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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 (30 November 2022) | Viewed by 19547

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Prof. Dr. Theodoros Karapanayiotides

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Guest Editor

2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Medicine, Faculty of Health Sciences, Thessaloniki, Greece
Interests: stroke; cryptogenic stroke; patent foramen ovale; neurosonology

Prof. Dr. Christos Krogias

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Guest Editor

Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44801 Bochum, Germany
Interests: stroke; sonography; ultrasound; ultrasound imaging; neuroimaging; neurology

Special Issue Information

Dear Colleagues,

Despite the COVID-19 pandemic surge, cerebrovascular disorders continue to represent major causes of disability and mortality worldwide. In recent years, we have witnessed the milestone of mechanical thrombectomy in acute stroke treatment. Further advances in stroke diagnosis and treatment include the application of reperfusion therapies in an extended time window based on advanced neuroimaging, better understanding of the underlying etiologies of cryptogenic stroke, the establishment of transdermal closure in selected patients with PFO-associated stroke, promising minimally invasive techniques for hematoma evacuation, and insights into the mechanisms of stroke-associated neuroinflammation and neurorepair emphasizing on sex and age. It is commonplace to state that for every question answered in clinical medicine and in basic science, multiple new queries and debates arise.

In this Special Issue of JCM, we aim to focus on all promising and developing areas of clinical and basic stroke research, covering fields from experimental ischemia and neuroprotection in the era of endovascular therapies to epidemiology of underrecognized vascular risk factors, brain–heart interaction, and optimization of selection criteria for PFO closure. Research highlighting evolving treatment and prevention paradigms, diagnostic techniques, and pathophysiology of stroke using a multidisciplinary precision-medicine-oriented approach would lie at the core of this Special Issue.

Prof. Dr. Theodoros Karapanayiotides
Prof. Dr. Christos Krogias
Guest Editors

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Keywords

stroke
thrombolysis
thrombectomy
recanalization
stroke prevention
cryptogenic stroke
PFO-associated stroke
stroke rehabilitation
stroke imaging
neurosonology
COVID-19-associated stroke

Published Papers (10 papers)

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Editorial

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4 pages, 182 KiB

Open AccessEditorial

Editorial: New Advances in Cerebrovascular Disorders

by Theodoros Karapanayiotides and Christos Krogias

J. Clin. Med. 2023, 12(18), 5877; https://doi.org/10.3390/jcm12185877 - 10 Sep 2023

Viewed by 544

Abstract

Cerebrovascular disorders constitute major causes of disability and mortality worldwide [...] Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

Research

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9 pages, 261 KiB

Open AccessArticle

Intima-Media Thickness and Pulsatility Index of Common Carotid Arteries in Acute Ischaemic Stroke Patients with Diabetes Mellitus

by Olivier Bill, Michael V. Mazya, Patrik Michel, Tiago Prazeres Moreira, Dimitris Lambrou, Ivo A. Meyer and Lorenz Hirt

J. Clin. Med. 2023, 12(1), 246; https://doi.org/10.3390/jcm12010246 - 29 Dec 2022

Cited by 6 | Viewed by 1799

Abstract

Ultrasonographic parameters such as the common carotid artery (CCA) pulsatility index (PI) and CCA intima-media thickness (IMT) have been associated with an increased mortality and risk of recurrent stroke, respectively. We hypothesized that these ultrasonographic parameters may be useful for monitoring diabetic patients after an acute stroke. We analysed retrospective data of consecutive acute ischaemic stroke patients from the ASTRAL registry who underwent pre-cerebral ultrasonographic evaluation within 7 days of symptom onset. We compared clinical, demographic, radiological and ultrasonographic parameters in diabetic versus non-diabetic patients (univariable and multivariable analyses) and the association of these parameters with CCA PI and CCA IMT. We analysed 1507 carotid duplex ultrasound examinations from patients with a median age of 74 years. Cardiovascular co-morbidities, including hypertension, hypercholesterolemia, obstructive sleep apnoea syndrome, higher body-mass index (BMI) and peripheral artery disease, were associated with diabetes mellitus (DM). Diabetics were more often under antiplatelet therapy and had atrial fibrillation at admission. Diabetic patients showed an increased CCA PI and IMT in line with more atherosclerotic changes on acute CTA compared to non-diabetic patients. Taking IMT as the dependent variable in a second analysis, DM, higher age, hypertension, smoking and CCA PI were associated with higher IMT. Taking CCA PI as the dependent variable in a third analysis, DM, higher age and higher NIHSS at admission were associated with higher CCA PI values. Increased IMT was also associated with higher PI. We show that CCA PI and IMT are higher in diabetic patients in the first week after an initial stroke. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

9 pages, 650 KiB

Open AccessArticle

Leukocyte Count Predicts Carotid Artery Stenosis in Men with Ischemic Stroke: Sub Study of the Preventive Antibiotics in Stroke Study (PASS)

by Twan J. van Velzen, Jeffrey Stolp, Willeke F. Westendorp, Yvo B. W. E. M. Roos, Diederik van de Beek and Paul J. Nederkoorn

J. Clin. Med. 2022, 11(24), 7286; https://doi.org/10.3390/jcm11247286 - 08 Dec 2022

Cited by 1 | Viewed by 871

Abstract

Background: Inflammation is important in the development of atherosclerosis. Research suggested sex-dependent differences for the value of inflammatory markers for risk stratification of stroke patients with internal carotid artery stenosis (ICAS). We investigated whether leukocytes and thrombocytes were associated with ≥50% ICAS in acute stroke and whether this was sex-dependent. Patients included in the Preventive Antibiotics in Stroke Study (PASS) were used. PASS is a randomized controlled trial that randomized between four days of preventive ceftriaxone intravenously or standard stroke care alone. It investigated whether ceftriaxone could improve functional outcome at three months after stroke. Methods: Patients included in PASS were evaluated for the predictive value of leukocytes and thrombocytes for ICAS. Ischemic stroke and TIA patients were selected out of PASS patients. Logistic regression analysis was performed adjusting for NIHSS and other covariates. Results: 2550 patients were included in PASS. 1413 of 2550 patients (55%) were evaluated in this sub study. Female patients showed a mean of 8.55 × 10⁹/L for leukocytes and 259 × 10⁹/L for thrombocytes. Men showed a mean of 8.29 × 10⁹/L for leukocytes and 224 × 10⁹/L for thrombocytes. Multivariate logistic regression analysis showed that leukocytes were independently associated with ICAS ≥ 50% in male patients (OR 1.094, p = 0.008), but not in female patients (OR 1.041, p = 0.360). Thrombocytes were not associated with ICAS. Conclusions: We conclude that blood leukocyte count independently predicts ICAS in men after acute stroke, but not in women. Clinical Trial unique identifier: ISRCTN66140176. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

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9 pages, 579 KiB

Open AccessArticle

Clinical Characteristics and Prognostic Factors of Non-Infectious Cerebral Venous Sinus Thrombosis

by Yu-Chieh Chen, Chun-Wei Chang, Hsiu-Chuan Wu, Chiung-Mei Chen, Chien-Hung Chang and Kuo-Hsuan Chang

J. Clin. Med. 2022, 11(20), 6096; https://doi.org/10.3390/jcm11206096 - 16 Oct 2022

Cited by 2 | Viewed by 1468

Abstract

Non-infectious cerebral venous thrombosis (CVT) is an uncommon type of cerebrovascular disease that usually affects young patients. It occurs frequently in female patients, probably due to the association of sex-specific risk factors for coagulopathies. Currently, the prognostic factors of CVT remain unclear. We retrospectively reviewed the clinical characteristics among 260 CVT patients, including 147 females and 113 males. A favorable clinical outcome was defined by the scores of the modified Rankin Scale (mRS) ≤ 2 at hospital discharge, while a poor clinical outcome was defined by an mRS score of 3 to 6. A headache (28.5%) was the most frequent presentation. The most commonly affected sinus was the transverse-sigmoid sinus (59.6%). Most of the cases (78.5%) were treated with anticoagulants. One hundred and fifty-seven patients (60.4%) were discharged with favorable clinical outcomes. Consciousness disturbance (odds ratio: 5.01, p < 0.001) was associated with a poor clinical outcome. Patients with poor clinical outcomes demonstrated higher D-dimer levels on admission (4137.76 ± 3317.07 vs. 2476.74 ± 2330.87 ng/mL FEU, p = 0.029) and longer hospitalization days (31.81 ± 26.29 vs. 13.96 ± 8.82 days, p < 0.001) compared with favorable clinical outcomes. These findings provide important information of clinical characteristics and prognosis for CVT. Aggressive monitoring and treatment should be considered in CVT patients with poor prognostic factors. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

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12 pages, 1599 KiB

Open AccessArticle

Vascular and Vasogenic Manifestations of Systemic ANCA-Associated Vasculitis with Renal Involvement in Non-Contrast Brain MRI in Patients with Acute Disease Onset

by Arkadiusz Lubas, Jacek Staszewski, Artur Maliborski, Magdalena Mosakowska, Grzegorz Spłocharski, Anna Bilbin-Bukowska, Izabela Wołoszyńska, Renata Piusińska-Macoch, Daniel Pałka, Arkadiusz Zegadło and Stanisław Niemczyk

J. Clin. Med. 2022, 11(16), 4863; https://doi.org/10.3390/jcm11164863 - 19 Aug 2022

Cited by 4 | Viewed by 1455

Abstract

Background. Data concerning central nervous system (CNS) alterations in ANCA-associated vasculitis with renal involvement (AAVR) are sparse. The study aimed to assess vascular and vasogenic brain alterations in patients with acute onset of AAVR and the applicability of non-contrast magnetic resonance imaging (MRI) techniques in this diagnosis. Methods. Thirty-eight patients with acute onset of AAVR were included in the study. BVAS/WG, c-ANCA, p-ANCA, renal function and perfusion, neurological assessment, and brain MRI were performed. Results. Cerebral vascular alternating narrowing and dilatation (VAND) was detected in 42.1% of patients, and the black-blood was significantly more diagnostic than the TOF technique (p < 0.001). VAND occurrence was independently associated with the concentration of p-ANCA. The vasogenic white matter lesions (VWML) were found in 94.4% of patients, and in their detection, SWAN was significantly better than the FLAIR technique (p = 0.002). The number of VWML correlated with age and cranial nerve damage. Hemosiderin deposits were found in 21.6% of patients and were associated with a gait impairment and paresthesia. Conclusions. Vascular and vasogenic alterations in the CNS are frequent in patients with acute onset of systemic ANCA-associated vasculitis with renal involvement. Non-contrast MRI is useful in the diagnosis of brain vasculitis. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

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10 pages, 243 KiB

Open AccessArticle

Pneumonia in Acute Ischemic Stroke Patients with Proximal Occlusions within the Anterior Circulation after Endovascular Therapy or Systemic Thrombolysis

by Henning Muhl, Christian Roth, Andreas Schröter, Maria Politi, Maria Alexandrou, Janina Dahl, Susanne Gindorf, Panagiotis Papanagiotou and Andreas Kastrup

J. Clin. Med. 2022, 11(3), 482; https://doi.org/10.3390/jcm11030482 - 18 Jan 2022

Cited by 2 | Viewed by 1355

Abstract

While endovascular treatment (ET) improves clinical outcomes in patients with proximal vessel occlusions compared to thrombolysis (IVT), the impact of ET on the frequency of stroke-associated pneumonia (SAP) is uncertain. We compared the rates of SAP in patients with large vessel occlusions in the anterior circulation after IVT or ET. We also determined risk factors for SAP, as well as the impact of SAP on early clinical outcomes. A total of 544 patients were treated with IVT, and 1061 patients received ET (with or without IVT). The rates of SAP did not differ significantly between ET (217/1061; 20%) and IVT (100/544; 18%) (p = 0.3). Overall, the occurrence of SAP was significantly associated with mortality and a poor clinical outcome. In the multivariable regression analysis, age, sex, the presence of dysphagia, early signs of ischemia on imaging and a history of stroke and mechanical ventilation were all significantly associated with the occurrence of SAP. In patients with large vessel occlusions, the introduction of ET did not result in lower rates of SAP compared with IVT. There is an ongoing need to reduce the rates of SAP in this patient population, for which the risk factors found here could become useful. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

8 pages, 1243 KiB

Open AccessArticle

Selective Serotonin Reuptake Inhibitors for the Prevention of Post-Stroke Depression: A Systematic Review and Meta-Analysis

by Daniel Richter, Jeyanthan Charles James, Andreas Ebert, Aristeidis H. Katsanos, Lisa Mazul-Wach, Quirin Ruland, Ralf Gold, Georg Juckel and Christos Krogias

J. Clin. Med. 2021, 10(24), 5912; https://doi.org/10.3390/jcm10245912 - 16 Dec 2021

Cited by 11 | Viewed by 2606

Abstract

There are controversial data on the efficacy and safety profile of selective serotonin reuptake inhibitors (SSRIs) to prevent post-stroke depression (PSD). We performed a systematic search in MEDLINE and SCOPUS databases to identify randomized-controlled trials questioning the use of early SSRI therapy in the post-stroke population and its effect on PSD incidence. We included 6 studies with 6560 participants. We extracted the data on PSD occurrence in association with the treatment arm (SSRI versus placebo), as reported by each study. For safety analysis, we extracted the information on adverse events. A random-effects model was used to calculate the pooled relative risk estimates. Early SSRI therapy was associated with a significant reduction of PSD occurrence compared to placebo (10.4% versus 13.8%; relative risk: 0.75 [95% CI, 0.66–0.86]; absolute risk reduction: 3.4%). SSRI therapy increases the risk of bone fracture (RR 2.28 [95% CI, 1.58–3.30]) and nausea (RR 2.05 [95% CI, 1.10–3.82]) in the post-stroke population. Considering the risk-benefit ratio of early SSRI therapy in the post-stroke population, future research should identify high-risk patients for PSD to improve the risk-benefit consideration of this therapy for use in clinical practice. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

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12 pages, 1390 KiB

Open AccessArticle

Omentin Is Independently Associated with Stroke Severity and Ipsilateral Carotid Artery Stenosis in Patients with Acute Cerebral Ischemia

by Maria Chondrogianni, Vaia Lambadiari, Aristeidis H. Katsanos, Maria Ioanna Stefanou, Lina Palaiodimou, Alexandros Stavros Triantafyllou, Georgios Karagiannis, Vasileios Konstantakos, Michael Ioakeimidis, Sokratis Triantafyllou, Christina Zompola, Chryssa Liantinioti, Alexandra Pappa, Ioannis Rizos, Konstantinos Voumvourakis, Georgios Tsivgoulis and Eleni Boutati

J. Clin. Med. 2021, 10(24), 5797; https://doi.org/10.3390/jcm10245797 - 11 Dec 2021

Cited by 4 | Viewed by 1864

Abstract

Mounting evidence indicates an association between adipokines and inflammation-related atherosclerosis. Here, we sought to investigate the association of vaspin and omentin with clinical characteristics and outcomes of patients with acute cerebral ischemia (ACI). Consecutive ACI patients were evaluated within 24 h from symptom-onset. Stroke aetiology was classified using TOAST criteria. Adipokines were assayed using quantikine enzyme immunoassay commercially available kits. Stroke severity was assessed by NIHSS-score, and ipsilateral carotid stenosis (≥50% by NASCET criteria) by ultrasound and CT/MR angiography. Major cerebrovascular events were assessed at three months. We included 135 ACI patients (05 (78%) and 30 (22%) with acute ischemic stroke and transient ischemic attack, respectively; mean age ± SD: 59 ± 10 years; 68% men; median NIHSS-score: 3 (IQR:1–7)). Omentin was strongly correlated to admission stroke severity (Spearman rho coefficient: +0.303; p < 0.001). Patients with ipsilateral carotid stenosis had higher omentin levels compared to patients without stenosis (13.3 ± 8.9 ng/mL vs. 9.5 ± 5.5 ng/mL, p = 0.014). Increasing omentin levels were independently associated with higher stroke severity (linear regression coefficient = 0.290; 95%CI: 0.063–0.516; p = 0.002) and ipsilateral carotid stenosis (linear regression coefficient = 3.411; 95%CI: 0.194–6.628; p = 0.038). No association of vaspin with clinical characteristics and outcomes was found. Circulating omentin may represent a biomarker for the presence of atherosclerotic plaque, associated with higher stroke severity in ACI patients. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

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Review

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21 pages, 4421 KiB

Open AccessReview

Advances in Noninvasive Carotid Wall Imaging with Ultrasound: A Narrative Review

by Maria Alexandratou, Angeliki Papachristodoulou, Xin Li, Sasan Partovi, Andjoli Davidhi, Vasileios Rafailidis, Panos Prassopoulos, Vasileios Kamperidis, Ioanna Koutroulou, Georgios Tsivgoulis, Nikolaos Grigoriadis, Christos Krogias and Theodore Karapanayiotides

J. Clin. Med. 2022, 11(20), 6196; https://doi.org/10.3390/jcm11206196 - 20 Oct 2022

Cited by 6 | Viewed by 4675

Abstract

Carotid atherosclerosis is a major cause for stroke, with significant associated disease burden morbidity and mortality in Western societies. Diagnosis, grading and follow-up of carotid atherosclerotic disease relies on imaging, specifically ultrasound (US) as the initial modality of choice. Traditionally, the degree of carotid lumen stenosis was considered the sole risk factor to predict brain ischemia. However, modern research has shown that a variety of other imaging biomarkers, such as plaque echogenicity, surface morphology, intraplaque neovascularization and vasa vasorum contribute to the risk for rupture of carotid atheromas with subsequent cerebrovascular events. Furthermore, the majority of embolic strokes of undetermined origin are probably arteriogenic and are associated with nonstenosing atheromas. Therefore, a state-of-the-art US scan of the carotid arteries should take advantage of recent technical developments and should provide detailed information about potential thrombogenic (/) and emboligenic arterial wall features. This manuscript reviews recent advances in ultrasonographic assessment of vulnerable carotid atherosclerotic plaques and highlights the fields of future development in multiparametric arterial wall imaging, in an attempt to convey the most important take-home messages for clinicians performing carotid ultrasound. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

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Other

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14 pages, 656 KiB

Open AccessSystematic Review

Mechanical Thrombectomy for Acute Ischemic Stroke in Patients with Malignancy: A Systematic Review

by Athina-Maria Aloizou, Daniel Richter, Jeyanthan Charles James, Carsten Lukas, Ralf Gold and Christos Krogias

J. Clin. Med. 2022, 11(16), 4696; https://doi.org/10.3390/jcm11164696 - 11 Aug 2022

Cited by 6 | Viewed by 1666

Abstract

Background: Ischemic stroke is a common occurrence in patients with concomitant malignancy. Systemic thrombolysis is often contraindicated in these patients, and mechanical thrombectomy (MT) is the preferred method of intervention. This review aims to collect the available data on the safety and efficacy of MT in cancer patients (CPs).Methods: The PubMed/MEDLINE and SCOPUS databases were systematically searched for studies assessing safety (mortality, intracranial hemorrhage) and efficacy (reperfusion, functional outcome) indices in CPs receiving MT. Potentially relevant parameters examined in solitary studies were also extracted (e.g., stroke recurrence, brain malignancy).Results: A total of 18 retrospective studies of various methodologies and objectives were identified. Rates of in-hospital mortality, intracranial hemorrhage of any kind, reperfusion rates, and discharge condition did not seem to present any considerable differences between CPs and patients without cancer. On the contrary, 90-day mortality was higher and 90-day functional independence was lower in CPs. Three studies on cancer-related stroke (no other identifiable etiology and high D-dimer levels in the presence of active cancer) showed constant tendencies towards unfavorable conditions. Conclusions: Per the available evidence, MT appears to be a safe treatment option for CPs. It is still unclear whether the 90-day mortality and outcome rates are more heavily influenced by the malignancy and not the intervention itself, so MT can be considered in CPs with prospects of a good functional recovery, undertaking an individualized approach. Full article

(This article belongs to the Special Issue New Frontiers in Cerebrovascular Disorders)

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