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Recent Advances in Clinical Management of Ischemic Stroke
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Recent Advances in Clinical Management of 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: closed (15 August 2023) | Viewed by 11217

Special Issue Editors

Prof. Dr. Laurent Suissa

E-Mail Website1 Website2
Guest Editor
1. Stroke Unit, University Hospital, F-13005 Marseille, France
2. Centre de Recherche en CardioVasculaire et Nutrition (C2VN), F-13005 Marseille, France
Interests: ischemic stroke; neurology; atrial fibrillation; thrombectomy; stroke thrombolysis; neurological disorders; stroke rehabilitation; cerebral ischemia
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Anthony Faivre

E-Mail Website
Guest Editor
Military Teaching Saint Anne Hospital, F-83000 Toulon, France
Interests: ischemic stroke; neurology; atrial fibrillation; thrombectomy; stroke thrombolysis; neurological disorders; stroke rehabilitation; cerebral ischemia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The clinical management of ischemic strokes is a major public health issue. Stroke is one of the main causes of death, the first cause of acquired disability in adults and the second cause of dementia after Alzheimer’s disease. Ischemic strokes due to large vessel occlusion (LVO) represent 30–40% of all ischemic strokes and are associated with the highest morbidity and mortality. LVO stroke management remains challenging in acute phase and in secondary prevention.

During the last decade, many advances have significantly improved the prognosis of LVO stroke patients. Remarkable progress in the reperfusion treatment of stroke patients with acute LVO have led to improved clinical outcomes using mechanical thrombectomy in addition to intravenous thrombolysis. Despite the unquestionable value of this major advancement, new insights are required in order to improve the clinical outcome of LVO strokes. Furthermore, the etiological diagnosis of LVO stroke subtypes is crucial in order to determine the most effective secondary therapy to prevent stroke recurrence. Because atrial fibrillation is the main source of LVO strokes, its detection is a major challenge for stroke physicians, particularly in the case of covert paroxysmal atrial fibrillation in patients presenting with embolic stroke of undetermined source. New strategies must be proposed to improve secondary stroke prevention.

This JCM Special Issue dedicated to recent advances in the clinical management of ischemic stroke is an opportunity to provide new insights in LVO stroke management in acute phase, including secondary prevention. I invite you to contribute to this exciting Issue.

Prof. Dr. Laurent Suissa
Prof. Dr. Anthony Faivre
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

  • ischemic stroke
  • thrombolysis
  • mechanical thrombectomy
  • atrial fibrillation
  • secondary prevention

Related Special Issue

Published Papers (6 papers)

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19 pages, 646 KiB  
Article
Predicting Penumbra Salvage and Infarct Growth in Acute Ischemic Stroke: A Multifactor Survival Game
by Gaia Sirimarco, Davide Strambo, Stefania Nannoni, Julien Labreuche, Carlo Cereda, Vincent Dunet, Francesco Puccinelli, Guillaume Saliou, Reto Meuli, Ashraf Eskandari, Max Wintermark and Patrik Michel
J. Clin. Med. 2023, 12(14), 4561; https://doi.org/10.3390/jcm12144561 - 08 Jul 2023
Cited by 1 | Viewed by 1041
Abstract
Background. Effective treatment of acute ischemic stroke requires reperfusion of salvageable tissue. We investigated the predictors of penumbra salvage (PS) and infarct growth (IG) in a large cohort of stroke patients. Methods. In the ASTRAL registry from 2003 to 2016, we selected middle [...] Read more.
Background. Effective treatment of acute ischemic stroke requires reperfusion of salvageable tissue. We investigated the predictors of penumbra salvage (PS) and infarct growth (IG) in a large cohort of stroke patients. Methods. In the ASTRAL registry from 2003 to 2016, we selected middle cerebral artery strokes <24 h with a high-quality CT angiography and CT perfusion. PS and IG were correlated in multivariate analyses with clinical, biochemical and radiological variables, and with clinical outcomes. Results. Among 4090 patients, 551 were included in the study, 50.8% male, mean age (±SD) 66.3 ± 14.7 years, mean admission NIHSS (±SD 13.3 ± 7.1) and median onset-to-imaging-time (IQR) 170 (102 to 385) minutes. Increased PS was associated with the following: higher BMI and lower WBC; neglect; larger penumbra; absence of early ischemic changes, leukoaraiosis and other territory involvement; and higher clot burden score. Reduced IG was associated with the following: non-smokers; lower glycemia; larger infarct core; absence of early ischemic changes, chronic vascular brain lesions, other territory involvement, extracranial arterial pathology and hyperdense middle cerebral artery sign; and higher clot burden score. When adding subacute variables, recanalization was associated with increased PS and reduced IG, and the absence of haemorrhage with reduced IG. Collateral status was not significantly associated with IG nor with PS. Increased PS and reduced IG correlated with better 3- and 12-month outcomes. Conclusion. In our comprehensive analysis, multiple factors were found to be responsible for PS or IG, the strongest being radiological features. These findings may help to better select patients, particularly for more aggressive or late acute stroke treatment. Full article
(This article belongs to the Special Issue Recent Advances in Clinical Management of Ischemic Stroke)
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10 pages, 1059 KiB  
Article
Is Thrombocytopenia an In-Hospital Mortality Risk Factor among Patients with Acute Ischemic Stroke? A Propensity Score-Matched Analysis from the MIMIC-IV Database
by Yan-Ru Wang, Li-Yu Yang, Cho-Hao Lee, Shu-Hao Chang, Po-Huang Chen and Hong-Jie Jhou
J. Clin. Med. 2023, 12(2), 580; https://doi.org/10.3390/jcm12020580 - 11 Jan 2023
Cited by 1 | Viewed by 1760
Abstract
(1) Background: We aimed to evaluate the aspect of thrombocytopenia in patients with acute ischemic stroke (AIS); (2) Methods: Patients with AIS were recruited in the Medical Information Mart for Intensive Care IV database from 2008 to 2019. The thrombocytopenia was defined as [...] Read more.
(1) Background: We aimed to evaluate the aspect of thrombocytopenia in patients with acute ischemic stroke (AIS); (2) Methods: Patients with AIS were recruited in the Medical Information Mart for Intensive Care IV database from 2008 to 2019. The thrombocytopenia was defined as a platelet blood count of less than 150 K/µL. We compared the patient characteristics and clinical outcomes using propensity score matching (PSM); (3) Results: Thrombocytopenia affected 151 out of the 1236 patients (12.2%). Patients with thrombocytopenia were older (70.5 ± 12.8 vs. 68.4 ± 14.4; SMD = 0.154) and had a higher Charlson comorbidity index (7.3 ± 2.5 vs. 6.7 ± 2.7; SMD = 0.228) and acute physiology score III (44.8 ± 21.0 vs. 38.2 ± 19.1; SMD = 0.328) than those without thrombocytopenia. The risk of in-hospital mortality did not increase linearly or nonlinearly with a lower platelet count (overall p value = 0.794; nonlinear p value = 0.646). After PSM, 147 pairs remained. Thrombocytopenia was not linked with in-hospital mortality (HR: 1.06, 95% CIs: 0.60–1.88); (4) Conclusions: We described the clinical characteristics of patients admitted for thrombocytopenia and AIS who did not receive reperfusion therapy; additionally, we found that thrombocytopenia was not an independent short-term risk factor of in-hospital mortality. Full article
(This article belongs to the Special Issue Recent Advances in Clinical Management of Ischemic Stroke)
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13 pages, 901 KiB  
Article
Atrial Fibrillation Detected by Implantable Monitor in Embolic Stroke of Undetermined Source: A New Clinical Entity
by Salomé Snyman, Elena Seder, Marc David-Muller, Victor Klein, Emilie Doche, Laurent Suissa, Jean-Claude Deharo, Emmanuelle Robinet-Borgomano and Baptiste Maille
J. Clin. Med. 2022, 11(19), 5740; https://doi.org/10.3390/jcm11195740 - 28 Sep 2022
Cited by 1 | Viewed by 1396
Abstract
Background: High incidence of covert paroxysmal atrial fibrillation (CPAF) detected by an implantable cardiac monitor (ICM) is expected in embolic stroke of undetermined source (ESUS) patients. This study aimed to determine the CPAF rate in an ESUS cohort using ICMs and compare stroke [...] Read more.
Background: High incidence of covert paroxysmal atrial fibrillation (CPAF) detected by an implantable cardiac monitor (ICM) is expected in embolic stroke of undetermined source (ESUS) patients. This study aimed to determine the CPAF rate in an ESUS cohort using ICMs and compare stroke characteristics of patients with CPAF to those with known or inpatient-diagnosed AF (KIDAF). Methods: ESUS patients with ICMs were enrolled. ESUS diagnosis was defined as a non-lacunar stroke in the absence of symptomatic atherosclerotic stenosis (≥50%), no major-risk cardioembolic source, and no other specific cause. ESUS characteristics of patients with CPAF were compared to ESUS patients without CPAF and to KIDAF stroke patients. Results: During the median follow-up of 476 (371–615) days, CPAF was newly detected in 38/163 (23.31%) patients within 236 (115.50–510.75) days after the stroke. CPAF was independently associated to older age, coronaropathy, left atrial dilation, and atrial hyperexcitability, but not to stroke severity. Compared to KIDAF strokes, ESUS with CPAF had lower rates of proximal occlusion leading to milder clinical severity (NIHSS: 3.00 (1.00–8.25) vs. 14.50 (6.00–21.00)). Conclusions: Our study revealed a high proportion of CPAF in ESUS. We highlight that CPAF is a distinct clinical entity compared to KIDAF based on differences in stroke characteristics and AF diagnosis temporality. Full article
(This article belongs to the Special Issue Recent Advances in Clinical Management of Ischemic Stroke)
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11 pages, 1956 KiB  
Article
The Role of Nondiabetic Hyperglycemia in Critically Ill Patients with Acute Ischemic Stroke
by Hung-Sheng Shih, Wei-Sheng Wang, Li-Yu Yang, Shu-Hao Chang, Po-Huang Chen and Hong-Jie Jhou
J. Clin. Med. 2022, 11(17), 5116; https://doi.org/10.3390/jcm11175116 - 30 Aug 2022
Cited by 1 | Viewed by 1931
Abstract
In this study, we aim to elucidate the association between nondiabetic hyperglycemia and the short-term prognosis of critically ill patients with acute ischemic stroke. We extracted data using the Medical Information Mart for Intensive Care IV from 2008 to 2019. The primary outcomes [...] Read more.
In this study, we aim to elucidate the association between nondiabetic hyperglycemia and the short-term prognosis of critically ill patients with acute ischemic stroke. We extracted data using the Medical Information Mart for Intensive Care IV from 2008 to 2019. The primary outcomes were set as intensive care units (ICU) and in-hospital mortality. We developed a Cox proportional hazards model to determine the nonlinear association between serum glucose levels and primary outcomes. Of the 1086 patients included, 236 patients had hyperglycemia. Patients with hyperglycemia were associated with higher ages, female gender, higher Charlson Comorbidity Index scores, and higher Acute Physiology Score III scores. After propensity score matching, 222 pairs remained. The hyperglycemia group had a significantly higher ICU mortality (17.6% vs. 10.8%; p = 0.041). Meanwhile, no significant differences in ICU length of stay (5.2 vs. 5.2; p = 0.910), in-hospital mortality (26.6% vs. 18.9%, p = 0.054), and hospital length of stay (10.0 vs. 9.1; p = 0.404) were observed between the two groups. The Kaplan–Meier curves for ICU and in-hospital survival before matching suggested significant differences; however, after matching, they failed to prove any disparity. Non-diabetic patients with acute ischemic stroke have poor clinical characteristic while encountering hyperglycemic events; therefore, careful monitoring in the acute phase is still required. Full article
(This article belongs to the Special Issue Recent Advances in Clinical Management of Ischemic Stroke)
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13 pages, 1439 KiB  
Article
Right Cortical Infarction and a Reduction in Putamen Volume May Be Correlated with Empathy in Patients after Subacute Ischemic Stroke—A Multimodal Magnetic Resonance Imaging Study
by Jian-Feng Qu, Yue-Qiong Zhou, Jian-Fei Liu, Hui-Hong Hu, Wei-Yang Cheng, Zhi-Hao Lu, Lin Shi, Yi-Shan Luo, Lei Zhao and Yang-Kun Chen
J. Clin. Med. 2022, 11(15), 4479; https://doi.org/10.3390/jcm11154479 - 31 Jul 2022
Cited by 1 | Viewed by 1560
Abstract
Empathy has not been well studied in patients following ischemic stroke. We aimed to evaluate the relationships of multimodal neuroimaging parameters with the impairment of empathy in patients who had experienced subacute ischemic stroke. Patients who had experienced a first-event acute ischemic stroke [...] Read more.
Empathy has not been well studied in patients following ischemic stroke. We aimed to evaluate the relationships of multimodal neuroimaging parameters with the impairment of empathy in patients who had experienced subacute ischemic stroke. Patients who had experienced a first-event acute ischemic stroke were recruited, and we assessed their empathy using the Chinese version of the Empathy Quotient (EQ) 3 months after the index stroke. Multimodal magnetic resonance imaging (MRI) was conducted in all the participants to identify acute infarction and assess brain volumes, white matter integrity, and other preexisting abnormalities. We quantified the brain volumes of various subcortical structures, the ventricles, and cortical lobar atrophy. The microstructural integrity of the white matter was reflected in the mean fractional anisotropy (FA) and mean diffusivity (MD), and the regional mean values of FA and MD were quantified after mapping using the ICBM_DTI_81 Atlas. Twenty-three (56.1%) men and 18 (43.9%) women (mean age: 61.73 years, range: 41–77 years) were included. The median National Institutes of Health Stroke Scale (NIHSS) score at discharge was 1 (range: 0–4). On univariate analysis, the EQ was correlated with right cortical infarction (r = −0.39, p = 0.012), putamen volume (r = 0.382, p = 0.014), right putamen volume (r = 0.338, p = 0.031), and the FA value of the right sagittal stratum. EQ did not correlated with the MD value in any region of interest or pre-existing brain abnormalities. Multiple stepwise linear regression models were used to identify factors associated with EQ. After adjusting for age and the NIHSS score on admission, the frequency of right cortical infarcts negatively correlated with EQ (standardized β = −0.358, 95% confidence interval =−0.708 to −0.076, p = 0.016), and the putamen volume positively correlated with EQ (standardized β = 0.328, 95% confidence interval =0.044 to 0.676, p = 0.027). In conclusion, in patients who have experienced subacute ischemic stroke, right cortical infarction and a smaller putamen volume are associated with the impairment of empathy. Full article
(This article belongs to the Special Issue Recent Advances in Clinical Management of Ischemic Stroke)
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14 pages, 1736 KiB  
Systematic Review
Timing and Dose of Constraint-Induced Movement Therapy after Stroke: A Systematic Review and Meta-Regression
by Yu-Kai Yang, Chieh-Yu Lin, Po-Huang Chen and Hong-Jie Jhou
J. Clin. Med. 2023, 12(6), 2267; https://doi.org/10.3390/jcm12062267 - 15 Mar 2023
Viewed by 2715
Abstract
The aim of this study is to investigate the effects of constraint-induced movement therapy on stroke patients who had intact cognition and some voluntary finger extension and to identify optimal protocols to apply this therapy method. We searched PubMed, Cochrane Library, and Embase [...] Read more.
The aim of this study is to investigate the effects of constraint-induced movement therapy on stroke patients who had intact cognition and some voluntary finger extension and to identify optimal protocols to apply this therapy method. We searched PubMed, Cochrane Library, and Embase for randomized controlled trials conducted prior to January 2022. The outcomes included the Motor Activity Log, Fugl-Meyer Assessment, and Wolf Motor Function Test. The inverse variance method fixed-effect model as well as the DerSimonian and Laird estimator random-effects model were applied, and the mean difference was calculated with 95% confidence interval to measure continuous outcomes. Six randomized controlled trials involving a total of 169 patients with stroke were enrolled. Compared with conventional rehabilitation methods, there was no significant effect of constraint-induced movement therapy when evaluated by the Motor Activity Log, including the amount of use (random-effect, standardized mean difference 0.65; 95%, confidence interval: −0.23–1.52) and quality of movement (random-effect, standardized mean difference 0.60; 95% confidence interval: −0.19–1.39). However, among patients with chronic stroke symptoms, meta-regression analyses showed better performance with a constraint time of at least 6 h per day and 6 h training per week when assessing the amount of use (p = 0.0035) and quality of movement (p = 0.0031). Daily intervention time did not lead to a significant difference in functional upper limb performance. An efficient protocol of constraint-induced movement therapy designed as 6 h of training per week with 6 h constraint per day could bring significant stroke symptom improvement to patients with chronic stroke. Full article
(This article belongs to the Special Issue Recent Advances in Clinical Management of Ischemic Stroke)
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