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Life
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Cerebrovascular Disease: Acute Ischemic Stroke Caused by Large Vessel Occlusion
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Cerebrovascular Disease: Acute Ischemic Stroke Caused by Large Vessel Occlusion

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (28 April 2023) | Viewed by 4256

Special Issue Editors

Dr. László Szapáry

E-Mail Website
Guest Editor
Stroke Dep., Dep. of Neurology, University of Pecs, Pécs, Hungary
Interests: stroke; large vessel occlusion; detection; stroke scales; imaging; therapy
Dr. Gergely Fehér

E-Mail Website
Guest Editor
Department of Primary Health Care, Medical School, University of Pécs, Pecs, Hungary
Interests: stroke; stroke mimics; neuropathic pain; burnout; internet addiction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Large vessel occlusion (LVO) is estimated to be present in between approximately 20 and 40% of AIS cases; this wide range is due to the application of different LVO definitions. The vast majority of LVOs occur in the anterior circulation, which is the most extensively studied subtype; only a minority affects posterior circulation strokes. LVOs can form locally, secondary to intracranial atherosclerosis, or can form an embolism from extracranial atherosclerotic plaques. Cardioembolic aetiologies (most likely atrial fibrillation) can also cause LVO development. Easy-to-use stroke scales could be valuable for EMS personnel to increase vigilance towards early LVO early detection; however, due to their inadequate or limited accuracy current guidelines, these scales are not recommended for routine use as diagnostic tools, and all AIS patients, regardless of LVO suspicion, should be transported to the nearest stroke centre. Despite the amount of biomarker research in the field of AIS so far, only a few markers that are potentially suitable for LVO detection have been identified, and these are only for research purposes and are not included in the current practical guidelines.

In general, stroke severity tends to be significantly higher in groups of these patients; therefore, the early recanalization of occluded vessels is necessary. Endovascular thrombectomy is primarily recommended within 6 hours from symptom onset in cases of ICA or M1 occlusions; however, more distal and posterior occlusions might also be treatable. By using advanced neuroimaging and assessing the salvageable tissue, it is possible to extend the therapeutic window of a thrombectomy by up to 24 hours.

For this Special Issue, we welcome original research, meta-analyses, and review articles on any topic associated with challenges in the diagnosis and management of large vessel occlusion, from preclinical research to multidisciplinary clinical management.

Topics relevant to this Special Issue include, but are not limited to:

  1. Preclinical patient selection, including the set up and inclusion of prehospital stroke scales and biomarker studies;
  2. Differential diagnoses of LVOs;
  3. Challenges in the hyperacute management of LVOs, including multimodal brain imaging;
  4. Challenges in endovascular treatment, including the use of extra- and intracranial stenting;
  5. Stroke of unknown time of onset;
  6. Imaging-based patient selection;
  7. The role of biomarkers.

Dr. László Szapáry
Dr. Gergely Fehér
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. Life 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.

 

Published Papers (3 papers)

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Research

12 pages, 803 KiB  
Article
Symptomatic Intracranial Hemorrhage after Ischemic Stroke Treated with Bridging Revascularization Therapy
by Simon Amaral, Gauthier Duloquin and Yannick Béjot
Life 2023, 13(7), 1593; https://doi.org/10.3390/life13071593 - 20 Jul 2023
Cited by 3 | Viewed by 1211
Abstract
(1) Background: bridging revascularization therapy is now the standard of care in patients with ischemic stroke due to large vessel occlusion. This study aimed to determine the frequency of symptomatic intracranial hemorrhage (sICH) related to this treatment, and to assess contributing factors and [...] Read more.
(1) Background: bridging revascularization therapy is now the standard of care in patients with ischemic stroke due to large vessel occlusion. This study aimed to determine the frequency of symptomatic intracranial hemorrhage (sICH) related to this treatment, and to assess contributing factors and patients’ outcomes. (2) Methods: consecutive ischemic stroke patients treated with bridging therapy were prospectively enrolled. sICH (intracranial hemorrhage with an increase in NIHSS score of ≥4 points) was assessed on imaging at 24 h. The functional status of patients was measured at 6 months using the mRS score; (3) Results: 176 patients were included (mean age 68.7 ± 1.2 years, 52.3% women), among whom 15 (8.5%) had sICH. Patients with sICH had more frequent alcohol abuse (30.1% versus 9.7%, p = 0.023), prestroke use of dual antiplatelet therapy (14.3% versus 1.3%, p = 0.002), higher NIHSS scores at admission (median score 20.5 versus 15, p = 0.01), greater systolic blood pressure upon admission, more frequent vascular intracranial calcifications (p = 0.004), leukoaraiosis (p = 0.001), and intracranial atheroma (p = 0.02), and higher neutrophil-to-lymphocyte ratios (p = 0.02) and neutrophil-to-platelet ratios (p = 0.04). At 6-month follow-up, 9 (60%) patients with sICH died, versus 18% of patients without sICH (p < 0.001). Only 1 (7%) patient with sICH had a good functional outcome, defined as an mRS score of 0 to 2, versus 51% of patients without sICH. (4) Conclusions: one in twelve ischemic stroke patients treated with bridging therapy suffered sICH. Given the observed poor outcomes after sICH, further studies are required to better identify patients at risk to help clinicians in guiding therapeutic strategies. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Acute Ischemic Stroke Caused by Large Vessel Occlusion)
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9 pages, 244 KiB  
Article
Incidence, Characteristics, and Outcomes of Stroke in Pediatric Patients with Celiac Disease
by Sima Vazquez, Akash Thaker, Bridget Nolan, Eris Spirollari, Kevin Clare, Steven Wolf, Patricia McGoldrick, Rolla Nuoman, Philip Overby and Fawaz Al-Mufti
Life 2023, 13(7), 1445; https://doi.org/10.3390/life13071445 - 26 Jun 2023
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Abstract
(1) Background: Celiac disease (CD) can cause long-term inflammation and endothelial dysfunction and has been cited as a risk factor for acute ischemic stroke (AIS) in pediatric patients. However, the rate and outcomes of AIS in pediatric patients with CD has not been [...] Read more.
(1) Background: Celiac disease (CD) can cause long-term inflammation and endothelial dysfunction and has been cited as a risk factor for acute ischemic stroke (AIS) in pediatric patients. However, the rate and outcomes of AIS in pediatric patients with CD has not been explored in a large population. Our objective is to explore the rate, severity, and outcomes of CD amongst pediatric AIS patients on a nationwide level. (2) Methods: The National Inpatient Sample (NIS) database was queried from 2016 to 2020 for pediatric patients with a principal diagnosis of AIS. Patients with a concurrent diagnosis of CD (AIS-CD) were compared to those without (AIS). Baseline demographics and comorbidities, clinical variables of severity, hospital complications, and the rates of tissue plasminogen activator (tPA) and mechanical thrombectomy were compared between the two groups. The main outcomes studied were mortality, discharge disposition, length of stay (LOS), and total hospital charges. (3) Results: Of 12,755 pediatric patients with a principal diagnosis of AIS, 75 (0.6%) had concurrent CD. There were no differences in the severity, discharge disposition, or mortality between the AIS-CD and AIS patients. Patients with AIS-CD were more likely to receive tPA at an outside hospital within 24 h of admission (p < 0.01) and more likely to undergo mechanical thrombectomy (p < 0.01) compared to the AIS patients. (4) Conclusions: CD patients made up only 0.6% of all pediatric AIS patients. No differences in the severity, mortality, or discharge disposition suggests a minimal to absent role of CD in the etiology of stroke. The CD-AIS patients were more likely to receive a tPA or undergo a mechanical thrombectomy; studies are needed to confirm the safety and efficacy of these interventions in pediatric patients. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Acute Ischemic Stroke Caused by Large Vessel Occlusion)
11 pages, 2398 KiB  
Article
Thrombus Density in Acute Basilar Artery Occlusion Depends on Slice Thickness and the Method of Manual Thrombus Delineation
by Liang Shu, Johannes Meyne, Olav Jansen and Ulf Jensen-Kondering
Life 2022, 12(8), 1273; https://doi.org/10.3390/life12081273 - 19 Aug 2022
Viewed by 1449
Abstract
Introduction: High thrombus attenuation on CT has been suggested as a predictor of successful recanalization. It is as well speculated that thrombi of different density may be susceptible to different methods of mechanical thrombectomy. In this study we sought to determine the [...] Read more.
Introduction: High thrombus attenuation on CT has been suggested as a predictor of successful recanalization. It is as well speculated that thrombi of different density may be susceptible to different methods of mechanical thrombectomy. In this study we sought to determine the effect of different methods of manual thrombus delineation and reconstructed slice thickness on thrombus density. Material and Methods: Fifty-six patients with acute occlusion of the basilar artery treated with endovascular therapy were retrospectively included. Clinical, demographic, radiological and outcome parameters were collected. Two raters measured absolute and relative thrombus density employing three different methods (one region of interest, three regions of interest, whole thrombus delineation) and using three different reconstructed slice thicknesses (0.625, 2.5 and 5 mm) of the original admission CT. Results: Thirty-nine patients were successfully recanalized (thrombolysis in cerebral infarction score ≥ 2b). Good clinical outcome (modified Rankin scale ≤ 2) occurred significantly more often in the recanalized group (36 vs. 6%, p = 0.023, Fisher’s exact test), in the non-recanalized group symptomatic intracranial hemorrhage occurred more often (9 vs. 29%, p = 0.001, Fisher’s exact test). Absolute and relative thrombus density were largely different between methods and slice thicknesses. Multiple regression showed a decrease of thrombus density with increasing slice thickness (β = −3.98, p < 0.001) and logistic regression showed a statistically significant but very small relation between density and recanalization (β = 0.006, odds ratio (95% confidence interval) = 1.006 (1.003–1.01), p < 0.001). Conclusions: The methods for manual thrombus delineation and reconstructed slice thickness had a significant influence on absolute and relative thrombus density. Density alone may be of limited value as a predictive marker for recanalization success in acute occlusion of the basilar artery. Standards for density measurements must be defined when comparing different studies and when evaluating different methods of mechanical thrombectomy. Full article
(This article belongs to the Special Issue Cerebrovascular Disease: Acute Ischemic Stroke Caused by Large Vessel Occlusion)
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