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Current Advances and Future Perspectives 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: 25 August 2026 | Viewed by 5052

Editor


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Guest Editor
Institute of Neuroscience, Italian National Research Council (CNR), 50019 Florence, Italy
Interests: dementia; Alzheimer’s diseases; Parkinson’s disease; polyneuropathies; stroke; stroke care; stroke hospital networks; translational stroke research
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Special Issue Information

Dear Colleagues,

This year, 2025, marks the thirtieth anniversary of the introduction of thrombolysis in treatments of acute ischemic stroke. For the first time ever, it became possible to “cure” ischemic stroke. In 1995, for the first time, a clinical NINDS trial successfully applied the penumbral concept, showing a positive outcome in acute stroke patients who underwent tPA intravenous infusion within 3 hours from the stroke onset.

This was followed by advanced research in brain imaging, thereby confirming the largely variable time course of the so called “penumbral battleground”. Endovascular treatments, which were introduced in clinical practice around 10 years ago, have added a complementary strong instrument to reverse the progression of the penumbral sufference (even after many more hours from stroke onset in carefully selected patients). Moreover, innovative technologies, including artificial intelligence, are reshaping and supporting stroke care.

Nevertheless, the entire spatiotemporal evolution of stroke pathology needs to be better understood—both before and after the ischemic event—when reperfusion and neuroprotection are key targets, as well as days, weeks, or months after the stroke happened, when repair and regeneration are relevant targets.

This Special Issue aims at attracting the interest of the entire stroke research community, highlighting both the challenges and the opportunities of recent advancements in preclinical and clinical knowledge of pathophysiology mechanisms of ischemic stroke.

We look forward to receiving your contributions.

Dr. Marzia Baldereschi
Guest Editor

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Keywords

  • acute ischemic stroke care
  • neuroimaging in ischemic stroke
  • alteplase and tenecteplase
  • endovascular treatments
  • recanalization and reperfusion
  • prognostication in stroke patients
  • blood–brain barrier in ischemic stroke
  • bi-omarkers in ischemic stroke
  • omics in stroke

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Published Papers (2 papers)

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Research

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10 pages, 1678 KB  
Article
Deep Medullary Vein Asymmetry and Clinical Outcomes in Patients with Ischemic Stroke and Successful Endovascular Treatment
by Giorgio Busto, Francesco Arba, Simone Ferretti, Mattia Tripari, Guido Fanfani, Giovanni Noto, Andrea Lastrucci, Angelo Barra, Alessandro Fiorenza, Sara Mancini, Cosimo Nardi, Davide Gadda, Andrea Ginestroni and Enrico Fainardi
J. Clin. Med. 2026, 15(10), 3813; https://doi.org/10.3390/jcm15103813 - 15 May 2026
Cited by 1 | Viewed by 390
Abstract
Background: Deep medullary vein (DMV) drainage has been suggested as a new biomarker for predicting clinical outcomes in patients with acute ischemic stroke (AIS). We evaluated this hypothesis in patients who received endovascular treatment (EVT) within 24 h of symptom onset. Methods: We [...] Read more.
Background: Deep medullary vein (DMV) drainage has been suggested as a new biomarker for predicting clinical outcomes in patients with acute ischemic stroke (AIS). We evaluated this hypothesis in patients who received endovascular treatment (EVT) within 24 h of symptom onset. Methods: We performed a retrospective study of consecutive AIS patients at a single institution treated with EVT achieving successful recanalization (final mTICI score ≥2b). DMV drainage was graded on a three-point scale (0-1-2) during the second peak venous phase of mCTA by assessing contrast filling, with grade 2 indicating a favorable DMV profile. Our primary outcomes were functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days, and ordinal mRS shift at 90 days. Secondary outcomes were excellent clinical status (mRS 0–1 at 90 days), hemorrhagic transformation, and symptomatic intracranial hemorrhage. We investigated independent associations using multivariable logistic and ordinal regression analyses as appropriate, adjusting for age, sex, baseline mRS, NIHSS at onset, occlusion site, intravenous thrombolysis, onset-to-CT time, and ASPECTS. Results: We included 506 patients; the mean age was 76 years. A favorable DMV profile was present in 394 (78%) patients. We found that DMV doubled the odds of achieving functional independence (OR = 2.22; 95% CI = 1.28–3.85) and was associated with a shift towards better functional outcomes in ordinal regression analysis (cOR = 1.93; 95% CI = 1.24–3.02), whereas we did not find any association between a favorable DMV profile and secondary outcomes. Conclusions: In AIS patients successfully recanalized with EVT, a favorable DMV profile was associated with better functional outcomes. Further investigations may clarify the clinical use and predictive ability of this novel radiological marker. Full article
(This article belongs to the Special Issue Current Advances and Future Perspectives of Ischemic Stroke)
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Review

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21 pages, 1354 KB  
Review
Clot Composition and Ischemic Stroke Etiology: A Contemporary Narrative Review
by Jacob Kosyakovsky, Christina P. Rossitto, Joseph P. Antonios, Daniela Renedo, Christopher J. Stapleton, Lauren H. Sansing, Dhasakumar S. Navaratnam, James A. Giles, Aman B. Patel, Charles C. Matouk and Nanthiya Sujijantarat
J. Clin. Med. 2025, 14(17), 6203; https://doi.org/10.3390/jcm14176203 - 2 Sep 2025
Cited by 4 | Viewed by 3910
Abstract
Acute ischemic stroke (AIS) is one of the leading global causes of mortality and morbidity. Clearer understanding of stroke etiology is a major clinical objective to determine appropriate strategies for secondary stroke prevention. Histological and molecular analysis of clots retrieved during mechanical thrombectomy [...] Read more.
Acute ischemic stroke (AIS) is one of the leading global causes of mortality and morbidity. Clearer understanding of stroke etiology is a major clinical objective to determine appropriate strategies for secondary stroke prevention. Histological and molecular analysis of clots retrieved during mechanical thrombectomy (MT) in AIS offers a unique opportunity to study clot composition and its relation to stroke etiology. The field of clot composition analysis has undergone substantial growth in recent years, driven in part by the establishment of MT as the standard of care, as well as its expanding indications. Although many features differ between large-artery atherosclerosis (LAA) and cardioembolic (CE) clots, application of these findings to predicting stroke etiology at a clinical level remains challenging. Moreover, a significant number of patients have multiple comorbidities or suffer a cryptogenic subtype. Next-generation techniques such as multiomic sequencing offer a powerful potential to elevate our understanding of clot pathology and provide the level of granularity required for clinical diagnosis and management. Herein, we provide an updated review of the current state of the field by exploring stroke etiologies and their relationship to clot pathology, including classic histologic features as well as more recent, emerging results from proteomic and transcriptomic analyses. Full article
(This article belongs to the Special Issue Current Advances and Future Perspectives of Ischemic Stroke)
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