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Exploring New Horizons: Pathogenic Mechanisms and Therapeutic Frontiers in Ischemic...
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Exploring New Horizons: Pathogenic Mechanisms and Therapeutic Frontiers in Ischemic Stroke

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 (12 January 2025) | Viewed by 7445

Special Issue Editor

Dr. Maurizio Acampa

E-Mail Website
Guest Editor
Stroke Unit, AOU Senese, Siena, Italy
Interests: cardiovascular risk factors; cryptogenic stroke; atrial cardiopathy; heart-brain connection; atrial fibrillation; cardioembolism; haemorrhagic transformation; stroke treatment

Special Issue Information

Dear Colleagues,

Establishing novel strategies for stroke prevention and treatment hinges upon the identification of modifiable risk factors contributing to this intricate disease. Additionally, it relies on gaining a deeper understanding of potentially obscure pathogenic mechanisms, particularly within the realm of cryptogenic strokes and less common stroke causes.

This Special Issue aims to explore the expansive spectrum of ischemic strokes, ranging from cryptogenic strokes to the manifestation of atypical pathogenic mechanisms observed across various subtypes. By meticulously dissecting both common and uncommon risk factors, researchers strive to unravel the mysteries surrounding stroke occurrence and craft personalized treatment approaches to mitigate their impact. Understanding the exact pathogenic mechanisms lays the foundation for more appropriate and tailored therapeutic strategies that account for the distinct characteristics of each stroke subtype, thereby fostering improved outcomes for patients worldwide.

Dr. Maurizio Acampa
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

  • cardiovascular risk factors
  • cryptogenic stroke
  • ESUS
  • atrial cardiopathy
  • non-stenosing atherosclerosis
  • cardioembolism
  • acute stroke treatment
  • antiplatelets
  • anticoagulants

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

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11 pages, 215 KiB  
Article
The Impact of Sex and Arterial Stiffness Interactions on the Outcome after an Acute Ischemic Stroke: A Retrospective Cohort Study
by Maurizio Acampa, Pietro Enea Lazzerini, Alessandra Cartocci, Ernesto Iadanza, Gabriele Cevenini, Carlo Domenichelli, Riccardo Accioli, Viola Salvini, Francesca Guideri, Rossana Tassi and Giuseppe Martini
J. Clin. Med. 2024, 13(14), 4095; https://doi.org/10.3390/jcm13144095 - 13 Jul 2024
Viewed by 1177
Abstract
Background/Objectives: Arterial stiffness (AS) is an independent predictor of cardiovascular events and is associated with a poor prognosis. While AS may represent a novel therapeutic target, recent evidence shows that it is sexually dimorphic. The aim of this study was to evaluate [...] Read more.
Background/Objectives: Arterial stiffness (AS) is an independent predictor of cardiovascular events and is associated with a poor prognosis. While AS may represent a novel therapeutic target, recent evidence shows that it is sexually dimorphic. The aim of this study was to evaluate relative sex differences in arterial stiffness and their possible impact on the outcome of acute ischemic stroke. Methods: We retrospectively evaluated a cohort of adult patients with the following inclusion criteria: acute ischemic stroke, which occurred within 24 h from the onset of symptoms, confirmed through neuroimaging examinations, additional evaluations including extracranial and transcranial arterial ultrasound examinations, transthoracic echocardiography, a 12-lead resting ECG, and continuous 24 h in-hospital blood pressure monitoring. Based on the 24 h blood pressure monitoring, the following parameters were evaluated: systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and arterial stiffness index (ASI). The modified Rankin scale (mRS) was assessed at 90 days to evaluate the 3-month clinical outcome, defining an unfavorable outcome as an mRS score ≥ 3. To assess the factors associated with unfavorable outcomes, a stepwise logistic regression model was performed on the total sample size, and the analyses were replicated after stratifying by sex. Results: A total of 334 patients (176 males, 158 females) were included in the analysis. There was a significant sex-dependent impact of ASI on the 90-day unfavorable Rankin score (mRS score ≥ 3) as only men had a reduced likelihood of favorable outcomes with increasing arterial stiffness (OR:1.54, 95% CI: 1.06–2.23; P-interaction = 0.023). Conclusions: The influence of ASI on the 3-month functional outcome after acute ischemic stroke is at least in part sex-related, suggesting that, in males, higher ASI values are associated with a worse outcome. Full article
(This article belongs to the Special Issue Exploring New Horizons: Pathogenic Mechanisms and Therapeutic Frontiers in Ischemic Stroke)

Review

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25 pages, 8323 KiB  
Review
Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype
by Marialuisa Zedde, Arturo De Falco, Carla Zanferrari, Maria Guarino, Francesca Romana Pezzella, Shalom Haggiag, Gianni Cossu, Rocco Quatrale, Giuseppe Micieli, Massimo Del Sette and Rosario Pascarella
J. Clin. Med. 2025, 14(4), 1293; https://doi.org/10.3390/jcm14041293 - 15 Feb 2025
Viewed by 968
Abstract
Spinal cord infarction (SCI) of arterial origin is a rare vascular event, and its incidence is probably underestimated. There are no strong epidemiological data, and the diagnostic pathway is complex and sometimes incomplete. Furthermore, many cases may be misdiagnosed as other forms of [...] Read more.
Spinal cord infarction (SCI) of arterial origin is a rare vascular event, and its incidence is probably underestimated. There are no strong epidemiological data, and the diagnostic pathway is complex and sometimes incomplete. Furthermore, many cases may be misdiagnosed as other forms of acute and subacute myelopathies. The focus of this review is the clinical and neuroradiological issues in diagnosing SCI and their respective reliability in a clinical setting. The new proposed diagnostic criteria of SCI, although not covering all aspects, highlight the need for a comprehensive approach, including even atypical cases, as the lack of cord compression on Magnetic Resonance Imaging (MRI) is the only mandatory feature for diagnosis. Some MRI features are supportive of the diagnosis, particularly when the anterior spinal artery territory is involved and diffusion-weighted imaging (DWI) is used. Several etiologies can be considered, considering traditional vascular risk factors and diseases affecting the aorta and its main branches, yet a significant proportion of cases remain without a definite etiology. The strongest predictor of SCI diagnosis is a clinical variable, i.e., a time to nadir of severe deficits < 12 h. Full article
(This article belongs to the Special Issue Exploring New Horizons: Pathogenic Mechanisms and Therapeutic Frontiers in Ischemic Stroke)
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23 pages, 831 KiB  
Review
Molecular Links and Clinical Effects of Inflammation and Metabolic Background on Ischemic Stroke: An Update Review
by Gaetano Pacinella, Anna Maria Ciaccio and Antonino Tuttolomondo
J. Clin. Med. 2024, 13(24), 7515; https://doi.org/10.3390/jcm13247515 - 10 Dec 2024
Cited by 2 | Viewed by 1266
Abstract
Stroke is a major global health concern, with 12.2 million new cases and 6.6 million deaths reported in 2019, making it the second leading cause of death and third leading cause of disability worldwide. Ischemic stroke, caused by blood vessel occlusion, accounts for [...] Read more.
Stroke is a major global health concern, with 12.2 million new cases and 6.6 million deaths reported in 2019, making it the second leading cause of death and third leading cause of disability worldwide. Ischemic stroke, caused by blood vessel occlusion, accounts for 87% of stroke cases and results in neuronal death due to oxygen and nutrient deprivation. The rising global stroke burden is linked to aging populations and increased metabolic risk factors like high blood pressure, obesity, and elevated glucose levels, which promote chronic inflammation. This article explores the intricate molecular and clinical interplay between inflammation and metabolic disorders, emphasizing their role in ischemic stroke development, progression, and outcomes. Full article
(This article belongs to the Special Issue Exploring New Horizons: Pathogenic Mechanisms and Therapeutic Frontiers in Ischemic Stroke)
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20 pages, 4075 KiB  
Review
Treatment-Related Reversible Cerebral Vasoconstriction Syndrome
by Giulia Avola and Alessandro Pezzini
J. Clin. Med. 2024, 13(19), 5930; https://doi.org/10.3390/jcm13195930 - 4 Oct 2024
Cited by 1 | Viewed by 3458
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but significant cause of intracranial arteriopathy and stroke in young adults. The syndrome encompasses a spectrum of disorders radiologically characterized by reversible narrowing and dilation of intracranial arteries, often triggered by vasoactive drugs or the [...] Read more.
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but significant cause of intracranial arteriopathy and stroke in young adults. The syndrome encompasses a spectrum of disorders radiologically characterized by reversible narrowing and dilation of intracranial arteries, often triggered by vasoactive drugs or the postpartum period. The hallmark clinical feature of RCVS is thunderclap headache with or without other neurological signs. Though endothelial dysfunction and sympathetic hyperactivation are hypothesized to be key mechanisms, the exact pathogenesis of RCVS is still unclear. RCVS’s diagnosis could be challenging, since vasospasm proceeds centripetally, initially involving distal small pial and cortical arteries, and angiographic studies, especially brain magnetic resonance angiography (MRA) and computed tomography angiography (CTA), may miss it in the early phase of the disease, while early signs such as vascular hyperintensities may be visible on T2/FLAIR sequences before vasospasm onset. Catheter angiography is the gold standard and it could be used to assess vasospasm reversibility post-intra-arterial vasodilator administration. Treatment is mainly symptomatic, and nimodipine is the most commonly administered therapy, given orally or intra-arterially in severe cases. Since many aspects of RCVS remain partially known, further research is needed to better understand the complex pathophysiology of this unique clinical condition and to optimize specific management strategies. Full article
(This article belongs to the Special Issue Exploring New Horizons: Pathogenic Mechanisms and Therapeutic Frontiers in Ischemic Stroke)
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