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Clinical Management of Acute Ischemic Stroke
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Special Issue "Clinical Management of Acute 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: 25 August 2023 | Viewed by 1543

Special Issue Editors

Dr. Giovanni Merlino

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Guest Editor
Stroke Unit and Clinical Neurology, Department of Neuroscience, Udine University Hospital, Udine, Italy.
Interests: stroke; thrombolysis; thrombectomy; post-stroke epilepsy
Dr. Maria Luisa Zedde

E-Mail Website
Guest Editor
Neurology Unit, Stroke Unit, Department of Neuromotor Physiology and Rehabilitation, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
Interests: stroke; neuroimaging; neurointerventional; angiography; rare neurovascular disorders; small vessel disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Stroke is the second leading cause of death and a major cause of disability worldwide. Although recanalization therapy has changed the outcome for patients with acute ischemic stroke during the last decades, several issues remain unresolved and vascular neurology/neuroradiologists still wait for answers. Tenecteplase is a next-generation genetically modified rtPA and is currently the most promising alternative agent to alteplase. However, more data are needed and current European Stroke Organization guidelines for patients with AIS of < 4.5 hours duration who are not eligible for MT suggest intravenous thrombolysis with alteplase over tenecteplase. The best medical treatment for minor, non-disabling, ischemic stroke is yet unknown. Several patients with acute ischemic stroke due to large vessel occlusion can develop “futile” recanalization, i.e., a poor clinical outcome despite a successful recanalization of the occluded vessel. Mechanisms and predictors of “futile” recanalization remain largely unrecognized and deserve further evaluation. Moreover, the balance between benefit and harm in the selection of the patients for i.v. or endovascular reperfusion is still hard to assess in individual cases because of the presence of several grey areas (e.g., field and meaning of perfusion studies vs. collateral status evaluation, pure hemodynamic stroke in the setting of chronic large vessel occlusions, multiple simultaneous vessel occlusions, the opportunity to tailor the treatment to the cause of the stroke and not only to the site of vessel occlusion, etc.). Epileptic status after acute ischemic stroke represents an uncommon, but harmful, consequence. Little is known about the outcome of these patients in terms of disability and mortality. These issues, and many others, will be covered by review papers, clinical, and experimental studies in this Special Issue of the Journal of Clinical Medicine focused on the clinical management of acute ischemic stroke.

Dr. Giovanni Merlino
Dr. Maria Luisa Zedde
Guest Editors

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

  • thrombolysis
  • thrombectomy
  • non-disabling ischemic stroke
  • futile recanalization
  • post-stroke epileptic status
  • perfusion
  • penumbra
  • hemodynamic stroke
  • intracranial stenosis
 

Published Papers (3 papers)

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Article
Higher Leukocyte Count Is Associated with Lower Presence of Carotid Lipid-Rich Necrotic Core: A Sub-Study in the Plaque at RISK (PARISK) Study
by
Twan Jowan van Velzen
,
Jeffrey Stolp
,
Dianne van Dam-Nolen
,
Mohamed Kassem
,
Jeroen Hendrikse
,
Marianne Eline Kooi
,
Daniel Bos
and
Paul J. Nederkoorn
J. Clin. Med. 2023, 12(4), 1370; https://doi.org/10.3390/jcm12041370 - 08 Feb 2023
Viewed by 438
Abstract
Background: Increasing evidence suggests that inflammation inside the vessel wall has a prominent role in atherosclerosis. In carotid atherosclerosis in particular, vulnerable plaque characteristics are strongly linked to an increased stroke risk. An association between leukocytes and plaque characteristics has not been investigated [...] Read more.
Background: Increasing evidence suggests that inflammation inside the vessel wall has a prominent role in atherosclerosis. In carotid atherosclerosis in particular, vulnerable plaque characteristics are strongly linked to an increased stroke risk. An association between leukocytes and plaque characteristics has not been investigated before and could help with gaining knowledge on the role of inflammation in plaque vulnerability, which could contribute to a new target for intervention. In this study, we investigated the association of the leukocyte count with carotid vulnerable plaque characteristics. Methods: All patients from the Plaque At RISK (PARISK) study whom had complete data on their leukocyte count and CTA- and MRI-based plaque characteristics were included. Univariable logistic regression was used to detect associations of the leukocyte count with the separate plaque characteristics (intra-plaque haemorrhage (IPH), lipid-rich-necrotic core (LRNC), thin or ruptured fibrous cap (TRFC), plaque ulceration and plaque calcifications). Subsequently, other known risk factors for stroke were included as covariates in a multivariable logistic regression model. Results: 161 patients were eligible for inclusion in this study. Forty-six (28.6%) of these patients were female with a mean age of 70 [IQR 64–74]. An association was found between a higher leukocyte count and lower prevalence of LRNC (OR 0.818 (95% CI 0.687–0.975)) while adjusting for covariates. No associations were found between the leucocyte count and the presence of IPH, TRFC, plaque ulceration or calcifications. Conclusions: The leukocyte count is inversely associated with the presence of LRNC in the atherosclerotic carotid plaque in patients with a recently symptomatic carotid stenosis. The exact role of leukocytes and inflammation in plaque vulnerability deserves further attention. Full article
(This article belongs to the Special Issue Clinical Management of Acute Ischemic Stroke)
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Article
Endovascular Thrombectomy with or without Intravenous Thrombolysis for Anterior Circulation Large Vessel Occlusion in the Imperial College London Thrombectomy Registry
by
Lucio D’Anna
,
Matteo Foschi
,
Michele Russo
,
Tsering Dolkar
,
Orsolya Vittay
,
Luke Dixon
,
Paul Bentley
,
Zoe Brown
,
Charles Hall
,
Omid Halse
,
Sohaa Jamil
,
Harri Jenkins
,
Dheeraj Kalladka
,
Joseph Kwan
,
Abid Malik
,
Maneesh Patel
,
Neil Rane
,
Dylan Roi
,
Abhinav Singh
,
Marius Venter
,
Kyriakos Lobotesis
and
Soma Banerjee
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J. Clin. Med. 2023, 12(3), 1150; https://doi.org/10.3390/jcm12031150 - 01 Feb 2023
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Abstract
Background and purpose. Mechanical thrombectomy (MT) is the standard of care for eligible patients with a large vessel occlusion (LVO) acute ischemic stroke. Among patients undergoing MT there has been uncertainty regarding the role of intravenous thrombolysis (IVT) and previous trials have yielded [...] Read more.
Background and purpose. Mechanical thrombectomy (MT) is the standard of care for eligible patients with a large vessel occlusion (LVO) acute ischemic stroke. Among patients undergoing MT there has been uncertainty regarding the role of intravenous thrombolysis (IVT) and previous trials have yielded conflicting results regarding clinical outcomes. We aim to investigate clinical, reperfusion outcomes and safety of MT with or without IVT for ischemic stroke due to anterior circulation LVO. Materials and Methods. This observational, prospective, single-centre study included consecutive patients with acute LVO ischemic stroke of the anterior circulation. The primary outcomes were the rate of in-hospital mortality, symptomatic intracranial haemorrhage and functional independence (mRS 0–2 at 90 days). Results. We enrolled a total of 577 consecutive patients: 161 (27.9%) were treated with MT alone while 416 (72.1%) underwent IVT and MT. Patients with MT who were treated with IVT had lower rates of in-hospital mortality (p = 0.037), higher TICI reperfusion grades (p = 0.007), similar rates of symptomatic intracranial haemorrhage (p = 0.317) and a higher percentage of functional independence mRS (0–2) at 90 days (p = 0.022). Bridging IVT with MT compared to MT alone was independently associated with a favorable post-intervention TICI score (>2b) (OR, 1.716; 95% CI, 1.076–2.735, p = 0.023). Conclusions. Our findings suggest that combined treatment with MT and IVT is safe and results in increased reperfusion rates as compared to MT alone. Full article
(This article belongs to the Special Issue Clinical Management of Acute Ischemic Stroke)
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Article
Post-Stroke Status Epilepticus: Time of Occurrence May Be the Difference?
by
Annacarmen Nilo
,
Giada Pauletto
,
Simone Lorenzut
,
Giovanni Merlino
,
Lorenzo Verriello
,
Francesco Janes
,
Francesco Bax
,
Gian Luigi Gigli
and
Mariarosaria Valente
J. Clin. Med. 2023, 12(3), 769; https://doi.org/10.3390/jcm12030769 - 18 Jan 2023
Viewed by 339
Abstract
(1) Background: Stroke is one of the most frequent causes of status epilepticus (SE) in adults. Patients with stroke and SE have poorer prognosis than those with stroke alone. We described characteristics and prognosis of early- and late-onset post-stroke SE (PSSE). (2) Methods: [...] Read more.
(1) Background: Stroke is one of the most frequent causes of status epilepticus (SE) in adults. Patients with stroke and SE have poorer prognosis than those with stroke alone. We described characteristics and prognosis of early- and late-onset post-stroke SE (PSSE). (2) Methods: We retrospectively analyzed consecutive stroke patients who experienced a first SE between August 2012 and April 2021, comparing clinical characteristics, stroke, and SE features between early- versus late-onset SE in relation to patients’ outcome. (3) Results: Forty stroke patients experienced PSSE. Fourteen developed an early-onset SE (35%) and twenty-six a late-onset SE (65%). Early-onset SE patients had a slightly higher NIHSS score at admission (6.9 vs. 6.0; p = 0.05). Early-onset SE was more severe than late-onset, according to STESS (Status Epilepticus Severity Score) (3.5 vs. 2.8; p = 0.05) and EMSE (Epidemiology-based Mortality score in Status Epilepticus) score (97.0 vs. 69.5; p = 0.04); furthermore, it had a significant impact on disability at 3-month and 1-year follow-up (p = 0.03 and p = 0.02). SE recurrence and seizures relapse were observed mainly in cases of late-onset SE. (4) Conclusions: Early-onset SE seems to be associated with higher disability in short- and long-term follow-up as possible expression of severe acute brain damage. Full article
(This article belongs to the Special Issue Clinical Management of Acute Ischemic Stroke)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

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