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Neurovascular Diseases: Clinical Advances and Challenges

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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: 25 November 2025 | Viewed by 8587

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Special Issue Editors

Dr. Roberto Colasanti

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Guest Editor

Department of Neuroscience, Division of Neurosurgery, AUSL Romagna, Maurizio Bufalini Hospital, Viale Ghirotti, 286, 47521 Cesena (FC), Italy
Interests: neurosurgery; neuro-oncology; skull base; cerebrovascular surgery; neuroanatomy; neurotrauma; spine surgery; neuro-imaging
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Dr. Silky Chotai

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Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
Interests: neuro-oncology; skull base surgery; neurosurgery; cerebrovascular surgery; neuro-imaging; neuroanatomy

Dr. Alessandro Di Rienzo

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Department of Neurosurgery, Università Politecnica delle Marche, 60121 Ancona, Italy
Interests: neurovascular surgery; spine oncology; neuro-oncology; skull base surgery; cerebrovascular surgery

Dr. Joham Choque-Velasquez

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Guest Editor

School of Medicine, Universidad Andina del Cusco, Cusco, Peru
Interests: neurovascular diseases; neuro-oncology; skull base surgery; neurosurgery; neuro-imaging

Special Issue Information

Dear Colleagues,

Neurovascular diseases remain one of the leading causes of global morbidity and mortality, thus representing a major public health threat.

In recent decades, various advancements have progressively improved the diagnosis of neurovascular diseases, as well as their clinical and surgical management. In addition, advancements in artificial intelligence and related technologies could optimize early and precise detection methodologies, as well as enhance treatment algorithms. However, challenges still remain.

The aim of this Special Issue is to spotlight the current research and progress for every aspect of the management of neurovascular diseases (primary and secondary prevention, when possible, diagnostic imaging, acute inpatient care, endovascular and/or surgical treatment, complication management, rehabilitation and recovery, and progress in translational science).

Our goal is to provide a detailed overview of key discoveries, novel diagnostic and innovative treatment methods, and improved applications of established approaches, while shedding light on emerging research areas and future perspectives.

We eagerly anticipate contributions on ischemic and hemorrhagic stroke, as well as on aneurysms and vascular malformations.

In addition, we encourage interdisciplinary collaborations, inviting contributions from neurosurgeons, neuroradiologists, neurologists, neurorehabilitation specialists, and other allied healthcare professionals.

Dr. Roberto Colasanti
Dr. Silky Chotai
Dr. Alessandro Di Rienzo
Dr. Joham Choque-Velasquez
Guest Editors

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Keywords

neurovascular diseases
ischemic stroke
hemorrhagic stroke
aneurysms
vascular malformations
diagnostic imaging
minimally invasive approaches
surgical techniques
endovascular interventions
treatment algorithms

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Published Papers (8 papers)

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Research

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13 pages, 258 KB

Open AccessArticle

Demographic and Premorbid Clinical Factors Predict Modified Rankin Score in Large and Medium Vessel Occlusion Ischemic Strokes

by Tara Srinivas, Dhairya A. Lakhani, Aneri B. Balar, Risheng Xu, Jee Moon, Caline Azzi, Nathan Hyson, Sijin Wen, Cynthia Greene, Janet Mei, Tyler McGaughey, Farzad Maroufi, Jeremy J. Heit, Tobias D. Faizy, Gregory W. Albers, Hamza Salim, Adam A. Dmytriw, Adrien Guenego, Meisam Hoseinyazdi and Vivek S. Yedavalli

J. Clin. Med. 2025, 14(17), 5960; https://doi.org/10.3390/jcm14175960 - 23 Aug 2025

Viewed by 408

Abstract

Background/Objectives: We report on the association of clinical, demographic, and peri- and intraoperative factors with patient outcomes in large- and, separately, medium-vessel acute ischemic stroke (AIS) occlusions treated with mechanical thrombectomy or medical thrombolysis. Increasingly, neuroimaging, particularly novel markers of collateral status, has become useful in predicting response to endovascular treatment (EVT) among AIS patients. However, the relationship between these neuroimaging markers, documented predictors of stroke outcomes, and post-EVT functional status in anterior circulation large-vessel occlusions (LVOs) as compared to medium-vessel occlusions (MeVOs) remains unclear. We evaluated whether shared predictors of 90-day post-EVT functional outcomes in LVO compared to MeVO AIS patients within our institution exist. Methods: We retrospectively evaluated AIS patients treated at our institution between 9 January 2017 and 10 January 2023. The following were the inclusion criteria were applied: (i) CTA confirmed anterior circulation large or medium vessel occlusion; (ii) diagnostic CT perfusion was performed; (iii) mechanical thrombectomy was performed. A low modified Rankin score (mRS) indicating good functional outcomes (i.e., functional independence) was defined as less than or equal to 2, in accordance with prior studies. Univariate and multivariate logistic regression analyses were conducted to determine associations between demographic, clinical, and radiologic factors and mRS ≤ 2. Results: A total of 249 LVO (mean age 65.3 ± 16.2, 53.8% female) and 91 MeVO (mean age 68.9 ± 13.3, 46.2% female) patients met the inclusion criteria. Upon multivariate regression adjusted for race, age, hypertension, diabetes mellitus, radiologic features, IV alteplase, admission NIHSS, and reperfusion status, young age (p = 0.004), low admission NIHSS (p = 0.0001), and good reperfusion status (p = 0.007) were associated with good functional outcomes in LVO stroke. By contrast, no factors were significantly associated with good functional outcomes in MeVO stroke. Conclusions: Known factors, including young age, low admission stroke severity, and successful reperfusion predict EVT outcomes in LVO stroke but not necessarily in MeVO stroke. Further studies regarding predictors of MeVO outcomes in nonsurgical cases, including collateral status, may guide optimal medical management for this population. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

14 pages, 820 KB

Open AccessArticle

Safety and Efficacy of Stereotactic Aspiration with Fibrinolysis for Supratentorial Spontaneous Intracerebral Hemorrhages: A Single-Center Experience

by Chia-Ning Chang, Chiung-Chyi Shen, Meng-Yin Yang, Wen-Yu Cheng and Chih-Ming Lai

J. Clin. Med. 2025, 14(11), 3636; https://doi.org/10.3390/jcm14113636 - 22 May 2025

Viewed by 629

Abstract

Background/Objectives: In recent years, stereotactic aspiration followed by fibrinolysis has been accepted as being a less invasive and more effective treatment for spontaneous intracerebral hemorrhage (ICH). The aim of this study was to evaluate the safety and clinical outcomes of frameless stereotactic aspiration and fibrinolysis using urokinase in a single medical center. Methods: This study included 123 patients with spontaneous supratentorial ICH who were treated with stereotactic aspiration and subsequent fibrinolysis using urokinase. Their clinical status, radiological images, and functional outcomes were assessed. Results: Unfavorable outcomes at discharge were associated with each patient’s preoperative Glascow Coma Score, as well as their initial and residual volumes of hematoma. Low mortality and minimal complications of rebleeding were also recorded. Conclusions: The results revealed that stereotactic aspiration and subsequent fibrinolysis with urokinase appeared to be a safe and feasible treatment modality for treating ICH. Further studies are still needed in order to better assess the optimal therapeutic window, thrombolytic dosage, long-term evaluation, and controlled comparisons of mortality, as well as disability outcomes in treated and untreated patients. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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13 pages, 1271 KB

Open AccessArticle

Blood Flow in the Internal Jugular Veins in the Lateral Decubitus Body Position in the Healthy People

by Agata Maria Kawalec-Rutkowska, Joanna Czaja, Marcin Skuła and Marian Simka

J. Clin. Med. 2025, 14(4), 1211; https://doi.org/10.3390/jcm14041211 - 12 Feb 2025

Viewed by 1413

Abstract

Background: Some studies have suggested that the lateral decubitus position during sleep may protect the brain from neurodegenerative processes. Although the mechanisms of such possible protection are not known, an optimal venous outflow may be responsible. Venous outflow from the cranial cavity is dependent on the body’s position. However, to date, flow in the internal jugular veins (IJVs) in the lateral position has not been studied quantitatively. Methods: Using ultrasonography, we measured the cross-sectional areas and flow volumes in the IJVs in a group of 25 healthy individuals aged 20–52 ± 12.1 years. These measurements were performed in the supine, upright, and lateral decubitus positions. Results: In the lateral decubitus position, we revealed a collapse of the IJV located higher, dilatation of the opposite vein, and a shift in flow from one vein to the opposite. In the right lateral position, the mean cross-sectional area and flow in the right IJV were 88.6 ± 71.1 mm² and 74.3 ± 97.5 mL/min, in the left IJV: 37.2 ± 33.4 mm² and 48.8 ± 82.8 mL/min. In the left lateral position, the right IJV was 38.4 ± 30.7 mm² and 56.7 ± 56.1 mL/min, and the left IJV was 75.9 ± 51.9 mm² and 99.7 ± 123.9 mL/min. However, there was also a high heterogeneity of the cross-sectional area changes, and in many participants, this pattern was not observed. Regarding flow volumes in the lateral body positions, in comparison with the supine position, the total outflow through both internal jugular veins was not significantly different. Conclusions: In terms of venous outflow, the lateral decubitus position did not differ significantly from the supine position. The working hypothesis of a potentially protective effect of this body position during sleep against neurodegeneration through improved venous outflow has not been proven, at least in healthy individuals. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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18 pages, 1062 KB

Open AccessArticle

Predicting Mortality in Subarachnoid Hemorrhage Patients Using Big Data and Machine Learning: A Nationwide Study in Türkiye

by Taghi Khaniyev, Efecan Cekic, Neslihan Nisa Gecici, Sinem Can, Naim Ata, Mustafa Mahir Ulgu, Suayip Birinci, Ahmet Ilkay Isikay, Abdurrahman Bakir, Anil Arat and Sahin Hanalioglu

J. Clin. Med. 2025, 14(4), 1144; https://doi.org/10.3390/jcm14041144 - 10 Feb 2025

Cited by 2 | Viewed by 1240

Abstract

Background/Objective: Subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality rates, necessitating prognostic algorithms to guide decisions. Our study evaluates the use of machine learning (ML) models for predicting 1-month and 1-year mortality among SAH patients using national electronic health records (EHR) system. Methods: Retrospective cohort of 29,274 SAH patients, identified through national EHR system from January 2017 to December 2022, was analyzed, with mortality data obtained from central civil registration system in Türkiye. Variables included (n = 102) pre- (n = 65) and post-admission (n = 37) data, such as patient demographics, clinical presentation, comorbidities, laboratory results, and complications. We employed logistic regression (LR), decision trees (DTs), random forests (RFs), and artificial neural networks (ANN). Model performance was evaluated using area under the curve (AUC), average precision, and accuracy. Feature significance analysis was conducted using LR. Results: The average age was 56.23 ± 16.45 years (47.8% female). The overall mortality rate was 22.8% at 1 month and 33.3% at 1 year. One-month mortality increased from 20.9% to 24.57% (p < 0.001), and 1-year mortality rose from 30.85% to 35.55% (p < 0.001) in the post-COVID period compared to the pre-COVID period. For 1-month mortality prediction, the ANN, LR, RF, and DT models achieved AUCs of 0.946, 0.942, 0.931, and 0.916, with accuracies of 0.905, 0.901, 0.893, and 0.885, respectively. For 1-year mortality, the AUCs were 0.941, 0.927, 0.926, and 0.907, with accuracies of 0.884, 0.875, 0.861, and 0.851, respectively. Key predictors of mortality included age, cardiopulmonary arrest, abnormal laboratory results (such as abnormal glucose and lactate levels) at presentation, and pre-existing comorbidities. Incorporating post-admission features (n = 37) alongside pre-admission features (n = 65) improved model performance for both 1-month and 1-year mortality predictions, with average AUC improvements of 0.093 ± 0.011 and 0.089 ± 0.012, respectively. Conclusions: Our study demonstrates the effectiveness of ML models in predicting mortality in SAH patients using big data. LR models’ robustness, interpretability, and feature significance analysis validate its importance. Including post-admission data significantly improved all models’ performances. Our results demonstrate the utility of big data analytics in population-level health outcomes studies. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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Review

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16 pages, 1161 KB

Open AccessReview

Heart Failure and Stroke: A Narrative Review

by Takehiro Katano, Hitoshi Mori and Satoshi Suda

J. Clin. Med. 2025, 14(17), 6044; https://doi.org/10.3390/jcm14176044 - 26 Aug 2025

Viewed by 703

Abstract

The global aging population has led to a growing prevalence of heart failure (HF), signaling a new era often referred to as the HF pandemic. HF is strongly associated with both ischemic and hemorrhagic stroke, contributing to the global burden of cerebrovascular disease. In particular, ischemic stroke is frequently observed in patients with HF due to the common coexistence of atrial fibrillation (AF). Given that stroke and HF are both major causes of morbidity and mortality worldwide, a comprehensive understanding of their interrelationship is essential. In 2021, HF was redefined as “a clinical syndrome characterized by symptoms and signs resulting from structural and/or functional cardiac abnormalities, accompanied by current or prior evidence of elevated natriuretic peptides and/or objective findings of pulmonary or systemic congestion,” and it is now classified according to ejection fraction. Among these categories, heart failure with reduced ejection fraction (HFrEF) has been the focus of extensive research, and its treatment has significantly advanced with the development of the so-called “Fantastic Four” pharmacologic therapies. A deeper understanding of the pathophysiological interplay between HF and stroke is crucial to inform future research and improve clinical practice. This review aims to comprehensively summarize the pathophysiological and clinical interrelationship between heart failure and stroke and to provide updated insights for future research and clinical management. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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Other

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20 pages, 1899 KB

Open AccessCase Report

Ruptured Posterior Inferior Cerebellar Artery Aneurysms: Integrating Microsurgical Expertise, Endovascular Challenges, and AI-Driven Risk Assessment

by Matei Șerban, Corneliu Toader and Răzvan-Adrian Covache-Busuioc

J. Clin. Med. 2025, 14(15), 5374; https://doi.org/10.3390/jcm14155374 - 30 Jul 2025

Viewed by 745

Abstract

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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7 pages, 1179 KB

Open AccessCase Report

Perioperative Stroke in MCA Aneurysm Surgery: The Hidden Risks of Amphetamine Use

by Firat Taskaya, Vanessa Magdalena Swiatek, Sifian Al-Hamid, Julius Reiser, Roland Schwab, Klaus-Peter Stein, Daniel Behme, Ali Rashidi, I. Erol Sandalcioglu and Belal Neyazi

J. Clin. Med. 2025, 14(9), 3246; https://doi.org/10.3390/jcm14093246 - 7 May 2025

Viewed by 602

Abstract

Background/Objectives: Perioperative strokes are a rare but recognized complication of cerebral aneurysm surgeries, often influenced by patient-specific factors. Amphetamine abuse, known for its vasospastic effects, is an underexplored risk factor in the neurosurgical setting. This report highlights the clinical and perioperative challenges associated with acute undisclosed amphetamine abuse in a patient undergoing elective clipping of an unruptured middle cerebral artery (MCA) aneurysm. Methods: A 46-year-old male presented with a 3 mm broad-based unruptured aneurysm in the proximal M1 segment of the right MCA. The patient reported a history of illicit drug use, including intravenous consumption. Upon further questioning, he admitted to intermittent use of amphetamines, although he denied any recent use. Elective aneurysm clipping via a transsylvian approach was performed after multidisciplinary consensus. Postoperatively, the patient developed anisocoria, prompting an emergency CT with perfusion and angiography, showing significant findings. Further imaging revealed a bilateral superior cerebellar artery territory infarction. Given the patient’s medical history, a toxicology screening later confirmed recent amphetamine use. Conclusions: This case highlights the need for preoperative evaluation, including routine toxicology screening, in patients with a history of substance abuse. Amphetamine use may present perioperative challenges and increase the risk of complications like vasospasm and stroke. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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16 pages, 2312 KB

Open AccessCase Report

Single-Stage Microsurgical Clipping of Multiple Intracranial Aneurysms in a Patient with Cerebral Atherosclerosis: A Case Report and Review of Surgical Management

by Corneliu Toader, Matei Serban, Razvan-Adrian Covache-Busuioc, Mugurel Petrinel Radoi, Ghaith Saleh Radi Aljboor, Horia Petre Costin, Milena-Monica Ilie, Andrei Adrian Popa and Radu Mircea Gorgan

J. Clin. Med. 2025, 14(1), 269; https://doi.org/10.3390/jcm14010269 - 5 Jan 2025

Cited by 4 | Viewed by 1978

Abstract

The management of multiple intracranial aneurysms presents significant clinical challenges, particularly when complicated by underlying conditions such as cerebral atherosclerosis. This case report highlights the successful treatment of a 66-year-old female diagnosed with three intracranial aneurysms located in the right middle cerebral artery (MCA), pericallosal artery, and M2 segment. The patient also had a history of systemic atherosclerosis and right-sided breast cancer, factors that increased the complexity of surgical intervention. The aim of this report is to demonstrate the efficacy of single-stage microsurgical clipping in managing multiple aneurysms with favorable outcomes in a complex patient profile. Methods: The patient underwent right-sided pterional craniotomy for microsurgical clipping of all three aneurysms during a single-stage procedure. Two aneurysms in the MCA were clipped using Yasargil clips, and a third aneurysm located at the bifurcation of the pericallosal artery was also secured with a clip. The procedure was performed under microscopic visualization, with meticulous dissection of the atherosclerotic vessels and careful intraoperative hemostasis. Postoperative care involved proactive perioperative management, including blood pressure control and vigilant neurological monitoring. Results: Postoperative imaging at three months confirmed proper clip placement with no evidence of residual aneurysm filling or ischemic complications. The patient exhibited a full neurological recovery, with no deficits or further complications, highlighting the effectiveness of the surgical approach in managing multiple aneurysms concurrently. Conclusions: This case supports the use of single-stage microsurgical clipping as an effective treatment for patients with multiple intracranial aneurysms, even in the presence of complicating factors such as atherosclerosis. A meticulous surgical technique and perioperative management are critical to achieving favorable outcomes and reducing the risk of delayed ischemia or other postoperative complications. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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