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Towards Precision Medicine for Cerebrovascular Diseases
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Towards Precision Medicine for Cerebrovascular Diseases

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (5 March 2023) | Viewed by 10456

Special Issue Editor

Dr. Phil Taussky

E-Mail Website
Guest Editor
Department of Neurosurgery, University of Utah Health, Salt Lake City, UT 84132, USA
Interests: neurovascular surgery; neurosurgery

Special Issue Information

Dear Colleagues, 

Cerebrovascular diseases have seen an enormous advance of new treatment options, including endovascular management of large vessel occlusions for stroke, aneurysm treatment options, radiosurgery for arteriovenous malformations, and management of cavernous malformation. With a plethora of new and advancing treatment modalities, the importance of precision medicine for cerebrovascular disease is becoming increasingly more relevant. The purpose of this Special Issue ‘Toward Precision Medicine for Cerebrovascular Diseases’ is to invite studies that address an individualized approach to the prevention and management of cerebrovascular diseases. This Special Issue will look closely at the latest endovascular management options for stroke and aneurysms and how different treatment tools should be custom tailored to individual patients using the latest technology. Beyond endovascular and surgical treatment options, the availability of novel platelet inhibitors and oral anticoagulants makes the application of precision medicine concepts relevant for individualized treatment of patients suffering from strokes, atherosclerosis, and venous thrombosis. Finally, the prevention of cerebrovascular disease has undergone enormous progress, and understanding a patient’s individual risk factors will also be an important focus of this Special Issue.

Dr. Phil Taussky
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 Personalized Medicine is an international peer-reviewed open access monthly 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

  • ischemic stroke
  • hemorrhagic stroke
  • aneurysm
  • endovascular therapy
  • platelet inhibition
  • oral anticoagulation
  • prevention
  • brain injury

Published Papers (5 papers)

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Research

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13 pages, 1872 KiB  
Article
Safety and Tolerability of Concentrated Intraventricular Nicardipine for Poor-Grade Aneurysmal Subarachnoid Hemorrhage–Related Vasospasm
by Kaneez Zahra, Ricardo A. Domingo, Marion T. Turnbull, Christan D. Santos, Sarah H. Peacock, Daniel A. Jackson, Rabih G. Tawk, Jason L. Siegel and William David Freeman
J. Pers. Med. 2023, 13(3), 428; https://doi.org/10.3390/jpm13030428 - 27 Feb 2023
Cited by 1 | Viewed by 1888
Abstract
Objective: To report the preliminary safety, tolerability, and cerebral spinal fluid (CSF) sampling utility of serial injections of concentrated intraventricular nicardipine (IVN) in the treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods: We report the clinical, radiographic, and laboratory safety and tolerability data of [...] Read more.
Objective: To report the preliminary safety, tolerability, and cerebral spinal fluid (CSF) sampling utility of serial injections of concentrated intraventricular nicardipine (IVN) in the treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods: We report the clinical, radiographic, and laboratory safety and tolerability data of a retrospective case series from a single academic medical center. All patients with aSAH developed vasospasm despite enteral nimodipine and received serial injections of concentrated IVN (2.5 mg/mL). CSF injection safety, tolerability, and utility are defined and reported. Results: A total of 59 doses of concentrated IVN were administered to three patients with poor-grade SAH. In Case 1, a 33-year-old man with modified Fisher scale (mFS) grade 4 and Hunt-Hess scale (HH) score 4 received 26 doses; in Case 2, a 36-year-old woman with mFS grade 4 and HH score 5 received 13 doses; and in Case 3, a 70-year-old woman with mFS grade 3 and HH score 4 received 20 doses. No major safety or tolerability events occurred. Two patients were discharged to a rehabilitation facility, and one died after discharge from the hospital. Conclusions: A concentrated 4 mg IVN dose (2.5 mg/mL) in a 1.6 mL injection appears relatively safe and tolerable and potentially offers a second-line strategy for treating refractory vasospasm in poor-grade SAH without compromising intracranial pressure or cerebral perfusion pressure. Full article
(This article belongs to the Special Issue Towards Precision Medicine for Cerebrovascular Diseases)
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11 pages, 2160 KiB  
Article
Spreading Depolarization as a Therapeutic Target in Severe Ischemic Stroke: Physiological and Pharmacological Strategies
by Lily Chau, Herbert T. Davis, Thomas Jones, Diana Greene-Chandos, Michel Torbey, C. William Shuttleworth and Andrew P. Carlson
J. Pers. Med. 2022, 12(9), 1447; https://doi.org/10.3390/jpm12091447 - 01 Sep 2022
Cited by 4 | Viewed by 1453
Abstract
Background: Spreading depolarization (SD) occurs nearly ubiquitously in malignant hemispheric stroke (MHS) and is strongly implicated in edema progression and lesion expansion. Due to this high burden of SD after infarct, it is of great interest whether SD in MHS patients can be [...] Read more.
Background: Spreading depolarization (SD) occurs nearly ubiquitously in malignant hemispheric stroke (MHS) and is strongly implicated in edema progression and lesion expansion. Due to this high burden of SD after infarct, it is of great interest whether SD in MHS patients can be mitigated by physiologic or pharmacologic means and whether this intervention improves clinical outcomes. Here we describe the association between physiological variables and risk of SD in MHS patients who had undergone decompressive craniectomy and present an initial case of using ketamine to target SD in MHS. Methods: We recorded SD using subdural electrodes and time-linked with continuous physiological recordings in five subjects. We assessed physiologic variables in time bins preceding SD compared to those with no SD. Results: Using multivariable logistic regression, we found that increased ETCO2 (OR 0.772, 95% CI 0.655–0.910) and DBP (OR 0.958, 95% CI 0.941–0.991) were protective against SD, while elevated temperature (OR 2.048, 95% CI 1.442–2.909) and WBC (OR 1.113, 95% CI 1.081–1.922) were associated with increased risk of SD. In a subject with recurrent SD, ketamine at a dose of 2 mg/kg/h was found to completely inhibit SD. Conclusion: Fluctuations in physiological variables can be associated with risk of SD after MHS. Ketamine was also found to completely inhibit SD in one subject. These data suggest that use of physiological optimization strategies and/or pharmacologic therapy could inhibit SD in MHS patients, and thereby limit edema and infarct progression. Clinical trials using individualized approaches to target this novel mechanism are warranted. Full article
(This article belongs to the Special Issue Towards Precision Medicine for Cerebrovascular Diseases)
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11 pages, 584 KiB  
Article
Factors Affecting Post-Stroke Depression in Acute Ischemic Stroke Patients after 3 Months
by Chan-Hyuk Lee, Su Hong Jeon, Min Ju Kim, Gyu Dam Ra, Yong-Hyun Lee, Seung Hyeon Hong, Byoung-Soo Shin and Hyun Goo Kang
J. Pers. Med. 2021, 11(11), 1178; https://doi.org/10.3390/jpm11111178 - 11 Nov 2021
Cited by 6 | Viewed by 1641
Abstract
Post-stroke depression (PSD) affects approximately one-third of stroke patients. PSD not only impairs recovery and lowers quality of life, but has also serious neurological consequences, high mortality, and stroke recurrence risks. Studies on PSD-related prognostic factors are still lacking, especially environmental factors. Moreover, [...] Read more.
Post-stroke depression (PSD) affects approximately one-third of stroke patients. PSD not only impairs recovery and lowers quality of life, but has also serious neurological consequences, high mortality, and stroke recurrence risks. Studies on PSD-related prognostic factors are still lacking, especially environmental factors. Moreover, relieving factors after PSD in stroke patients has not been reported. This study aimed to investigate (study design 1) risk factors for PSD diagnosis after three months, and (study design 2) related factors for the relieving of early PSD after three months. This retrospective study included 227 patients hospitalized for acute ischemic stroke within three days at Jeonbuk National University Hospital from January to December 2019. The depressive status was assessed using the Hamilton Depression Rating Scale (HDRS) at admission and after three months. Clinical and laboratory data were analyzed for relevant prognostic factors. (Study design 1) HDRS score at admission (adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI) 1.14–1.31; p < 0.001) and hospitalization period (aOR 1.11, 95% CI 1.02–1.20; p = 0.013) were confirmed as prognostic factors of PSD after three months. (Study design 2) The National Institute of Health Stroke Scale (NIHSS) score at discharge (aOR 0.80, 95% CI 0.68–0.94; p = 0.006) and HDRS score at admission (aOR 0.80, 95% CI 0.71–0.89; p < 0.001) were confirmed as prognostic factors of depression improvement after three months. In conclusion, environmental factors such as hospitalization period could be important in managing PSD. Factors related to PSD improvement are expected to be helpful in establishing a strategy for PSD recovery. Full article
(This article belongs to the Special Issue Towards Precision Medicine for Cerebrovascular Diseases)
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Review

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7 pages, 219 KiB  
Review
Patient-Tailored Stenting versus Endarterectomy for the Treatment of Asymptomatic Carotid Artery Stenosis
by Michael T. Bounajem, Ramesh Grandhi, Craig J. Kilburg and Philipp Taussky
J. Pers. Med. 2022, 12(6), 882; https://doi.org/10.3390/jpm12060882 - 27 May 2022
Viewed by 1590
Abstract
Carotid artery stenosis is a major cause of acute ischemic strokes in adults. Given the consequences and sequelae of an acute ischemic stroke, intervention while patients are still asymptomatic is a key opportunity for stroke prevention. Although carotid endarterectomy has been the gold [...] Read more.
Carotid artery stenosis is a major cause of acute ischemic strokes in adults. Given the consequences and sequelae of an acute ischemic stroke, intervention while patients are still asymptomatic is a key opportunity for stroke prevention. Although carotid endarterectomy has been the gold standard of treatment for carotid stenosis for many years, recent advances in carotid stenting technology, practitioner experience, and dual antiplatelet therapy have expanded the use for treatments other than endarterectomy. Review of the current literature has demonstrated that endarterectomy and carotid artery stenting produce overall similar results for the treatment of asymptomatic carotid stenosis, but certain factors may help guide physicians and patients in choosing one treatment over the other. Age 70 years and older, renal disease, poor medication compliance, and unstable plaque features all portend better outcomes from endarterectomy, whereas age under 70 years, high cervical location of disease, cardiac disease, and reliable medication compliance favor stenting. The decision to pursue endarterectomy versus stenting is therefore complex, and although large studies have demonstrated similar outcomes, the approach to treatment of asymptomatic carotid stenosis must be optimized for each individual patient to achieve the best possible outcome. Full article
(This article belongs to the Special Issue Towards Precision Medicine for Cerebrovascular Diseases)
10 pages, 1609 KiB  
Review
Tailored Treatment Options for Cerebral Cavernous Malformations
by Jessa E. Hoffman, Blake Wittenberg, Brent Morel, Zach Folzenlogen, David Case, Christopher Roark, Samy Youssef and Joshua Seinfeld
J. Pers. Med. 2022, 12(5), 831; https://doi.org/10.3390/jpm12050831 - 20 May 2022
Cited by 1 | Viewed by 3100
Abstract
The diagnosis and treatment of cerebral cavernous malformations (CCMs), or cavernomas, continues to evolve as more data and treatment modalities become available. Intervention is necessary when a lesion causes symptomatic neurologic deficits, seizures, or has high risk of continued hemorrhage. Future medical treatment [...] Read more.
The diagnosis and treatment of cerebral cavernous malformations (CCMs), or cavernomas, continues to evolve as more data and treatment modalities become available. Intervention is necessary when a lesion causes symptomatic neurologic deficits, seizures, or has high risk of continued hemorrhage. Future medical treatment directions may specifically target the pathogenesis of these lesions. This review highlights the importance of individualized treatment plans based on specific CCM characteristics. Full article
(This article belongs to the Special Issue Towards Precision Medicine for Cerebrovascular Diseases)
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