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Acute Ischemic Stroke Management Strategies
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Acute Ischemic Stroke Management Strategies

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

Deadline for manuscript submissions: 20 October 2026 | Viewed by 4778

Special Issue Editor

Dr. Marta Iacobucci

E-Mail Website
Guest Editor
Interventional and Diagnostic Neuroradiology, University Hospital Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
Interests: acute ischemic stroke; neuroprotection; reperfusion injury

Special Issue Information

Dear Colleagues,

The landscape of acute ischemic stroke (AIS) management has undergone a paradigm shift in recent years, largely due to the advent of advanced neurointerventional techniques and the refinement of pharmacological treatments. Despite significant progress in the acute phase, challenges persist in maximizing patient outcomes, expanding treatment eligibility, and improving recovery for those affected by this devastating condition. As a result, current research efforts are increasingly focused on innovative techniques and therapeutic strategies aimed at both the acute treatment and long-term recovery of AIS patients. The next frontier lies in the integration of novel endovascular techniques, molecular therapies, and personalized medicine approaches. Expanding the treatment window for thrombectomy, refining neuroprotective drugs, advancing stem cell therapies, and harnessing the power of AI and predictive models represent exciting opportunities for the future of stroke care. As these research efforts progress, they hold the potential not only to improve the acute management of ischemic stroke but also to reshape the landscape of recovery, offering hope for more effective treatments and better outcomes for stroke patients globally. 

Therefore, in this Special Issue, the authors are invited to submit papers related to “Acute Ischemic Stroke Management Strategies” exploring new perspective of therapy in acute ischemic stroke.

Dr. Marta Iacobucci
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 250 words) can be sent to the Editorial Office for assessment.

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

  • mechanical thrombectomy
  • leptomeningeal collateral circulation
  • neuroprotection
  • reperfusion injury
  • ischemic penumbra

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Published Papers (5 papers)

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Research

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15 pages, 736 KB  
Article
Low Fibrinogen Levels Are Associated with an Increased Risk of Parenchymal Hematoma in Ischemic Stroke Treated with Intravenous Thrombolysis
by Libor Šimůnek, Veronika Kunešová, Lucie Burešová, Viktor Weiss, René Jura, Petr Geier, Petra Reková, Daniel Václavík, Martin Šrámek, Robert Mikulík and Roman Herzig
J. Clin. Med. 2026, 15(5), 1691; https://doi.org/10.3390/jcm15051691 - 24 Feb 2026
Viewed by 421
Abstract
Background: Intravenous thrombolysis (IVT), used in acute ischemic stroke (AIS), may be complicated by the development of intracranial hemorrhage. The role of fibrinogen levels, including their decrease, as a possible predictor of intracranial hemorrhage, has not yet been fully clarified. We aimed [...] Read more.
Background: Intravenous thrombolysis (IVT), used in acute ischemic stroke (AIS), may be complicated by the development of intracranial hemorrhage. The role of fibrinogen levels, including their decrease, as a possible predictor of intracranial hemorrhage, has not yet been fully clarified. We aimed to evaluate the association between fibrinogen levels and their decrease 6 and 24 h after IVT and the risk of parenchymal hematoma (PH), as the clinically most significant type of intracranial hemorrhage. Methods: In an observational, nationwide, multicenter study, data from adult patients who underwent IVT for AIS from the Registry of Stroke Care Quality (RES-Q) in the Czech Republic (2019–2021) were analyzed. An association between fibrinogen levels and their decrease 6 and 24 h after IVT and the risk of PH was assessed. Results: We analyzed a set of 27 patients with PH (13 males; median age 78.0 years) and a control group (CG) of 97 patients without intracranial hemorrhage (58 males; median age 78.0 years). Fibrinogen levels 6 h after IVT (median 1.93 [PH] vs. 2.57 [CG] g/L, p = 0.012) and the ratio of baseline fibrinogen to fibrinogen 6 h after IVT (median 1.78 [PH] vs. 1.26 [CG]; p = 0.008) were associated with the development of PH. The optimal cut-off value of fibrinogen 6 h after IVT for predicting PH was <2.0 g/L. Conclusions: Fibrinogen levels 6 h after IVT and the ratio of baseline fibrinogen to fibrinogen 6 h after IVT are associated with an increased risk of PH in patients with acute ischemic stroke treated with IVT. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke Management Strategies)
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15 pages, 875 KB  
Communication
Thrombus Composition and the Evolving Role of Tenecteplase in Acute Ischemic Stroke
by Senta Frol and Matija Zupan
J. Clin. Med. 2025, 14(24), 8675; https://doi.org/10.3390/jcm14248675 - 7 Dec 2025
Cited by 1 | Viewed by 821
Abstract
Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide, requiring rapid reperfusion to minimize damage. Current treatments, including intravenous thrombolysis (IVT) with alteplase (rt-PA) and mechanical thrombectomy (MT), face limitations such as thrombolysis resistance, dosing complexity, and reduced efficacy [...] Read more.
Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide, requiring rapid reperfusion to minimize damage. Current treatments, including intravenous thrombolysis (IVT) with alteplase (rt-PA) and mechanical thrombectomy (MT), face limitations such as thrombolysis resistance, dosing complexity, and reduced efficacy in large vessel occlusions (LVOs) or fibrin-rich clots. Tenecteplase (TNK), a bioengineered thrombolytic agent with superior pharmacokinetics, simplified administration, and higher fibrin specificity, offers promising advantages over rt-PA, including potential synergy with MT and efficacy against resistant thrombi. Direct oral anticoagulants (DOACs) further complicate AIS management, but evidence suggests that DOAC-treated patients may experience better thrombolysis outcomes due to distinct thrombus characteristics. Advances in imaging now enable precise visualization of vessel occlusion and treatment effects, opening opportunities to refine therapies. Combination approaches targeting fibrin thrombus components may enhance thrombolysis and improve outcomes in resistant cases. Future research should explore TNK’s role in intra-arterial (IA) applications, combination therapies, and its interaction with MT to optimize reperfusion strategies. TNK’s simplified use and promising efficacy position it as a potential breakthrough in AIS management, with the potential to improve functional recovery and reduce treatment complexity. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke Management Strategies)
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11 pages, 1529 KB  
Article
Evaluation of Intracranial Arteriovenous Malformations Using Ischemic Stroke Color-Coded Maps Software, a New Rapid Post-Processing Tool in CT Angiography
by Francesco D’Argento, Tommaso Verdolotti, Rosa D’Abronzo, Davide De Leoni, Emanuele Ferravante, Francesco Arbia, Marta Iacobucci, Simona Gaudino, Matteo Mancino, Chiara Schiarelli, Giuseppe Garignano and Alessandro Pedicelli
J. Clin. Med. 2025, 14(16), 5833; https://doi.org/10.3390/jcm14165833 - 18 Aug 2025
Viewed by 1602
Abstract
Background/Objectives: In patients with intracranial arteriovenous malformation (AVM), the first diagnostic analysis is often performed in emergency conditions by Computed Tomography (CT) and multiphase CT angiography (CTA). Nevertheless, once ruptured, an AVM might be hardly recognized by an inexperienced neuroradiologist, due to [...] Read more.
Background/Objectives: In patients with intracranial arteriovenous malformation (AVM), the first diagnostic analysis is often performed in emergency conditions by Computed Tomography (CT) and multiphase CT angiography (CTA). Nevertheless, once ruptured, an AVM might be hardly recognized by an inexperienced neuroradiologist, due to the presence of hematoma or to the destructuring of the lesion. The aim of our study is to outline the utility of color-coded maps derived from multiphase CT angiography in the assessment of cerebral AVMs, evaluating inter-observer agreement between radiologists with different years’ experience and comparing the results with the gold standard, angiography. Methods: The color-coded maps were obtained retrospectively by multiphase CT angiography on a workstation using FastStroke software ColorViz (GE Healthcare, Milwaukee, WI, USA). The color-coded maps were evaluated, independently, by two neuroradiologists, and inter-observer agreement was evaluated. Finally, the AVM’s features (arterial feeders, nidus type, venous drainage type) obtained with color-coded maps were compared with angiographic analysis. The Ethical Committee for Research in Medical Imaging approved this study (Institutional Review Board number 6467). Informed consent was obtained for every patient. Results: A total of 26 patients with intracranial hemorrhage and arteriovenous malformation underwent multiphase CT angiography and were analyzed. Our statistical analysis showed the reproducibility of the color-coded maps and agreement with the angiographic findings, especially in the evaluation of venous drainage type. Conclusions: The ColorViz color-coded maps have proved to be an effective tool in the identification and assessment of AVMs, providing rapid and clear information on intracranial vascular dynamics, even for inexperienced radiologists. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke Management Strategies)
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Review

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23 pages, 761 KB  
Review
Deep Vein Thrombosis Prevention in Acute Ischemic Stroke Patients with Lower Limb Paralysis: A Narrative Review
by Jianyu Peng, Shiyan Long and Ling Feng
J. Clin. Med. 2026, 15(6), 2091; https://doi.org/10.3390/jcm15062091 - 10 Mar 2026
Cited by 1 | Viewed by 721
Abstract
Patients with lower limb paralysis following acute ischemic stroke (AIS) are at a markedly increased risk of deep vein thrombosis (DVT), which may lead to pulmonary embolism and substantially higher mortality and disability. This review comprehensively reviews studies from the past decade on [...] Read more.
Patients with lower limb paralysis following acute ischemic stroke (AIS) are at a markedly increased risk of deep vein thrombosis (DVT), which may lead to pulmonary embolism and substantially higher mortality and disability. This review comprehensively reviews studies from the past decade on the epidemiology, pathophysiology, and prevention of DVT in AIS patients with lower limb paralysis. The pathogenesis of DVT in this population is multifactorial, involving venous stasis due to immobility, stroke-induced hypercoagulability, endothelial dysfunction, neutrophil extracellular trap-mediated immunothrombosis, and autonomic dysregulation. Effective prevention requires individualized risk stratification, integrating clinical assessment, biomarkers, and imaging tools. Current prophylactic strategies include pharmacological anticoagulation (primarily low-molecular-weight heparin), mechanical interventions (such as intermittent pneumatic compression), and early mobilization and rehabilitation. While combined approaches have demonstrated significant benefits, challenges remain regarding the timing of anticoagulation, balancing bleeding risks, extended thromboprophylaxis, and novel immunothrombosis targets. Future research should focus on personalized prevention protocols, the application of artificial intelligence-based predictive models, and innovative therapies targeting endothelial injury and immune-mediated thrombosis, aiming to improve thromboprophylaxis and overall outcomes in this high-risk population. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke Management Strategies)
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35 pages, 3665 KB  
Review
Parent Artery Disease-Related Stroke: What Is the Impact on Endovascular Treatment? A Narrative Review
by Marialuisa Zedde, Francesca Romana Pezzella, Piergiorgio Lochner and Rosario Pascarella
J. Clin. Med. 2026, 15(3), 983; https://doi.org/10.3390/jcm15030983 - 26 Jan 2026
Viewed by 708
Abstract
Background/Objectives: Parent artery disease (PAD) is a significant yet often overlooked contributor to ischemic strokes, particularly affecting the perforating arteries. This study aims to evaluate the impact of PAD on endovascular treatment outcomes in patients with intracranial atherosclerosis. Methods: A narrative review was [...] Read more.
Background/Objectives: Parent artery disease (PAD) is a significant yet often overlooked contributor to ischemic strokes, particularly affecting the perforating arteries. This study aims to evaluate the impact of PAD on endovascular treatment outcomes in patients with intracranial atherosclerosis. Methods: A narrative review was conducted, synthesizing the existing literature on PAD and its relationship with endovascular interventions. Key studies were analyzed to assess the effectiveness of imaging techniques like high-resolution Magnetic Resonance Imaging (MRI) and the implications of plaque morphology on treatment strategies. Results: The findings indicate that PAD significantly complicates endovascular procedures, often leading to perforating artery occlusions and increased rates of stroke recurrence. Patients with PAD-related strokes demonstrated larger lesion volumes and more severe neurological deficits compared to those with small vessel disease. The review highlights the challenges of accurately diagnosing PAD using conventional imaging techniques, emphasizing the need for advanced modalities to identify atheromatous plaques that may not cause significant stenosis. Conclusions: The study underscores the necessity for a shift in clinical practice towards recognizing and managing PAD in patients with ischemic strokes. Enhanced imaging techniques and tailored endovascular strategies are essential to improve patient outcomes and minimize the risk of recurrent strokes. Further research is needed to establish comprehensive guidelines for addressing PAD in acute stroke management. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke Management Strategies)
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