Clinical Management of Acute Ischemic Stroke

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

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