Cerebrovascular Disease: Update on Diagnosis and Treatment

A special issue of Neurology International (ISSN 2035-8377). This special issue belongs to the section "Brain Tumor and Brain Injury".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 4630

Special Issue Editors


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Guest Editor
Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
Interests: cerebrovascular diseases; small vessel diseases; hemorrhagic stroke; cavernous angioma; cerebral amyloid angiopathy; CADASIL; FMD; gene
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Interests: MRI; angiography; small vessel disease; cerebral amyloid angiopathy; hemorrhagic stroke; gene
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cerebrovascular disease (CVD) encompasses a range of disorders affecting the blood vessels in the brain, leading to significant morbidity and mortality worldwide. Conditions such as stroke, transient ischemic attack (TIA), and vascular dementia represent major public health challenges. Accurate diagnosis and timely intervention are critical to improving patient outcomes and minimizing long-term disability. As our understanding of the pathophysiology of cerebrovascular diseases evolves, so too do the diagnostic and therapeutic approaches. This Special Issue aims to provide a comprehensive update on the latest advancements in the diagnosis and treatment of cerebrovascular disease, addressing both established and emerging strategies.

The primary aim of this Special Issue is to gather and disseminate cutting-edge research and clinical insights into the diagnosis and management of cerebrovascular diseases. We seek to explore innovative diagnostic modalities, including advanced imaging techniques and biomarkers, as well as new therapeutic interventions, such as novel pharmacological agents and interdisciplinary management approaches. The scope of this issue includes, but is not limited to, studies on acute stroke management, secondary prevention strategies, rehabilitation techniques, and the integration of technology in patient care. By providing a platform for the latest research, we hope to enhance clinical practice and inform future directions in cerebrovascular disease management.

Historically, the field of cerebrovascular disease has undergone significant transformations. Advances in neuroimaging technologies and a better understanding of risk factors have revolutionized the diagnosis of CVD. The introduction of thrombolytic therapy and endovascular interventions has changed the landscape of acute stroke treatment, while ongoing research continues to refine management strategies for chronic cerebrovascular conditions. Despite these advancements, challenges remain in the early detection of CVD and effective treatment modalities, particularly in diverse populations. This Special Issue will trace the history of cerebrovascular disease management, highlighting key milestones and current gaps that require further exploration.

This Special Issue will feature cutting-edge research that highlights the latest breakthroughs in the diagnosis and treatment of cerebrovascular diseases. We aim to include studies that utilize novel imaging techniques, such as perfusion MRI and machine learning algorithms for stroke prediction, as well as research on emerging therapeutic agents that target the underlying mechanisms of cerebrovascular pathology. Additionally, we welcome investigations into multidisciplinary approaches that integrate medical, surgical, and rehabilitation strategies to optimize patient outcomes. By showcasing these advancements, we hope to foster collaboration and innovation in the field of cerebrovascular disease.

We invite original research articles, reviews, clinical guidelines, and case studies that contribute to the understanding and management of cerebrovascular disease. Specifically, we seek the following:

  • Original research articles that present novel findings related to diagnostic techniques or treatment interventions;
  • Comprehensive reviews that synthesize current knowledge and highlight gaps in the literature, offering insights into future research directions;
  • Clinical guidelines or consensus statements that provide evidence-based recommendations for the diagnosis and management of cerebrovascular disease;
  • Case studies that illustrate unique clinical presentations, innovative treatment approaches, or successful management strategies in cerebrovascular disease. Through this Special Issue, we aim to create a collaborative space for researchers, clinicians, and healthcare professionals to share knowledge and advance the field of cerebrovascular disease diagnosis and treatment.

You may choose choose our Joint Special Issue in Brain Sciences.

Dr. Marialuisa Zedde
Dr. Rosario Pascarella
Guest Editors

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Keywords

  • ischemic stroke
  • SVD
  • vasculitides
  • fibromuscular dysplasia
  • thrombolysis
  • EVT
  • plaque imaging
  • intracranial stenosis

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Published Papers (4 papers)

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Research

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13 pages, 1195 KB  
Article
Individualized Upfront Treatment Selection for Aneurysmal Subarachnoid Hemorrhage and Functional Outcomes: A Single-Center Retrospective Before-and-After Cohort Study
by Atsushi Nakayashiki, Kunihiko Umezawa, Yasuo Nishijima, Ryutaro Suzuki, Michiko Yokosawa and Hidenori Endo
Neurol. Int. 2026, 18(5), 93; https://doi.org/10.3390/neurolint18050093 (registering DOI) - 15 May 2026
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Abstract
Background/Objectives: The optimal upfront modality selection for real-world aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. We evaluated outcomes after an institutional change from an endovascular treatment (EVT)-first default to a modality-neutral individualized pathway. Methods: This single-center retrospective before-and-after cohort study included consecutive patients with [...] Read more.
Background/Objectives: The optimal upfront modality selection for real-world aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. We evaluated outcomes after an institutional change from an endovascular treatment (EVT)-first default to a modality-neutral individualized pathway. Methods: This single-center retrospective before-and-after cohort study included consecutive patients with aSAH who underwent aneurysm securing during two fixed time periods (pre-change: 1 May 2023 to 31 July 2024; post-change: 1 August 2024 to 31 October 2025). The primary outcome was a favorable 90-day modified Rankin Scale (mRS) score of 0–2. The primary analysis used Firth penalized logistic regression adjusted for age, pre-morbid mRS ≥ 2, and World Federation of Neurosurgical Societies grade IV–V. Conventional logistic regression and ordinal mRS shift analysis were performed as sensitivity analyses. Results: A total of 104 patients were included (pre-change, n = 48; post-change, n = 56). EVT decreased from 79.2% to 37.5%, and microsurgery increased from 20.8% to 62.5% (p < 0.001). Favorable outcomes occurred in 25/48 patients (52.1%) in the pre-change period and 36/56 patients (64.3%) in the post-change period (p = 0.235). In adjusted analyses, the post-change period was associated with favorable outcome (aOR 3.82; 95% CI, 1.31–12.79; p = 0.009), consistent with the sensitivity analysis (aOR, 4.41; 95% CI, 1.43–15.95; p = 0.009). Shift analysis also favored the post-change period (adjusted common OR, 2.36; 95% CI, 1.15–4.91; p = 0.021). Secondary outcomes and procedure-related complications were similar between the two periods. Conclusions: A shift from an EVT-first default to a modality-neutral individualized pathway was associated with more favorable adjusted 90-day functional outcomes. Multicenter confirmation is warranted. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)
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11 pages, 1148 KB  
Article
Posterior Communicating Artery Configuration and Laterality of Thalamic and Lenticulostriate Infarction
by Junpei Nagasawa, Masamichi Hozumi, Tatsuhiro Yokoyama, Makiko Ogawa, Junya Ebina, Mari Shibukawa, Takehisa Hirayama and Osamu Kano
Neurol. Int. 2026, 18(3), 61; https://doi.org/10.3390/neurolint18030061 - 22 Mar 2026
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Abstract
Background: Anatomical variations in the posterior communicating artery (PCoA) are common, but their association with ischemic stroke remains unclear. In this study, we investigated the relationship between PCoA configuration and the localization of perforator infarction. Methods: We conducted a single-center, retrospective observational study [...] Read more.
Background: Anatomical variations in the posterior communicating artery (PCoA) are common, but their association with ischemic stroke remains unclear. In this study, we investigated the relationship between PCoA configuration and the localization of perforator infarction. Methods: We conducted a single-center, retrospective observational study of consecutive patients admitted with acute ischemic stroke between April 2016 and July 2023. Patients with a single, unilateral lacunar infarction confined to the thalamic or lenticulostriate artery (LSA) territory were included. PCoA configuration was assessed using time-of-flight magnetic resonance angiography and dichotomized as present (normal PCoA or fetal-type posterior cerebral artery) or absent (hypoplastic or aplastic PCoA). Using a within-patient, hemisphere-based approach, the presence of PCoA on the infarcted side was directly compared with that on the contralateral side. McNemar’s test with continuity correction was used for laterality analysis. Results: A total of 64 patients met the inclusion criteria, including 45 with LSA infarction and 19 with thalamic infarction. The prevalence of PCoA presence on the infarcted hemisphere was 20.0% in the LSA group and 26.3% in the thalamic group, identical to that observed on the contralateral hemisphere in each group. Within-patient comparisons revealed no significant difference in PCoA presence between infarcted and non-infarcted hemispheres in either territory (all p > 0.05). Conclusions: In patients with unilateral perforator infarction involving the thalamic or LSA territories, PCoA configuration was not associated with infarct laterality. These findings suggest that variations in PCoA anatomy have a limited influence on hemispheric vulnerability to perforator infarction, supporting the predominant role of local small-vessel pathology rather than proximal collateral anatomy in the development of lacunar stroke. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)
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15 pages, 1352 KB  
Article
Unruptured Intracranial Aneurysm Risk Scores Underperform in Predicting Subsequent Rupture: A Retrospective Single-Center Study
by Kamil Krystkiewicz, Aleksander Kowal, Magdalena Krystkiewicz-Orzechowska, Filip Arczewski, Karol Dziedzic and Marcin Tosik
Neurol. Int. 2025, 17(11), 189; https://doi.org/10.3390/neurolint17110189 - 20 Nov 2025
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Abstract
Background/Objectives: Risk-stratification tools, including the PHASES, UIATS, and ELAPSS, are commonly used to guide management of incidentally detected unruptured intracranial aneurysms (UIAs), but their predictive accuracy in real-world settings remains unclear. This study evaluated how these scores would have advised treatment in patients [...] Read more.
Background/Objectives: Risk-stratification tools, including the PHASES, UIATS, and ELAPSS, are commonly used to guide management of incidentally detected unruptured intracranial aneurysms (UIAs), but their predictive accuracy in real-world settings remains unclear. This study evaluated how these scores would have advised treatment in patients who subsequently presented with aneurysmal subarachnoid hemorrhage (aSAH). Methods: We retrospectively analyzed adults treated for aSAH at Copernicus Memorial Hospital (Łódź, Poland) between January 2022 and June 2024. For each ruptured aneurysm, we calculated PHASES (5-year rupture risk), UIATS recommendation, and ELAPSS (5-year growth risk) as if the lesion had been detected incidentally. Identical assessments were performed for UIAs that remained unruptured. Discrimination for rupture was evaluated using receiver-operating characteristic analysis (AUC). Results: Of 180 aneurysms (mean age 66.9 ± 11.3 years), 103 (57%) were ruptured. Patients with ruptured aneurysms were significantly older (69.9 vs. 64.0 years; p = 0.003), while sex, hypertension, smoking, and aneurysm morphology did not differ significantly. UIATS more frequently favored conservative management in ruptured aneurysms (56.3% vs. 39.0%; p = 0.046). PHASES (1.6% vs. 1.6%) and ELAPSS (3-year: 14.5% vs. 12.6%; 5-year: 22.6% vs. 20.0%) showed no significant differences between groups. Age was the only independent predictor of rupture (OR = 1.05/year; p < 0.001). The model’s cross-validated AUC was 0.731. Conclusions: Most ruptured aneurysms would not have been recommended for treatment based on UIATS. PHASES, ELAPSS, and UIATS did not reliably discriminate between ruptured and unruptured aneurysms, emphasizing the need for more precise and individualized risk assessment tools. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)
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10 pages, 2782 KB  
Case Report
Ischemic Stroke as the First Manifestation of Takayasu Arteritis: A Case Report
by Dominika Jakubowicz-Lachowska, Magdalena Sarnowska, Monika Chorąży and Alina Kułakowska
Neurol. Int. 2026, 18(3), 57; https://doi.org/10.3390/neurolint18030057 - 18 Mar 2026
Viewed by 654
Abstract
Introduction: Ischemic stroke in young adults is uncommon and is frequently associated with rare etiologies, including autoimmune diseases and vasculitis. Takayasu arteritis (TA) is a chronic inflammatory large-vessel arteriopathy involving the aorta and its major branches and may result in cerebral ischemia due [...] Read more.
Introduction: Ischemic stroke in young adults is uncommon and is frequently associated with rare etiologies, including autoimmune diseases and vasculitis. Takayasu arteritis (TA) is a chronic inflammatory large-vessel arteriopathy involving the aorta and its major branches and may result in cerebral ischemia due to arterial stenosis or thrombosis. Case Presentation: We report the case of a 26-year-old woman with a history of suspected rheumatoid arthritis and Lyme disease who presented with acute left-sided hemiparesis and dysarthria. At admission, large-vessel vasculitis had not yet been suspected, and the patient was treated according to standard acute stroke protocols. Computed tomography angiography (CTA) revealed occlusion of the right middle cerebral artery bifurcation and the right common carotid artery, with inflammatory changes involving the brachiocephalic trunk and subclavian arteries. Intravenous thrombolysis (iv rtPA) was followed by mechanical thrombectomy (MT), resulting in neurological improvement. Outcome: Further diagnostic work-up confirmed TA, and immunosuppressive therapy with cyclophosphamide and infliximab was initiated. Conclusion: This case underscores the importance of considering inflammatory large-vessel disease in young patients presenting with acute ischemic stroke and illustrates that endovascular reperfusion may be feasible in this clinical setting. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)
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