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Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery

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A special issue of Neurology International (ISSN 2035-8377). This special issue belongs to the section "Movement Disorders and Neurodegenerative Diseases".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 14988

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Dr. Sonu M. M. Bhaskar

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1. Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
2. Global Health Neurology Lab and NSW Brain Clot Bank, Sydney, Australia
Interests: cerebrovascular disorders; stroke; biomarkers; social inequalities in health
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Special Issue Information

Dear Colleagues,

The treatment of acute ischemic stroke has altered significantly with the advent of reperfusion therapies, yet critical challenges related to the optimization of neuroprotection, the mitigation of secondary injury, and the enhancement of post-stroke recovery remain. This Special Issue, entitled "Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery", aims to present cutting-edge advancements that address these challenges and redefine stroke care, from hyperacute intervention to long-term functional restoration.

This Special Issue will explore the latest breakthroughs in thrombolysis, endovascular thrombectomy, and adjunctive neuroprotective strategies, providing mechanistic insights into ischemia–reperfusion injury, blood–brain barrier dysfunction, and inflammatory cascades. We particularly encourage contributions that address emerging molecular targets for neuroprotection, novel imaging biomarkers for precision therapy, and the integration of artificial intelligence into treatment decision-making.

Additionally, we seek high-impact studies on post-stroke recovery, including neuroplasticity-driven rehabilitation, brain–computer interfaces, neuromodulation, and personalized strategies that prevent stroke-related cognitive impairment. This Special Issue will particularly focus on translational research that integrates preclinical discoveries with real-world clinical applications, as well as approaches to health systems that reduce disparities and improve outcomes across diverse populations.

By compiling multidisciplinary articles concerning stroke pathophysiology, intervention, and recovery, this Special Issue aims to push the boundaries of stroke research and accelerate the transition toward precision medicine in cerebrovascular care.

Dr. Sonu M. M. Bhaskar
Guest Editor

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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. Neurology International is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

stroke
reperfusion therapy
imaging
biomarkers
disease burden
pathophysiology
stroke care
neuroprotective
post-stroke recovery

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Related Special Issue

Treatment Strategy and Mechanism of Acute Ischemic Stroke in Neurology International (14 articles)

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Research

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19 pages, 3560 KB

Open AccessArticle

Experimental Characterisation of Differently Composed Thrombus Entities with Spectral-Detector-CT

by Schekeb Aludin, Agreen Horr, Lars-Patrick Schmill, Carmen Wolf, Olav Jansen, Bodo Kurz, Julian Andersson, Svea Seehafer, Naomi Larsen, Patrick Langguth and Jens Trentmann

Neurol. Int. 2026, 18(2), 38; https://doi.org/10.3390/neurolint18020038 - 21 Feb 2026

Cited by 1 | Viewed by 638

Abstract

Background/Objectives: Thrombus composition influences the success of endovascular therapy in stroke, but conventional CT is limited in determining it. Spectral-detector-CT (SDCT) can apply material-decomposition and virtual monoenergetic (MonoE) imaging, which may provide a way to gain information on thrombus composition. This experimental study aimed to evaluate the differentiability of heterogeneous thrombi with variable red blood cell (RBC) content using SDCT. Methods: Ten thrombus entities with different compositions on RBC and plasma, thus fibrin content, were manufactured (volumetric RBC%/Plasma% = 90/10; 80/20; 70/30; 60/40; 50/50; 40/60; 30/70; 20/80; 10/90; 5/95) and scanned in an SDCT. Conventional Hounsfield-unit (HU) values, spectral electron density (ED), effective atomic number (Z-effective) and HU in MonoE maps ranging from 40– to 200 keV were evaluated for thrombus differentiation. Results: Conventional HU increased with RBC content, allowing us to differentiate the entities (p < 0.001). ED values also increased with RBC content and allowed for differentiation too (p < 0.001). Z-effective values showed no differences among the different entities (p > 0.05). Regarding the mass-attenuation curves from 40 to 200 keV the different thrombi showed a similar curve progression with highest HU values at 40 and lowest at 200 keV. The thrombi could be distinguished overall at each monoenergetic level by HU (p < 0.001 for each level). The absolute decrease in HU between 40 and 200 keV was thereby not significantly different between the different entities, but the relative decrease was, as it was more pronounced in thrombi with lower RBC content (p < 0.001). Conclusions: Spectral CT enables differentiation between thrombi with different RBC and fibrin contents by means of ED or analysis of the mass-attenuation curve. This offers alternative possibilities that go beyond characterisation based on CT-density alone. The additional inclusion of spectral parameters in thrombus diagnostics could therefore improve diagnosis and treatment. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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12 pages, 816 KB

Open AccessArticle

Blood–Brain Barrier Dysfunction, Edema Formation and Functional Recovery in Ischemic and Hemorrhagic Stroke: A Retrospective Study

by Christian A. Müller, Jochen A. Sembill, Bernd Kallmünzer, Maximilian Bailer, Ludwig Singer, Tobias Engelhorn, Arnd Dörfler, Stefan Schwab, Stefanie Balk and Maximilian I. Sprügel

Neurol. Int. 2025, 17(11), 177; https://doi.org/10.3390/neurolint17110177 - 1 Nov 2025

Viewed by 1433

Abstract

Objectives: We aimed to determine temporal patterns of blood–brain barrier (BBB) dysfunction, edema formation and functional recovery in acute stroke. Materials and Methods: Patients of two observational studies on ischemic and hemorrhagic stroke between 2006 and 2019 were analyzed. Blood–brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio. Edema formation was measured on all available imaging scans during hospital stay. Relative edema was defined as the ratio of edema volume to stroke volume. Multivariable regression models were applied to analyze associations and calculate predicted probabilities. Results: Overall, 138 stroke patients, 103 (74.6%) with ischemic stroke and 35 (25.4%) with hemorrhagic stroke, were analyzed. The predicted probability of substantial BBB dysfunction was approximately 46 (37–55) % among patients analyzed on 1 day after symptom onset and declined with increasing time, thereafter reaching 10 (3–29) % on day 30. The maximal extent of edema was lower in ischemic versus hemorrhagic stroke (relative edema: 1.5 [1.2–1.8] vs. 2.6 [1.9–4.5], p = 0.003) and occurred earlier after stroke onset (5.9 [4.6–8.5] days vs. 12.3 [9.7–16.4] days, p = 0.009). BBB dysfunction was associated with increased edema formation (adjusted relative edema: 4.0 [2.8–4.5] vs. 2.3 [1.8–3.0], p = 0.037) and lower chances of functional recovery (20/48 [41.7%] vs. 51/90 [56.7%], adjusted Odds Ratio: 0.37 [0.16–0.88], p = 0.025) in both ischemic and hemorrhagic stroke patients. Conclusions: BBB dysfunction frequently occurred in acute ischemic and hemorrhagic stroke and was associated with secondary injury and worse clinical outcomes. Future studies should evaluate BBB dysfunction as a potential therapeutic target using advanced imaging techniques early after stroke onset. Edema formation was aggravated and prolonged in hemorrhagic versus ischemic stroke. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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34 pages, 7149 KB

Open AccessArticle

Impact of Statin Therapy on the Risk of Stroke Recurrence, Mortality, and Dementia After Ischemic Stroke (ISMARDD Study): A Comprehensive Meta-Analysis

by Muskaan Gupta, Kevin J. Spring, Roy G. Beran and Sonu Bhaskar

Neurol. Int. 2025, 17(11), 176; https://doi.org/10.3390/neurolint17110176 - 1 Nov 2025

Cited by 2 | Viewed by 3992

Abstract

Background: Ischemic stroke (IS) remains a leading global cause of mortality, recurrence, and long-term disability, with survivors also at risk of post-stroke dementia (PSD) and cognitive impairment (PSCI). The precise impact of statin therapy across different IS populations, including those with cardioembolic/atrial fibrillation (CE/AF) strokes and patients with low-baseline low-density lipoprotein (LDL) cholesterol, remains unclear, as does the influence of statin timing, intensity, type, and solubility. Methods: We conducted the Impact of Statin Therapy on the Risk of Stroke Recurrence, Mortality, and Dementia After Ischemic Stroke (ISMARDD) meta-analysis, synthesizing evidence from 51 studies (n = 521,126), to evaluate the association between post-stroke statin therapy and key outcomes: all-cause mortality, stroke recurrence, cognition, and C-reactive protein (CRP). PSD was defined as new, persistent cognitive decline meeting standard diagnostic criteria, and PSCI as measurable but sub-threshold cognitive deficits. Random-effects models were used, and certainty was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: Statin therapy significantly reduced all-cause mortality within 3 months (OR 0.32), at 1 year (OR 0.35), and beyond 1 year (OR 0.56). Stroke recurrence was modestly reduced both within 1 year (OR 0.77) and after 1 year (OR 0.76). Statin use was associated with a lower risk of PSD (OR 0.74) but not PSCI overall. Benefits extended to CE/AF-related strokes and patients with low-baseline LDL cholesterol, both showing significantly lower mortality with statin use. Early initiation (<24 h) was linked with reduced recurrence, though effects of statin intensity, type, and solubility were inconsistent. Statins also significantly reduced CRP levels, underscoring anti-inflammatory and pleiotropic mechanisms. Conclusions: The ISMARDD study demonstrates that statins confer survival benefit and selective cognitive protection (notably reduced PSD risk) after ischemic stroke, with modest recurrence benefit, supporting their broad use in secondary prevention. These findings highlight the need for precision-guided approaches tailored to stroke subtype, pharmacogenomics, and treatment timing to optimize therapeutic outcomes. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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23 pages, 7111 KB

Open AccessArticle

Pulmonary Embolism After Acute Ischaemic Stroke (PEARL-AIS): Global Prevalence, Risk Factors, Outcomes, and Evidence Grading from a Meta-Analysis

by Darryl Chen, Yuxiang Yang and Sonu M. M. Bhaskar

Neurol. Int. 2025, 17(10), 168; https://doi.org/10.3390/neurolint17100168 - 12 Oct 2025

Cited by 1 | Viewed by 1942

Abstract

Objectives: Pulmonary embolism (PE) is an uncommon but potentially fatal complication of acute ischaemic stroke (AIS). Its global burden and prevention remain incompletely defined. We performed a systematic review and meta-analysis (PEARL-AIS) to estimate prevalence, risk factors, outcomes, and prophylactic efficacy, with GRADE evidence appraisal. Methods: Following PRISMA 2020 and MOOSE guidelines, five databases (PubMed, Embase, Cochrane, Scopus, Web of Science) were searched (1995–2024). The protocol was prospectively registered (OSF s25ny). Random-effects models (DerSimonian–Laird; REML sensitivity) were used to pool prevalence and odds ratios; heterogeneity was evaluated with I², Cochran’s Q, and τ². Influence (leave-one-out) and subgroup analyses for prevalence and mortality of PE in AIS were explored. Bias was assessed using the Modified Jadad Scale; overall certainty was graded with the GRADE framework. Results: Twenty-four studies met the inclusion criteria (n = 25,666,067), of which seventeen studies (n = 23,637,708) contributed to pooled prevalence analyses. The pooled prevalence of PE after AIS was 0.40% (95% CI 0.33–0.49), approximately six-fold higher than in the general population, with considerable heterogeneity (I² > 90%, Cochrane classification). The pooled mortality among AIS patients with PE was 12.9% (95% CI 1.6–31.7). Mortality risk was significantly higher in AIS patients with PE (OR 4.96, 95% CI 2.98–8.24). Atrial fibrillation (29%), cancer (19%), and smoking (23%) were common; hypertension (54%) and diabetes (23%) were prevalent but not predictive, with diabetes showing a paradoxical protective association (OR 0.88, 95% CI 0.84–0.92). Pharmacological prophylaxis was associated with a reduced risk of PE (OR 0.64, 95% CI 0.46–0.90; I² = 0%), supported by moderate-certainty evidence. Conclusions: PE is an uncommon but often fatal complication of AIS. Traditional venous thromboembolism predictors underperform in this context, suggesting a stroke-specific thromboinflammatory mechanism linking the brain and lung axis. Despite considerable heterogeneity and low-to-moderate certainty of evidence, pharmacological prophylaxis demonstrates a consistent protective effect. Systematic PE surveillance and tailored prophylactic strategies should be integral to contemporary stroke care, while future studies should refine risk stratification and elucidate the mechanistic underpinnings of this brain–lung thromboinflammatory continuum. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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11 pages, 741 KB

Open AccessArticle

Effect of Cilostazol in the Expression of Biomarkers and Neurological Outcome Following Experimentally Induced Cerebrovascular Accident—Experimental Protocol

by Christiana Anastasiadou, Stavroula Kastora, Alkistis Kapelouzou, Anastasios Papapetrou, Angelos Megalopoulos, Nikolaos Kostomitsopoulos, Efthymios Paronis, Andreas Lazaris, George Geroulakos, Christos Liapis, Nikolaos Saratzis and John Kakisis

Neurol. Int. 2025, 17(8), 126; https://doi.org/10.3390/neurolint17080126 - 11 Aug 2025

Viewed by 1055

Abstract

Objective: Several strategies have been described for stroke prevention, and the most commonly used medication is aspirin. Cilostazol, which is a substance with a pleiotropic effect, is still not well investigated. In this study, we aimed to delineate the effects of mono- and combinatorial pre-treatment upon neurological status and biomarkers, namely protein S100b, GFAP, procalcitonin, and galectin-3, following stroke. Methods: Twelve-week-old Sprague–Dawley rats were randomly assigned to four groups, each containing six rats: control group (normal saline), cilostazol group (30 mg/kg/daily), aspirin group (10 mg/kg/daily), and aspirin/cilostazol group. Each substance was administered by gavage for four weeks. All animals were subjected to cerebral ischemia for 2 h using intraluminal middle cerebral artery occlusion. A neurological examination was performed, serum concentrations of biomarkers were determined, and the animals were then sacrificed. Results: All treatment groups exhibited variations in the severity of immediate neurological presentation. Unlike the control group, where all rats presented with severe focal neurology or mortality, most rats in the treatment groups displayed no to moderate focal neurology. Moreover, the aspirin/cilostazol group consistently exhibited significantly lower levels in the studied biomarkers compared to other groups. Conclusions: Co-administration of cilostazol and aspirin significantly ameliorates the immediate expression of the studied biomarkers. Further large-scale studies are needed to investigate the effect of combined therapy for primary and secondary prevention of stroke, using not only serum biomarkers but other specific clinical and laboratory endpoints. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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14 pages, 664 KB

Open AccessArticle

The Association of Cerebral Blood Flow Measured Using Extracranial Carotid Ultrasound with Functional Outcomes in Patients with Anterior Circulation Large Vessel Occlusion After Endovascular Thrombectomy—A Retrospective Study

by Xin-Hong Lin, Kuan-Wen Chen, Chung-Fu Hsu, Ting-Wei Chang, Chao-Yu Shen and Hsin-Yi Chi

Neurol. Int. 2025, 17(5), 67; https://doi.org/10.3390/neurolint17050067 - 25 Apr 2025

Viewed by 1507

Abstract

Background: Endovascular mechanical thrombectomy (EVT) is regarded as the standard treatment for acute ischemic stroke with large vessel occlusion. Few studies have examined the evolution of cerebral flow after the acute stage of ischemic stroke. In this study, we examined the association of functional outcomes with cerebral blood flow by extracranial carotid sonography during the subacute phase after EVT and multiple prognostic variables. Methods: We conducted a single-center, retrospective, observational study between January 2018 and June 2023. Patients with acute stroke resulting from anterior circulation large vessel occlusion who underwent EVT were included. All patients underwent carotid sonography in the second week after EVT. Patients with fair (modified Rankin Scale [mRS]: 0–3) and poor outcomes (mRS: 4–6) were compared to determine the association between and identify the predictors of these factors and functional outcomes. Results: A total of 89 patients were included (female: 38 (42.7%); mean age: 69.45 ± 13.59 years). Multivariable logistic regression analysis revealed that three factors were independent predictors of fair outcomes: (1) the Alberta Stroke Program Early CT Score (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.16–2.78; p = 0.009); (2) Thrombolysis in Cerebral Infarction 2b to 3 (OR: 4.91; 95%CI: 1.10–21.89; p = 0.037); (3) the ratio of treatment-side blood flow between the internal carotid artery and common carotid artery (QTI/QTC, OR: 45.35; 95% CI: 1.11–1847.51; p = 0.04). Conclusions: The ratio of QTI/QTC is a clinically relevant parameter as a potential predictor of favorable outcomes. This parameter can be used to formulate patient prognostic scores and help clinicians determine whether adequate cerebral perfusion is maintained during the subacute phase. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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Review

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20 pages, 962 KB

Open AccessReview

Dynamic Changes in Endothelial Glycocalyx and Inflammatory Response in Patients with Acute Ischemic Stroke Treated with Mechanical Thrombectomy: Pathophysiological Aspects and Clinical Implications

by Berya Günay, Samyuktha Ramesh Dhayanand, Marijana Matas, Vlatka Sotosek and Lara Baticic

Neurol. Int. 2026, 18(5), 77; https://doi.org/10.3390/neurolint18050077 - 23 Apr 2026

Viewed by 337

Abstract

Acute ischemic stroke (AIS) is characterized by complex interactions among vascular occlusion, endothelial injury, and inflammatory activation, which collectively influence clinical outcomes. Increasing attention has focused on the endothelial glycocalyx, a critical regulator of vascular permeability, mechanotransduction, and inflammatory signaling. Disruption of the endothelial glycocalyx during ischemia and subsequent reperfusion contributes to blood–brain barrier (BBB) dysfunction and secondary brain injury. Mechanical thrombectomy has emerged as the reference standard treatment for large vessel occlusion in AIS. This review synthesizes current evidence on endothelial glycocalyx degradation and associated inflammatory cascades in cute ischemic stroke, with particular emphasis on patients undergoing mechanical thrombectomy. We examine the mechanisms underlying endothelial and BBB injury, ischemia–reperfusion-mediated vascular dysfunction, and systemic inflammatory responses (SIRS). In addition, the potential clinical relevance of circulating biomarkers indicative of endothelial glycocalyx shedding and endothelial damage is discussed. By integrating molecular pathophysiology with contemporary reperfusion strategies, this review highlights the importance of endothelial protection as a potential adjunct to mechanical thrombectomy. While mechanical thrombectomy remains the gold standard therapy for AIS due to large vessel occlusion, targeting endothelial glycocalyx integrity and post-reperfusion inflammation may represent a promising approach to optimizing neurological outcomes and reducing complications. Further research is required to elucidate specific pathophysiological mechanisms and to develop targeted therapeutic strategies aimed at reducing stroke-related morbidity and mortality. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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16 pages, 1105 KB

Open AccessSystematic Review

Effectiveness of Electrical Stimulation on Upper Limb Function During the Acute Phase of Stroke: A Systematic Review and Meta-Analysis

by Sagrario Pérez-de la Cruz

Neurol. Int. 2026, 18(5), 91; https://doi.org/10.3390/neurolint18050091 - 13 May 2026

Viewed by 309

Abstract

Background/Objectives: Stroke remains a leading cause of global disability, with upper limb impairment affecting over 80% of patients. During the acute phase (first seven days), a critical neuroplastic window exists where interventions may significantly influence recovery. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of electrical stimulation—specifically Functional Electrical Stimulation (FES) and Neuromuscular Electrical Stimulation (NMES)—on upper limb functional recovery and complication prevention during the acute phase of stroke. Methods: A systematic search was conducted across eight databases (including Medline, PEDRo, and Cochrane) for randomized and non-randomized clinical trials published between 2016 and 2025. Methodological quality was assessed using the PEDRo scale. Quantitative synthesis was performed via meta-analysis using a random-effects model, focusing on the Fugl-Meyer Assessment (FMA-UE). Results: Eight randomized clinical trials were selected with a total of 384 participants. The meta-analysis results showed a positive and statistically significant effect in favor of the experimental group compared to the control group (Z = 2.39; p = 0.02), with a combined Standardized Mean Difference of 0.53 (95% CI: 0.10 to 0.96), indicating a moderate effect size on the Fugl-Meyer Assessment Upper Extremity scale. Although high heterogeneity was detected (I² = 74%), the analysis suggests that Functional Electrical Stimulation (FES) and Neuromuscular Electrical Stimulation (NMES) improve manual dexterity, prevent disuse atrophy, and reduce glenohumeral subluxation. Conclusions: Electrical stimulation shows a positive trend in early stroke recovery; however, it should be considered a promising adjunct rather than a definitive treatment. Further research into standardized protocols is required to confirm their clinical significance. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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16 pages, 841 KB

Open AccessSystematic Review

Medication Adherence Following Stroke and TIA: A Qualitative Synthesis of Patient, Caregiver and Clinician Perspectives

by Erin O’Kane, Rhiannon De Ivey, Katie Pearson, Christa Awad, Khalifa Mohammed, Nathan Williamson, Richard Andrew Lumb, Ami Mehta and Eugene Yee Hing Tang

Neurol. Int. 2026, 18(2), 34; https://doi.org/10.3390/neurolint18020034 - 11 Feb 2026

Viewed by 1286

Abstract

Background/Objectives: Stroke survivors require life-long secondary prevention to reduce recurrence, but they also often face long-term impairments that may limit medication adherence (MA) including cognitive, physical, and psychological effects. This updated qualitative meta-synthesis aims to descriptively explore and synthesise the experiences and perspectives of stroke/TIA survivors, informal and formal carers of stroke survivors, and healthcare professionals involved in post-stroke/TIA care, with a focus on factors influencing and hindering MA. Methods: A qualitative meta-synthesis was conducted in accordance with PRISMA guidance. Searches were undertaken across MEDLINE, CINAHL, Embase, PsycINFO, Scopus and Web of Science for studies published from 1 January 2018. Study quality was assessed using the Joanna Briggs Institute checklist and data synthesised using Thomas and Harden’s method. Results: Of 5463 titles and abstracts screened, 212 underwent full-text review with 13 papers meeting inclusion criteria from eight countries with a total of 435 participants. Seven key themes were identified: knowledge and understanding, beliefs and attitudes, practical barriers, social support, healthcare system, psychological factors and medication characteristics. Survivors showed a varied understanding of their condition and prescribed medicines, with unclear communication often contributing to confusion. Beliefs and attitudes shaped adherence, ranging from confidence in treatment to scepticism. Practical barriers included financial costs, physical impairments, and limited access to services. Social support from family, friends, and healthcare professionals was also important. Psychological wellbeing, coping strategies, and medication side effects further influenced adherence, highlighting the challenges faced by this patient group. Conclusions: Medication adherence post-stroke/TIA is shaped by multiple complex factors including knowledge, beliefs, attitudes, and lived experience. As a descriptive synthesis of qualitative evidence, these findings do not permit conclusions regarding causality or intervention effectiveness but provide insight into perceived barriers and facilitators that may inform future intervention development and clinical questioning. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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9 pages, 5779 KB

Open AccessCase Report

Extracranial Vertebral Artery Dissecting Aneurysm Presenting as Vertebrobasilar Stroke in a Young Adult: Case Report of Flow-Diverter Stenting

by Maria Angelica-Coronel, Melissa Luque-Llano, Narledis Nuñez-Bravo, Carlos Rebolledo and Ernesto Barceló-Martínez

Neurol. Int. 2025, 17(11), 187; https://doi.org/10.3390/neurolint17110187 - 18 Nov 2025

Viewed by 1321

Abstract

Background: Extracranial vertebral artery aneurysms (EVAAs) are exceptionally rare vascular lesions and an uncommon cause of posterior circulation stroke. Their diagnosis is often delayed due to nonspecific symptoms, yet prompt recognition is essential to guide management. Objective: This study aimed to report a rare case of an extracranial vertebral artery dissecting aneurysm presenting as a posterior circulation stroke in a young adult, successfully managed with flow-diverter stenting. Clinical Case: A 33-year-old woman presented with sudden-onset dysarthria, vertigo, nausea, and vomiting. Brain magnetic resonance imaging revealed infarcts in the left occipital lobe, cerebellar peduncle, and both cerebellar hemispheres. Computed tomography angiography (CTA) demonstrated a fusiform aneurysm in the V2 segment of the left vertebral artery, and digital subtraction angiography (DSA) confirmed a dissecting aneurysm. The patient was successfully treated with a flow-diverting stent and remained stable at 6 months’ follow-up with mRS 1. Results: EVAA are uncommon but can manifest as posterior circulation ischemic events in young patients. Endovascular treatment with flow-diverting stents has been reported as a feasible option in selected cases, although evidence remains limited to case reports and small series. Conclusions: This case underscores the importance of considering rare yet potentially treatable etiologies of vertebrobasilar stroke in young patients and highlights the value of a multidisciplinary approach to management. Full article

(This article belongs to the Special Issue Innovations in Acute Stroke Treatment, Neuroprotection, and Recovery)

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