA) patients present an increased risk of cerebrovascular events. However, whether these patients present an increased white matter hyperintensities (WMHs) load compared to the general population is still under debate. Our study aimed to evaluate the relationship between cerebral hemodynamics, right-to-left shunt (RLS) and WMHs in MA patients, young patients with cryptogenic stroke or motor transient ischemic attack (TIA) and controls. Methods: We enrolled 30 MA patients, 20 young (<60 years) patients with cryptogenic stroke/motor TIA, and 10 controls. All the subjects underwent a transcranial Doppler bubble test to detect RLS and cerebral hemodynamics assessed by the breath holding index (BHI) for the middle (MCA) and posterior (PCA) cerebral arteries. Vascular risk factors were collected. The WMHs load on FLAIR MRI sequences was quantitatively assessed. Results: The stroke/TIA patients presented a higher prevalence of RLS (100%) compared with the other groups (p < 0.001). The MA patients presented a higher BHI compared with the other groups in the PCA (p = 0.010) and higher RLS prevalence (60%) than controls (30%) (p < 0.001). The WMHs load did not differ across groups. BHI and RLS were not correlated to the WMHs load in the groups. Conclusions: A preserved or more reactive cerebral hemodynamics and the presence of a RLS are likely not involved in the genesis of WMHs in MA patients. A higher BHI may counteract the risk related to their higher prevalence of RLS. These results need to be confirmed by further studies to be able to effectively identify the protective role of cerebral hemodynamics in the increased RLS frequency in MA patients. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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9 pages, 339 KiB

Open AccessArticle

Effect of the COVID-19 Pandemic in the Prehospital Management of Patients with Suspected Acute Stroke: A Retrospective Cohort Study

by Natasza Blek, Lukasz Szarpak and Jerzy Robert Ladny

Int. J. Environ. Res. Public Health 2022, 19(8), 4769; https://doi.org/10.3390/ijerph19084769 - 14 Apr 2022

Cited by 8 | Viewed by 2232

Abstract

Acute Ischemic Stroke (AIS) can be successfully handled if it is noticed early in the prehospital setting and immediately diagnosed in the emergency department (ED). The coronavirus pandemic has altered the way health care is delivered and has had a profound impact on healthcare delivery. The effects could include prioritizing the prevention of COVID-19 spread, which could result in the discontinuation or deferral of non-COVID-19 care. We used the National Emergency Medical Service Command Support System, a register of medical interventions performed by emergency medical services (EMS) in Poland, to assess the impact of the COVID-19 epidemic across the Masovian Voivodeship on suspected stroke patients’ baseline characteristics, prehospital vital parameters, clinical and neurological status, emergency procedures performed on the prehospital phase and EMS processing times. Between 1 April 2019 and 30 April 2021, the study population included 18,922 adult suspected stroke patients who were treated by EMS teams, with 18,641 admitted to the emergency departments. The overall number of suspected stroke patients treated by EMS remained unchanged during COVID-19 compared to the pre-COVID-19 period; however, the average time from call to hospital admission increased by 15 min. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

8 pages, 811 KiB

Open AccessArticle

Carotid Artery Plaque Progression: Proposal of a New Predictive Score and Role of Carotid Intima-Media Thickness

by Nicoletta Brunelli, Claudia Altamura, Carmelina Maria Costa, Riccardo Altavilla, Paola Palazzo, Paola Maggio, Marilena Marcosano and Fabrizio Vernieri

Int. J. Environ. Res. Public Health 2022, 19(2), 758; https://doi.org/10.3390/ijerph19020758 - 11 Jan 2022

Cited by 12 | Viewed by 2509

Abstract

Background: We aimed to investigate if the carotid intima-media thickness (IMT) at baseline and the HAD₂S score, composed of the sum of single risk factors (hypertension, age ≥ 75 years, diabetes, dyslipidemia, smoking), were predictive of plaque progression. Methods: We performed a retrospective analysis on real-life prospectively collected data from patients with any detectable carotid plaque at follow up. The plaque score, calculated at baseline (T0) and at a median follow up of 36.6 months (IQR 39.6–34.3) (T3), was defined as 0: no plaque or stenosis < 30%; 1: stenosis in the range 30–49%; 2: in the range 50–69%; 3: in the range 70–99% and 4: occlusion. Carotid IMT was measured at T0 and T3; HAD₂S score was calculated at baseline. Results: We included 340 patients with a mean age of 69.9 (9.1) years and 25.3% subjects had plaque progression. Individuals with progression had a median HAD₂S score of 3 (1) while those without progression had 2 (1). Patients with progression had a mean baseline IMT of 0.86 (0.17) while those without progression had 0.77 (0.18) (p < 0.0001). A correlation between progression and baseline IMT was found (p = 0.002). Conclusion: Baseline IMT could be considered a predictor of progression. Patients with progression had an HAD₂S score higher than those without evolution. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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16 pages, 1371 KiB

Open AccessArticle

Risk Factors for the Recurrence of CVD Incidents in Post-Stroke Patients over a 5-Year Follow-Up Period Based on the ICF Classification

by Mateusz Lucki, Ewa Chlebuś, Agnieszka Wareńczak and Przemysław Lisiński

Int. J. Environ. Res. Public Health 2021, 18(11), 6021; https://doi.org/10.3390/ijerph18116021 - 3 Jun 2021

Cited by 2 | Viewed by 3205

Abstract

Background and Objectives: Stroke is a strong risk factor for recurrent cardiovascular disease (CVD) incidents. The risk of post-stroke CVD incidents can be reduced by eliminating the most relevant risk factors. The aim of the study was to compare the incidence of recurrent CVD events and to determine the quantitative and qualitative differences in CVD risk factors over the 5-year follow-up period in patients with ischemic stroke (IS) and haemorrhagic stroke (ICH) with the use of ICF classification categories to present these differences. Materials and Methods: The study was retrospective. The study groups included 55 post-IS patients and 47 post-ICH patients. The results were translated into the categories from the International Classification of Functioning, Disability and Health (ICF) classification. Results: As compared to post-ICH patients, post-IS patients were significantly more frequently observed to have recurrent CVD incidents (p < 0.001), including fatal CVD incidents (p = 0.003). More risk factors in total were identified in both post-IS patients (p = 0.031) and post-ICH patients (p = 0.002) who had a recurrent CVD incident. Post-IS patients were more often found to have arterial blood pressure higher than 140/90 mmHg (p = 0.045). On the other hand, post-ICH patients were more frequently observed to have carotid artery stenosis in the range of 50–69% (p = 0.028) and an eGFR of <15 mL/min/1.73 m² (p = 0.001). Conclusions: The type of primary stroke determines the type and incidence of risk factors as well as the recurrence rate of CVD incidents over a 5-year follow-up period. Patients after IS have a higher risk of recurrence of CVD events, including fatal ones in the 5-year follow-up compared to patients after ICH. In addition, post-IS patients who have a recurrent CVD event over a 5-year follow-up have more risk factors for a CVD event than ICH. The ICF classification can be useful for assessing and analysing risk factors for recurrent CVD incidents, which can help to improve the effectiveness of secondary prevention. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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13 pages, 444 KiB

Open AccessFeature PaperArticle

Effects of Animal-Assisted Therapy on Gait Performance, Respiratory Function, and Psychological Variables in Patients Post-Stroke

by Ho-Jung An and Shin-Jun Park

Int. J. Environ. Res. Public Health 2021, 18(11), 5818; https://doi.org/10.3390/ijerph18115818 - 28 May 2021

Cited by 9 | Viewed by 4927

Abstract

Background: Animal-assisted therapy using dogs is being administered to patients post-stroke for the purpose of recovering psychological and physical activity. Objective: This study was conducted to confirm the effect of animal-assisted therapy using dogs on gait performance, pulmonary function, and psychological variables in patients post-stroke. All outcomes were analyzed using two-way repeated-measure analysis. Methods: In total, 30 post-stroke patients were divided into an experimental group (gait training by animal-assisted activity, n = 15) and a control group (gait training, n = 15). Gait performance (cadence, gait speed, stride length, symmetric index), respiratory pulmonary function (forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP)), and psychological variables (rehabilitation motivation and depression assessment) were measured before and after eight weeks of intervention. Results: Gait performance, respiratory pulmonary function, and psychological variables significantly increased in the experimental group compared to the control group. Conclusion: Based on this study, it was found that animal-assisted therapy using dogs is an effective intervention for recovery of psychological and physical activity in patients post-stroke. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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15 pages, 2935 KiB

Open AccessArticle

Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach

by Neil Heron, Seán R. O’Connor, Frank Kee, David R. Thompson, Neil Anderson, David Cutting, Margaret E. Cupples and Michael Donnelly

Int. J. Environ. Res. Public Health 2021, 18(9), 4861; https://doi.org/10.3390/ijerph18094861 - 2 May 2021

Cited by 7 | Viewed by 4684

Abstract

This paper describes the development of the ‘Brain-Fit’ app, a digital secondary prevention intervention designed for use in the early phase after transient ischaemic attack (TIA) or minor stroke. The aim of the study was to explore perceptions on usability and relevance of the app in order to maximise user engagement and sustainability. Using the theory- and evidence-informed person-based approach, initial planning included a scoping review of qualitative evidence to identify barriers and facilitators to use of digital interventions in people with cardiovascular conditions and two focus groups exploring experiences and support needs of people (N = 32) with a history of TIA or minor stroke. The scoping review and focus group data were analysed thematically and findings were used to produce guiding principles, a behavioural analysis and explanatory logic model for the intervention. Optimisation included an additional focus group (N = 12) and individual think-aloud interviews (N = 8) to explore perspectives on content and usability of a prototype app. Overall, thematic analysis highlighted uncertainty about increasing physical activity and concerns that fatigue might limit participation. Realistic goals and progressive increases in activity were seen as important to improving self-confidence and personal control. The app was seen as a useful and flexible resource. Participant feedback from the optimisation phase was used to make modifications to the app to maximise engagement, including simplification of the goal setting and daily data entry sections. Further studies are required to examine efficacy and cost-effectiveness of this novel digital intervention. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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8 pages, 1132 KiB

Open AccessArticle

Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke

by Enrico Pampana, Sebastiano Fabiano, Gianluca De Rubeis, Luca Bertaccini, Alessandro Stasolla, Alberto Pingi, Valeria Cozzolino, Marilena Mangiardi, Sabrina Anticoli, Claudio Gasperini and Enrico Cotroneo

Int. J. Environ. Res. Public Health 2021, 18(5), 2670; https://doi.org/10.3390/ijerph18052670 - 6 Mar 2021

Cited by 10 | Viewed by 3726

Abstract

Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03–1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7); p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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11 pages, 1280 KiB

Open AccessArticle

Changes in Prehospital Stroke Care and Stroke Mimic Patterns during the COVID-19 Lockdown

by Kazimieras Melaika, Lukas Sveikata, Adam Wiśniewski, Altynshash Jaxybayeva, Aleksandra Ekkert, Dalius Jatužis and Rytis Masiliūnas

Int. J. Environ. Res. Public Health 2021, 18(4), 2150; https://doi.org/10.3390/ijerph18042150 - 23 Feb 2021

Cited by 15 | Viewed by 6176

Abstract

The impact of COVID-19 lockdown on prehospital stroke care is largely unknown. We aimed to compare stroke care patterns before and during a state-wide lockdown. Thus, we analysed prospective data of stroke alerts referred to our stroke centre between 1 December 2019 and 16 June 2020, and compared them between two periods—15 weeks before and 13 weeks during the state-wide lockdown declared in Lithuania on 16 March 2020. Among 719 referrals for suspected stroke, there was a decrease in stroke alerts (rate ratio 0.61, 95% CI (0.52–0.71)), stroke admissions (0.63, 95% CI (0.52–0.76)), and decrease in prehospital stroke triage quality (positive predictive value 72.1% vs. 79.9%, p = 0.042) during the lockdown. The onset-to-door time was longer (153.0 vs. 120.5 min, p = 0.049) and seizures and intracranial tumours were more common among stroke mimics (16.9% vs. 6.7%, p = 0.012 and 9.6% vs. 3.0%, p = 0.037, respectively). We conclude that there was a decline in prehospital stroke triage quality during the lockdown despite low COVID-19 incidence in the country. Moreover, we observed an increase in hospital arrival delays and severe conditions presenting as stroke mimics. Our findings suggest that improved strategies are required to maintain optimal neurological care during public health emergencies. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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Review

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12 pages, 335 KiB

Open AccessReview

The Impact of the Pandemic on Acute Ischaemic Stroke Endovascular Treatment from a Multidisciplinary Perspective: A Nonsystematic Review

by Milda Grigonyte, Agne Kraujelyte, Elija Januskeviciute, Giedrius Semys, Oresta Kriukelyte, Egle Kontrimaviciute, Nomeda Rima Valeviciene and Dalius Jatuzis

Int. J. Environ. Res. Public Health 2021, 18(18), 9464; https://doi.org/10.3390/ijerph18189464 - 8 Sep 2021

Cited by 2 | Viewed by 2418

Abstract

Background: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic. Methods: A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis. Results: The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied. Conclusions: Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

11 pages, 2195 KiB

Open AccessReview

Multifactorial Predictors of Late Epileptic Seizures Related to Stroke: Evaluation of the Current Possibilities of Stratification Based on Existing Prognostic Models—A Comprehensive Review

by Adam Wiśniewski and Dalius Jatužis

Int. J. Environ. Res. Public Health 2021, 18(3), 1079; https://doi.org/10.3390/ijerph18031079 - 26 Jan 2021

Cited by 3 | Viewed by 2744

Abstract

Background: Epilepsy associated with strokes is a significant clinical and public health problem and has a negative impact on prognosis and clinical outcome. A late epileptic seizure occurring seven days after stroke is actually equated with poststroke epilepsy due to the high risk of recurrence. Predictive models evaluated in the acute phase of stroke would allow for the stratification and early selection of patients at higher risk of developing late seizures. Methods: The most relevant papers in this field were reviewed to establish multifactorial predictors of late seizures and attempt to standardize and unify them into a common prognostic model. Results: Clinical and radiological factors have become the most valuable and reproducible predictors in many reports, while data on electroencephalographic, genetic, and blood biomarkers were limited. The existing prognostic models, CAVE and SeLECT, based on relevant, readily available, and routinely assessed predictors, should be validated and improved in multicenter studies for widespread use in stroke units. Conclusions: Due to contradictory reports, a common and reliable model covering all factors is currently not available. Further research might refine forecasting models by incorporating advanced radiological neuroimaging or quantitative electroencephalographic analysis. Full article

(This article belongs to the Special Issue Prevention and Treatment of Cerebrovascular Diseases)

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