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Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment
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Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 5890

Special Issue Editors

Dr. Alba Scerrati

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Guest Editor
1. Department of Neurosurgery, S. Anna University Hospital, Via Aldo Moro, 44124 Ferrara, Italy
2. Department of Translational Medicine, University of Ferrara, Via Aldo Moro, 44124 Ferrara, Italy
Interests: skull-based surgery; neurovascular surgery; cerebrovascular diseases; cerebrospinal fluid (CSF) dynamics
Dr. Giorgio Mantovani

E-Mail Website
Guest Editor Assistant
1. Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
2. Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
Interests: cerebrovascular circulation; cerebrospinal fluid (CSF) dynamics; functional neurosurgery for pain

Special Issue Information

Dear Colleagues,

Cerebrovascular diseases are a group of conditions that affect blood flow and the blood vessels in the brain. These can be caused by different kind of alterations, including atherosclerosis, thrombosis, embolisms. We can categorize these diseases as stroke, transient ischemic attack (TIA), aneurysm, and vascular malformation. Arteries are most commonly involved, but veins can also be affected by these kinds of diseases.

The aim of this Special Issue is to collate papers presenting new evidence and novelties about cerebrovascular disease, both for arterial diseases and especially for the less commonly reported venous diseases affecting the brain.

Dr. Alba Scerrati
Guest Editors

Dr. Giorgio Mantovani
Guest Editor Assistant

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

  • ischemic stroke
  • cerebral aneurysms
  • cerebral vascular malformation
  • cerebral venous disease
  • cerebral venous thrombosis

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Published Papers (5 papers)

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Research

13 pages, 3065 KiB  
Article
Feasibility Study for Multimodal Image-Based Assessment of Patient-Specific Intracranial Arteriovenous Malformation Hemodynamics
by Janneck Stahl, Laura Stone McGuire, Tatiana Abou-Mrad, Sylvia Saalfeld, Daniel Behme, Ali Alaraj and Philipp Berg
J. Clin. Med. 2025, 14(8), 2638; https://doi.org/10.3390/jcm14082638 - 11 Apr 2025
Viewed by 370
Abstract
Background/Objectives: Intracranial arteriovenous malformations (AVMs) exhibit a complex vasculature characterized by a locally occurring tangled nidus connecting the arterial and venous system bypassing the capillary network. Clinically available imaging modalities may not give sufficient spatial or temporal resolution. Adequate 3D models of [...] Read more.
Background/Objectives: Intracranial arteriovenous malformations (AVMs) exhibit a complex vasculature characterized by a locally occurring tangled nidus connecting the arterial and venous system bypassing the capillary network. Clinically available imaging modalities may not give sufficient spatial or temporal resolution. Adequate 3D models of large vascular areas and a detailed blood flow analysis of the nidus including the surrounding vessels are not available yet. Methods: Three representative AVM cases containing multimodal image data (3D rotational angiography, magnetic resonance angiography, magnetic resonance venography, and phase-contrast quantitative magnetic resonance imaging) are investigated. Image segmentation results in partial 3D models of the different vascular segments, which are merged into large-scale neurovascular models. Subsequently, image-based blood flow simulations are conducted based on the segmented models using patient-specific flow measurements as boundary conditions. Results: The segmentation results provide comprehensive 3D models of the overall arteriovenous morphology including realistic nidus vessels. The qualitative results of the hemodynamic simulations show realistic flow behavior in the complex vasculature. Feeding arteries exhibit increased wall shear stress (WSS) and higher flow velocities in two cases compared to contralateral vessels. In addition, feeding arteries are exposed to higher overall WSS with increased value variation between individual vessels (20.1 Pa ± 17.3 Pa) compared to the draining veins having a 62% lower WSS (8.9 Pa ± 5.9 Pa). Blood flow distribution is dragged towards the dominating circulation side feeding the nidus for all the cases quantified by the volume flow direction changes in the posterior communicating arteries. Conclusions: This multimodal study demonstrates the feasibility of the presented workflow to acquire detailed blood flow predictions in large-scale AVM models based on complex image data. The hemodynamic models serve as a base for endovascular treatment modeling influencing flow patterns in distally located vasculatures. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment)
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13 pages, 2343 KiB  
Article
Use of Double-Layer Carotid Stents Is Associated with Improved Patient Survival and Lower Neurological Complications: A Single-Center Retrospective Observational Study
by Kipras Mikelis, Marius Kurminas, Givi Lengvenis, Radvilas Jančiauskas, Nerijus Misonis, Povilas Budrys, Rokas Šerpytis and Andrius Berūkštis
J. Clin. Med. 2025, 14(3), 888; https://doi.org/10.3390/jcm14030888 - 29 Jan 2025
Viewed by 704
Abstract
Background/Objectives: Dual-layer stents (DLS) with micromesh technology may offer better protection from plaque protrusion compared to single-layer stents (SLS), but little data are available. The aim of this study is to compare clinical outcomes of elective carotid artery stenting for asymptomatic and [...] Read more.
Background/Objectives: Dual-layer stents (DLS) with micromesh technology may offer better protection from plaque protrusion compared to single-layer stents (SLS), but little data are available. The aim of this study is to compare clinical outcomes of elective carotid artery stenting for asymptomatic and symptomatic patients treated for primary CAS with DLS or SLS in a high-volume center. Methods: This study is a single-center retrospective cohort study and included patients who underwent elective CAS between December 2006 and September 2023. The final analysis included patient baseline characteristics, postoperative complications and patient outcomes. Results: A total of 573 patients underwent elective carotid artery stenting in the study period. Most of the 573 patients undergoing CAS were male (62.5%), and the median age of patients at the time of CAS was 70 years. Of the 573 eligible patients, 43.5% (n = 249) were asymptomatic and 56.4% (n = 323) were symptomatic. Analyzing neurological complications, it was found that the only factor that had a statistically significant effect was the type of stent used. Patients who had a carotid stenting procedure using a single-layer carotid stent had statistically significantly more periprocedural neurological complications (8.3% (n = 35)) than the double-mesh stent group (2% (n = 3)), mostly due to more transient ischemic attacks in the single-layer stent group (4% (n = 17)) compared to the double-mesh group (0.7% (n = 1)). Conclusions: The use of carotid double-layer stents is associated with a low rate of periprocedural and postprocedural events. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment)
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12 pages, 420 KiB  
Article
AM-PAC 6-Clicks Basic Mobility and Daily Activities Scores Predict 90-Day Modified Rankin Score in Patients with Acute Ischemic Stroke Secondary to Large Vessel Occlusion
by Andrew Cho, Dhairya A. Lakhani, Aneri B. Balar, Hamza Salim, Manisha Koneru, Argye Hillis, Marlis Gonzalez Fernández, Vaibhav Vagal, Victor Urrutia, Tobias D. Faizy, Jeremy J. Heit, Greg W. Albers, Ishan Mazumdar, Kevin Chen, Sadra Sepehri, Minsoo Kim, Licia Luna, Janet Mei, Vivek S. Yedavalli and Nathan Hyson
J. Clin. Med. 2024, 13(23), 7119; https://doi.org/10.3390/jcm13237119 - 25 Nov 2024
Cited by 3 | Viewed by 1225
Abstract
Background: The relative level of functional impairment in stroke patients is a significant determinant of post-acute care. The Activity Measure for Post Acute Care 6-Clicks (AM-PAC) scores for basic mobility and daily activity are rapid standardized assessments whose utilities in predicting long-term stroke [...] Read more.
Background: The relative level of functional impairment in stroke patients is a significant determinant of post-acute care. The Activity Measure for Post Acute Care 6-Clicks (AM-PAC) scores for basic mobility and daily activity are rapid standardized assessments whose utilities in predicting long-term stroke outcomes have not yet been studied. Methods: We performed a retrospective analysis of acute ischemic stroke patients and their outcomes. We evaluated the distribution of outcomes using the chi-square test. We then compared the proportions of patients with good stroke outcomes for different combinations of favorable scores. We performed two-proportion z-tests to determine the significance, and p < 0.05 was considered significant. Results: 282 patients met all of the inclusion criteria between 12 January 2017 and 19 March 2023 (M age = 66.4, 59.9% female). After dichotomizing the scores as “favorable” vs. “unfavorable”, we found that 128/155 (82.6%) patients with favorable basic mobility had good stroke outcomes vs. 20/127 (15.7%) with unfavorable basic mobility (p < 0.0001). Similarly, for favorable daily activity, it was 103/113 (91.2%) vs. 45/169 (26.6%), for both favorable, it was 100/109 (91.7%) vs. 48/173 (27.7%), and for neither favorable, it was 17/123 (13.8%) vs. 131/159 (82.4%), all with p < 0.0001. When comparing among groups, both favorable patients differed significantly from those with favorable basic mobility alone (p = 0.033) but not those with favorable daily activity alone (p = 0.875). Even after adjusting for age, the odds ratios of favorable scores were greater than 20 for any combination (p < 0.001). Conclusions: Basic mobility and daily activity AM-PAC scores at discharge are independent predictors of anterior circulation acute ischemic stroke outcomes at 90 days. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment)
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11 pages, 2643 KiB  
Article
Clinicopathological Observations in Acute Stroke Patients Treated with Intravenous Thrombolysis
by Lilla Hudák, Kitti Bernadett Kovács, Zsuzsa Bagoly, István Szegedi, Viktor Bencs, Linda Lóczi, Rita Orbán-Kálmándi, Henrietta Péter-Pakó, Zsófia Fülesdi, Blanka Busi, Attila Nagy, Beáta Perjési-Kiss, László Oláh and László Csiba
J. Clin. Med. 2024, 13(19), 6012; https://doi.org/10.3390/jcm13196012 - 9 Oct 2024
Viewed by 1257
Abstract
Background: Ischemic stroke is a leading cause of mortality worldwide, and intravenous thrombolysis, while improving functional outcomes, still leaves a significant mortality rate. This study aimed to investigate the clinical and pathological data of thrombolysed stroke patients who subsequently died and underwent [...] Read more.
Background: Ischemic stroke is a leading cause of mortality worldwide, and intravenous thrombolysis, while improving functional outcomes, still leaves a significant mortality rate. This study aimed to investigate the clinical and pathological data of thrombolysed stroke patients who subsequently died and underwent autopsy, focusing on hemorrhagic transformation (HT). Methods: Over a 10-year period, 1426 acute ischemic stroke patients received thrombolysis at our center, with an in-hospital mortality rate of 11.7%. Autopsies were performed on 98 of the 167 deceased patients. Results: HT was found in 47% of these cases, only less than half occurring within a day of thrombolysis. Significant independent predictors of HT included higher lactate dehydrogenase (LD) levels and higher INR values at admission. HT directly caused death in 30% of cases, often through herniation, while other complications (pulmonary embolism, pneumonia) were also common. Conclusions: These findings highlight the importance of postmortem investigations to accurately determine the incidence of HT and contributing factors. Our data indicate that in the vast majority of HT cases, the role of contributing factors other than rt-PA may be important. Of the routinely assessed clinical and laboratory parameters at admission, only LD and INR were found to be independent predictors of HT in the autopsied studied cohort. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment)
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14 pages, 1394 KiB  
Article
Natural History and Predictors for Hemorrhage in Supratentorial Brain Arteriovenous Malformations
by Ioana Miron, Viorel M. Prună, Dan M. Visarion, George E. D. Petrescu and Radu M. Gorgan
J. Clin. Med. 2024, 13(13), 3760; https://doi.org/10.3390/jcm13133760 - 27 Jun 2024
Cited by 2 | Viewed by 1781
Abstract
Background/Objectives: Approximately half of the patients harboring supratentorial brain arterio-venous malformations (stAVMs) present with hemorrhage, and another considerable proportion suffer from epileptic seizures. An important milestone in the management of this vascular pathology is acknowledging their natural history, especially across long periods of [...] Read more.
Background/Objectives: Approximately half of the patients harboring supratentorial brain arterio-venous malformations (stAVMs) present with hemorrhage, and another considerable proportion suffer from epileptic seizures. An important milestone in the management of this vascular pathology is acknowledging their natural history, especially across long periods of time. The aim of this study was to assess the predictive factors for hemorrhage and for epileptic seizures as presenting symptoms in stAVMs. Methods: We retrospectively analyzed patients with stAVMs admitted to our institution between 2012 and 2022 and evaluated predictive factors for hemorrhage and the risk factors associated with epileptic seizures. Results: The cohort included 169 patients, 78 of them (46.2%) presenting with intracerebral hemorrhage (ICH). Seventy-seven (45.5%) patients suffered from epileptic seizures. The annual hemorrhagic rate was 1.28%/year. Unruptured lesions (p = 0.001, OR 3.1, 95% CI 1.6–6.2), superficial venous drainage (p = 0.007, OR 2.7, 95% CI 1.3–5.7) and large nidus size (p = 0.025, OR 4, 95% CI 1.2–13.5) were independently associated with seizures. Among unruptured lesions, superficial venous drainage (OR 2.6, p = 0.036, 95% CI 1.06–6.3) and frontal/temporal/parietal location (OR 2.7, p = 0.040, 95 CI% 1.04–6.9) significantly increased the risk of seizures as a presenting symptom in multivariate analysis. Patients younger than 18 (p = 0.003, OR 4.5, 95% CI 1.6–12.2), those with AVMs < 3 cm (p = 0.03, OR 2, 95% CI 1.07–3.9) or those with deep located AVMs (p = 0.035, OR 2.3, 95% CI 1.06–5.1) presented statistically more often with ICH in multivariate regression. Small size (HR 1.8, 95% CI 1.09–3, p = 0.022) and exclusively deep venous drainage (HR 2.2, 95% CI 1.2–4, p = 0.009) were independent predictors for ICH, in time-dependent birth-to-diagnosis analysis. After shifting the birth-to-diagnosis curve by 10 years, unique arterial feeder demonstrated a positive correlation with ICH presentation as well. Conclusions: Small AVMs, those with exclusively deep venous drainage, unique arterial feeder or deep location may pose higher hemorrhagic risks for the patient, and therapeutic strategies should be tailored accordingly. When managing unruptured brain AVMs, it is important to consider the risk of developing seizures, in addition to the lifelong risk of hemorrhage, in determining the optimal treatment approach for each patient. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment)
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