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Cerebrovascular Diseases: Diagnosis, Prognosis, and Intervention
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Cerebrovascular Diseases: Diagnosis, Prognosis, and Intervention

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 (31 March 2024) | Viewed by 4229

Special Issue Editor

Dr. Giovanni Frisullo

E-Mail Website
Guest Editor
1. Neuroscience Department, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
2. Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy
Interests: cerebrovascular disease; stroke; autoimmune disease; integrated care pathway; autoimmunity
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cerebrovascular diseases, which include stroke, carotid, vertebral and intracranial stenosis, aneurysms, and vascular malformations, are the most common diseases of the nervous system, associated with high mortality, a high disability rate, high recurrence rate, and a high impact on the healthcare system. Until the late 1990s, the only approved stroke therapy was Aspirin; however, in the last decade, both in the field of ischemic stroke and intracranial bleeding, new diagnostic approaches (genetic, immunological, advanced neuroradiological imaging studies, etc.) and the introduction of new infusion therapies or endovascular treatments (systemic thrombolytic, reversal of factor Xa inhibitors, mechanical thrombectomy, the development of new endovascular devices, etc.) have improved the prognosis of patients suffering from cerebrovascular disease, allowing personalized therapy.

This Special Issue aims to present new advances in the field of new diagnostic or therapeutic approaches in patient management with cerebrovascular diseases, providing new research data, challenges, and perspectives on stroke and vascular malformations.

We welcome the submission of original papers, systematic reviews, and meta-analyses focusing on the aforementioned topic.

Dr. Giovanni Frisullo
Guest Editor

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

  • stroke
  • intracranial hemorrhage
  • thrombolysis
  • thrombectomy
  • endovascular devices
  • aneurysms
  • small vessel disease

Published Papers (4 papers)

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9 pages, 1231 KiB  
Article
Advanced Glycation End-Products in Blood Serum—Novel Ischemic Stroke Risk Factors? Implication for Diabetic Patients
by Aleksandra Kuzan, Anna Kozak-Sykała, Anna Fiedorowicz, Wojciech Kałas, Leon Strządała and Andrzej Gamian
J. Clin. Med. 2024, 13(2), 443; https://doi.org/10.3390/jcm13020443 - 13 Jan 2024
Viewed by 614
Abstract
New predictors of ischemic incidents are constantly sought since they raise the awareness of patients and their doctors of stroke occurrence. The goal was to verify whether Advanced Glycation End Products (AGEs), in particular AGE10, could be one of them. The AGE10 measurement [...] Read more.
New predictors of ischemic incidents are constantly sought since they raise the awareness of patients and their doctors of stroke occurrence. The goal was to verify whether Advanced Glycation End Products (AGEs), in particular AGE10, could be one of them. The AGE10 measurement was conducted using a non-commercial ELISA assay in the blood serum of neurological patients without cerebrovascular event (n = 24), those with transient brain attack (TIA) (n = 17), and severe ischemic stroke (n = 35). Twice as many of the people with TIA or severe stroke presented high AGE10 serum concentrations compared to the patients with other neurological conditions (χ2 = 8.2, p = 0.004; χ2 = 8.0, p = 0.005, respectively). The risk of ischemic incident was significantly risen in people with higher levels of AGE10 (OR = 6.5, CI95%: 1.7–24.8; OR = 4.7, CI95%: 1.5–14.5 for TIA and stroke subjects, respectively). We observed a positive correlation (r = 0.40) between high AGE10 levels and diabetes. Moreover, all the diabetic patients that had a high AGE10 content experienced either a severe ischemic stroke or TIA. The patients with high levels of AGE10 exhibited higher grades of disability assessed by the NIHSS scale (r = 0.35). AGE10 can be considered a new biomarker of ischemic stroke risk. Patients with diabetes presenting high AGE10 levels are particularly prone to the occurrence of cerebrovascular incidents. Full article
(This article belongs to the Special Issue Cerebrovascular Diseases: Diagnosis, Prognosis, and Intervention)
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13 pages, 1591 KiB  
Article
Frequency and Characteristics of Non-Neurological and Neurological Stroke Mimics in the Emergency Department
by Jordi Kühne Escolà, Bessime Bozkurt, Bastian Brune, Woon Hyung Chae, Lennart Steffen Milles, Doreen Pommeranz, Lena Brune, Philipp Dammann, Ulrich Sure, Cornelius Deuschl, Michael Forsting, Clemens Kill, Christoph Kleinschnitz, Martin Köhrmann and Benedikt Frank
J. Clin. Med. 2023, 12(22), 7067; https://doi.org/10.3390/jcm12227067 - 13 Nov 2023
Viewed by 1271
Abstract
Background: Stroke mimics are common in the emergency department (ED) and early detection is important to initiate appropriate treatment and withhold unnecessary procedures. We aimed to compare the frequency, clinical characteristics and predictors of non-neurological and neurological stroke mimics transferred to our ED [...] Read more.
Background: Stroke mimics are common in the emergency department (ED) and early detection is important to initiate appropriate treatment and withhold unnecessary procedures. We aimed to compare the frequency, clinical characteristics and predictors of non-neurological and neurological stroke mimics transferred to our ED for suspected stroke. Methods: This was a cross-sectional study of consecutive patients with suspected stroke transported to the ED of the University Hospital Essen between January 2017 and December 2021 by the city’s Emergency Medical Service. We investigated patient characteristics, preclinical data, symptoms and final diagnoses in patients with non-neurological and neurological stroke mimics. Multinominal logistic regression analysis was performed to assess predictors of both etiologic groups. Results: Of 2167 patients with suspected stroke, 762 (35.2%) were diagnosed with a stroke mimic. Etiology was non-neurological in 369 (48.4%) and neurological in 393 (51.6%) cases. The most common diagnoses were seizures (23.2%) and infections (14.7%). Patients with non-neurological mimics were older (78.0 vs. 72.0 y, p < 0.001) and more likely to have chronic kidney disease (17.3% vs. 9.2%, p < 0.001) or heart failure (12.5% vs. 7.1%, p = 0.014). Prevalence of malignancy (8.7% vs. 13.7%, p = 0.031) and focal symptoms (38.8 vs. 57.3%, p < 0.001) was lower in this group. More than two-fifths required hospitalization (39.3 vs. 47.1%, p = 0.034). Adjusted multinominal logistic regression revealed chronic kidney and liver disease as independent positive predictors of stroke mimics regardless of etiology, while atrial fibrillation and hypertension were negative predictors in both groups. Prehospital vital signs were independently associated with non-neurological stroke mimics only, while age was exclusively associated with neurological mimics. Conclusions: Up to half of stroke mimics in the neurological ED are of non-neurological origin. Preclinical identification is challenging and a high proportion requires hospitalization. Awareness of underlying etiologies and differences in clinical characteristics is important to provide optimal care. Full article
(This article belongs to the Special Issue Cerebrovascular Diseases: Diagnosis, Prognosis, and Intervention)
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14 pages, 1409 KiB  
Article
Initial Temporal Muscle Thickness and Area: Poor Predictors of Neurological Outcome in Aneurysmal Subarachnoid Hemorrhage in a Central European Patient Cohort
by Cihat Karadag, Marcel A. Kamp, Igor Fischer, Hieronymus D. Boogaarts, Kerim Beseoglu, Sajjad Muhammad, Jan F. Cornelius and Björn B. Hofmann
J. Clin. Med. 2023, 12(16), 5210; https://doi.org/10.3390/jcm12165210 - 10 Aug 2023
Cited by 1 | Viewed by 955
Abstract
The temporalis muscle area (TMA) has been proclaimed as a surrogate parameter for estimating skeletal muscle mass. Pilot studies in Asian populations suggested temporal muscle thickness (TMT) and TMA as prognostic factors for neurological outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients. This study [...] Read more.
The temporalis muscle area (TMA) has been proclaimed as a surrogate parameter for estimating skeletal muscle mass. Pilot studies in Asian populations suggested temporal muscle thickness (TMT) and TMA as prognostic factors for neurological outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients. This study aimed to validate these findings in a larger European patient cohort. We retrospectively analyzed age, sex, aneurysm location, treatment, World Federation of Neurosurgical Societies (WFNS) grade, Fisher score, and modified Rankin Score (mRS) at six months in patients with aSAH. TMT and TMA measurements were obtained from initial native CT scans. Logistic regression with the dichotomized six-month mRS as the outcome incorporating TMT, weighted average of TMT, or TMA as predictors was performed. Of the included 478 patients, 66% were female, the mean age was 56, and 48% of patients had an mRS of three to six after six months. The mean TMT at the level of the Sylvian fissure was 5.9 (±1.7) mm in males and 4.8 (±1.8) mm in females. The mean TMA was 234.5 (±107.9) mm2 in females and 380 (±134.1) mm2 in males. WFNS grade (p < 0.001), Fisher score (p < 0.001), and age (p < 0.05) correlated significantly with the mRS after six months. No correlation was found between mRS after six months and the TMT at the Sylvian fissure (p = 0.3), the weighted average of TMT (p = 0.1), or the TMA (p = 0.1). In this central European patient cohort of 478 individuals, no significant associations were found between TMT/TMA and neurological outcomes following aSAH. Further prospective studies in diverse patient populations are necessary to determine the prognostic value of TMA and TMT in aSAH patients. Full article
(This article belongs to the Special Issue Cerebrovascular Diseases: Diagnosis, Prognosis, and Intervention)
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18 pages, 6019 KiB  
Systematic Review
The Diagnostic Accuracy of Transcranial Color-Coded Doppler Ultrasound Technique in Stratifying Intracranial Cerebral Artery Stenoses in Cerebrovascular Disease Patients: A Systematic Review and Meta-Analysis
by Simon Takadiyi Gunda, Jerica Hiu-Yui Yip, Veronica Tsam-Kit Ng, Ziman Chen, Xinyang Han, Xiangyan Chen, Marco Yiu-Chung Pang and Michael Tin-Cheung Ying
J. Clin. Med. 2024, 13(5), 1507; https://doi.org/10.3390/jcm13051507 - 05 Mar 2024
Viewed by 776
Abstract
The early and accurate stratification of intracranial cerebral artery stenosis (ICAS) is critical to inform treatment management and enhance the prognostic outcomes in patients with cerebrovascular disease (CVD). Digital subtraction angiography (DSA) is an invasive and expensive procedure but is the gold standard [...] Read more.
The early and accurate stratification of intracranial cerebral artery stenosis (ICAS) is critical to inform treatment management and enhance the prognostic outcomes in patients with cerebrovascular disease (CVD). Digital subtraction angiography (DSA) is an invasive and expensive procedure but is the gold standard for the diagnosis of ICAS. Over recent years, transcranial color-coded Doppler ultrasound (TCCD) has been suggested to be a useful imaging method for accurately diagnosing ICAS. However, the diagnostic accuracy of TCCD in stratifying ICASs among patients with CVD remains unclear. Therefore, this systematic review and meta-analysis aimed at evaluating the diagnostic accuracy of TCCD in the stratification of intracranial steno-occlusions among CVD patients. A total of six databases—Embase, CINAHL, Medline, PubMed, Google Scholar, and Web of Science (core collection)—were searched for studies that assessed the diagnostic accuracy of TCCD in stratifying ICASs. The meta-analysis was performed using Meta-DiSc 1.4. The Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2) assessed the risk of bias. Eighteen studies met all of the eligibility criteria. TCCD exhibited a high pooled diagnostic accuracy in stratifying intracranial steno-occlusions in patients presenting with CVD when compared to DSA as a reference standard (sensitivity = 90%; specificity = 87%; AUC = 97%). Additionally, the ultrasound parameters peak systolic velocity (PSV) and mean flow velocity (MFV) yielded a comparable diagnostic accuracy of “AUC = 0.96”. In conclusion, TCCD could be a noble, safe, and accurate alternative imaging technique to DSA that can provide useful diagnostic information in stratifying intracranial steno-occlusions in patients presenting with CVD. TCCD should be considered in clinical cases where access to DSA is limited. Full article
(This article belongs to the Special Issue Cerebrovascular Diseases: Diagnosis, Prognosis, and Intervention)
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