Controversies in Stroke and Cerebrovascular Disease

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Stroke and Cerebrovascular Disease".

Deadline for manuscript submissions: 31 August 2026 | Viewed by 1021

Special Issue Editor


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Guest Editor
Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
Interests: vascular surgery; aortic aneurysms; stroke; carotid disease; peripheral vascular disease; fluid mechanics; vascular ultrasound; artificial intelligence

Special Issue Information

Dear Colleagues,

Stroke and cerebrovascular disease are among the leading causes of death and disability worldwide. Significant funding, time, and effort have been devoted to its management to limit its devastating effects. Even as studies have resolved some of the conflicts in the diagnosis and management of patients affected by this devastating disease, new technologies have been created, giving rise to new controversies, while old discrepancies have been rekindled with new data. This issue is devoted to addressing review articles about current research on some of these controversies.

Some of the current controversies in stroke and cerebrovascular disease include the following:

  1. What is the best treatment for the prevention of large vessel ischemic stroke: medical management, carotid endarterectomy, transcervical carotid stenting, or transfemoral carotid stenting?
  2. What is the best anticoagulant therapy for embolic stroke?
  3. How effective are the new implantable devices for preventing cardioembolic stroke?
  4. What are the benefits of electrophysiologic treatments, surgery, and medications for the prevention of embolic stroke?
  5. Is the neurointerventional management of cerebral emboli always better than lytic therapy for the treatment of acute stroke?
  6. What are effective cerebral protective managements for brain preservation following cardiac arrest, stroke, and head trauma?
  7. Are there any treatment methods effective for cryptogenic stroke?
  8. Does perfusion imaging extend the time limit for the treatment of stroke?
  9. When should asymptomatic carotid disease be treated?
  10. What is the best blood pressure management regimen for stroke?
  11. Which medications may reduce the risk of recurrent stroke?
  12. What are the most effective monitoring techniques to use during stroke treatment?

We welcome articles that enlighten our readers about the best management strategies for the prevention and treatment of one of life’s most devastating maladies. Helpful articles for our readers would include both current studies and reviews of recent developments in these areas of controversy.

Prof. Dr. Alan P. Sawchuk
Guest Editor

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Keywords

  • stroke treatment
  • prevention of large vessel ischemic stroke
  • anticoagulant therapy for embolic stroke
  • cryptogenic stroke
  • neurointerventional management
  • lytic therapy
  • blood pressure management

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Published Papers (1 paper)

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Review

21 pages, 577 KB  
Review
Between a Rock and a Hard Place: Balancing Embolic Stroke and Intracerebral Hemorrhage Risk in Left Atrial Appendage Occlusion
by Juan Felipe Daza-Ovalle, Johanna Seiden, Daniel Labovitz, Erick Daniel Martinez, Deepti Athreya and Charles Esenwa
J. Cardiovasc. Dev. Dis. 2026, 13(3), 148; https://doi.org/10.3390/jcdd13030148 - 23 Mar 2026
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Abstract
Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral [...] Read more.
Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral amyloid angiopathy (CAA), or neuroimaging markers of cerebral small vessel disease (SVD). Left atrial appendage occlusion (LAAO) has emerged as an alternative stroke prevention strategy for patients with contraindications to anticoagulation; however, optimal patient selection and post-procedural antithrombotic management remain uncertain, largely because existing bleeding risk scores inadequately capture ICH risk. Most hemorrhagic risk scores were designed to estimate systemic bleeding and demonstrate limited ability to predict ICH, as they do not incorporate hemorrhage etiology or neuroimaging features. Importantly, ICH recurrence risk varies substantially by subtype, with the highest risk observed in CAA-related hemorrhage, the lowest in hypertensive SVD, and intermediate risk in mixed or secondary etiologies. These distinctions have direct implications for anticoagulation decisions and consideration of LAAO. Finally, we synthesize contemporary evidence on ICH risk stratification, neuroimaging biomarkers, and antithrombotic strategies following LAAO. We propose a multidisciplinary, evidence-based decision-making framework integrating clinical risk scores, neuroimaging findings, and hemorrhage phenotype to support individualized stroke prevention strategies in high-risk patients with AF. Full article
(This article belongs to the Special Issue Controversies in Stroke and Cerebrovascular Disease)
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