Clinical Advances in Diagnosis and Treatment of Cerebrovascular Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: 1 June 2024 | Viewed by 3176

Special Issue Editors


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Guest Editor
Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
Interests: cerebrovascular disease; cognition; delayed cerebral ischemia; revascularization; stroke
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, USA
Interests: cerebrovascular disease; neuroimmunology; stroke; subarachnoid hemorrhage; traumatic brain injury
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cerebrovascular disease remains the leading cause of global morbidity and mortality. Recent strides in the field are transforming our understanding and management at an unprecedented pace. The adoption of distal embolectomies is expanding, while minimally invasive techniques now facilitate the extraction of intraparenchymal hemorrhages. Concurrently, advancements in artificial intelligence have optimized early and precise detection methodologies. The era of “big data” allows nuanced insights and precision in interventions.

We hope in this Special Issue to delve deep into cerebrovascular research, spotlighting seminal advancements in both diagnosis and therapeutic modalities. Our goal is to provide readers with a detailed overview of key clinical discoveries and emerging research areas, covering new diagnostic imaging, advanced treatment methods, and significant progress in translational science.

We eagerly anticipate contributions that elucidate ischemic and hemorrhagic pathologies, as well as arterio-venous anomalies. This Special Issue entitled “Clinical Advances in Diagnosis and Treatment of Cerebrovascular Diseases” aims to present the most contemporary knowledge, enhancing evidence-based clinical practice.

Dr. Mario Zanaty
Dr. Panagiotis Mastorakos
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

  • cerebrovascular disease
  • diagnostic imaging
  • ischemic stroke
  • hemorrhagic stroke
  • arterio-venous anomalies
  • endovascular interventions
  • Artificial Intelligence in healthcare

Published Papers (4 papers)

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Research

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12 pages, 462 KiB  
Article
The Relative Cerebral Blood Volume (rCBV) < 42% Is Independently Associated with Collateral Status in Anterior Circulation Large Vessel Occlusion
by Dhairya A. Lakhani, Aneri B. Balar, Manisha Koneru, Sijin Wen, Burak Berksu Ozkara, Hanzhang Lu, Richard Wang, Meisam Hoseinyazdi, Janet Mei, Risheng Xu, Mehreen Nabi, Ishan Mazumdar, Andrew Cho, Kevin Chen, Sadra Sepehri, Nathan Hyson, Victor Urrutia, Licia Luna, Argye E. Hillis, Jeremy J. Heit, Greg W. Albers, Ansaar T. Rai, Adam A. Dmytriw, Tobias Faizy, Max Wintermark, Kambiz Nael and Vivek S. Yedavalliadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(6), 1588; https://doi.org/10.3390/jcm13061588 - 10 Mar 2024
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Abstract
Background: The pretreatment CT perfusion (CTP) marker the relative cerebral blood volume (rCBV) < 42% lesion volume has recently been shown to predict 90-day functional outcomes; however, studies assessing correlations of the rCBV < 42% lesion volume with other outcomes remain sparse. Here, [...] Read more.
Background: The pretreatment CT perfusion (CTP) marker the relative cerebral blood volume (rCBV) < 42% lesion volume has recently been shown to predict 90-day functional outcomes; however, studies assessing correlations of the rCBV < 42% lesion volume with other outcomes remain sparse. Here, we aim to assess the relationship between the rCBV < 42% lesion volume and the reference standard digital subtraction angiography (DSA)-derived American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN) collateral score, hereby referred as the DSA CS. Methods: In this retrospective evaluation of our prospectively collected database, we included acute stroke patients triaged by multimodal CT imaging, including CT angiography and perfusion imaging, with confirmed anterior circulation large vessel occlusion between 1 September 2017 and 1 October 2023. Group differences were assessed using the Student’s t test, Mann–Whitney U test and Chi-Square test. Spearman’s rank correlation and logistic regression analyses were used to assess associations between rCBV < 42% and DSA CS. Results: In total, 222 patients (median age: 69 years, 56.3% female) met our inclusion criteria. In the multivariable logistic regression analysis, taking into account age, sex, race, hypertension, hyperlipidemia, diabetes, atrial fibrillation, prior stroke or transient ischemic attack, the admission National Institute of Health stroke scale, the premorbid modified Rankin score, the Alberta stroke program early CT score (ASPECTS), and segment occlusion, the rCBV < 42% lesion volume (adjusted OR: 0.98, p < 0.05) was independently associated with the DSA CS. Conclusion: The rCBV < 42% lesion volume is independently associated with the DSA CS. Full article
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Review

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13 pages, 574 KiB  
Review
Contemporary Methods for Detection and Intervention of Distal Medium and Small Vessel Occlusions
by Anthony Piscopo, Mario Zanaty and Kathleen Dlouhy
J. Clin. Med. 2023, 12(18), 6071; https://doi.org/10.3390/jcm12186071 - 20 Sep 2023
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Abstract
The efficacy of using mechanical thrombectomy for proximal large vessel occlusions has been demonstrated in multiple large-scale trials and has further raised the question of its potential utility for distal medium and small vessel occlusions (DMSVOs). Their longer, more tortuous course and smaller [...] Read more.
The efficacy of using mechanical thrombectomy for proximal large vessel occlusions has been demonstrated in multiple large-scale trials and has further raised the question of its potential utility for distal medium and small vessel occlusions (DMSVOs). Their longer, more tortuous course and smaller corresponding vascular territories render a significant challenge for detection and intervention. The aim of this study is to provide a comprehensive overview of the current imaging and endovascular intervention options for DMSVOs and review the current works in the literature. Compared with traditional computed tomography angiography (CTA) and CT perfusion, recent advances such as multiphase CTA and maps derived from the time-to-maximum parameter coupled with artificial intelligence have demonstrated increased sensitivity for the detection of DMSVOs. Furthermore, newer generations of mini stent retrievers and thromboaspiration devices have allowed for the access and navigation of smaller and more fragile distal arteries. Preliminary studies have suggested that mechanical thrombectomy using this newer generation of devices is both safe and feasible in distal medium-sized vessels, such as M2. However, endovascular intervention utilizing such contemporary methods and devices must be balanced at the discretion of operator experience and favorable vascular anatomy. Further large-scale multicenter clinical trials are warranted to elucidate the indications for as well as to strengthen the safety and efficacy of this approach. Full article
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Other

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10 pages, 2941 KiB  
Brief Report
Association between Left Atrial Appendage Morphology and Clot Histology in Patients with Embolic Ischemic Stroke: An Exploratory Study
by Givi Lengvenis, Julius Drachneris, Edvardas Žurauskas, Aleksandra Ekkert, Andrius Berūkštis, Marius Kurminas, Rokas Girčius, Kipras Mikelis, Andrej Afanasjev, Kristina Ryliškienė, Arvydas Laurinavičius and Algirdas Edvardas Tamošiūnas
J. Clin. Med. 2024, 13(6), 1734; https://doi.org/10.3390/jcm13061734 - 17 Mar 2024
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Abstract
Background: Acute embolic ischemic stroke poses a significant healthcare challenge. Histological clot features’ variability among patients with acute ischemic stroke treated by mechanical thrombectomy has potential implications for determining treatment and etiology. This study investigated the clot histological feature differences among patients who [...] Read more.
Background: Acute embolic ischemic stroke poses a significant healthcare challenge. Histological clot features’ variability among patients with acute ischemic stroke treated by mechanical thrombectomy has potential implications for determining treatment and etiology. This study investigated the clot histological feature differences among patients who experienced cardioembolic stroke and embolic stroke of undetermined source with different left atrial appendage (LAA) morphologies. Methods: We conducted a prospective observational study involving 79 patients with acute embolic ischemic stroke undergoing mechanical thrombectomy. Computed tomography angiography images were used to classify LAA morphologies. An artificial intelligence algorithm assessed the clot fibrin and red blood cell contents. Results: Patients with chicken-wing LAA morphology exhibited lower mean clot fibrin proportions than did those with non-chicken-wing morphology (p < 0.001). Linear regression analysis showed that chicken-wing LAA was significantly associated with a lower clot fibrin proportion (estimate, −0.177; 95% CI [−0.259, −0.096]; p < 0.001). The successful recanalization rate and first-pass effect between the groups did not differ significantly. Conclusions: The chicken-wing LAA morphological type is associated with lower clot fibrin contents, suggesting potentially different embolism mechanisms or diverse embolic sources, compared with the non-chicken-wing LAA types. Further studies are required to investigate this association. Full article
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9 pages, 329 KiB  
Brief Report
Assessment of Blood Loss during Neuroendovascular Procedures
by Michael Goutnik, Andrew Nguyen, Chance Fleeting, Aashay Patel, Brandon Lucke-Wold, Dimitri Laurent, Tamara Wahbeh, Shawna Amini, Fadi Al Saiegh, Matthew Koch, Brian Hoh and Nohra Chalouhi
J. Clin. Med. 2024, 13(3), 677; https://doi.org/10.3390/jcm13030677 - 24 Jan 2024
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Abstract
(1) Background: Neuroendovascular procedures have generally been considered to have minor or inconsequential blood loss. No study, however, has investigated this question. The purpose of this study is to quantify the blood loss associated with neuroendovascular procedures and identify predictors of blood loss, [...] Read more.
(1) Background: Neuroendovascular procedures have generally been considered to have minor or inconsequential blood loss. No study, however, has investigated this question. The purpose of this study is to quantify the blood loss associated with neuroendovascular procedures and identify predictors of blood loss, using hemoglobin change as a surrogate for blood loss. (2) Methods: A retrospective review of 200 consecutive endovascular procedures (diagnostic and therapeutic) at our institution from January 2020 to October 2020 was performed. Patients had to have pre- and post-operative hematocrit and hemoglobin levels recorded within 48 h of the procedure (with no intervening surgeries) for inclusion. (3) Results: The mean age of our cohort was 60.1 years and the male representation was 52.5%. The mean pre-operative hemoglobin/hematocrit was significantly lower among females compared to males (12.1/36.2 vs. 13.0/38.5, p = 0.003, p = 0.009). The mean hemoglobin decrease was 0.5 g/dL for diagnostic angiograms compared to 1.2 g/dL for endovascular interventions (p < 0.0001), and 1.0 g/dL for all procedures combined. In a multivariate linear regression analysis, pre-operative antiplatelet/anticoagulant use was associated with a statistically significant decrease in hemoglobin. (4) Conclusions: Our data support that blood loss from diagnostic angiograms is marginal. Blood loss in endovascular interventions, however, tends to be higher. Pre-operative blood antiplatelet/anticoagulant use and increasing age appear to increase bleeding risk and may require closer patient monitoring. Full article
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