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Brain Sciences
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The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery,...
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The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery, and Recurrence

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 9127

Special Issue Editors

Dr. Sherief Ghozy

E-Mail Website
Guest Editor
1. Department of Neuroradiology, Mayo Clinic, Rochester, MN 55905, USA
2. Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), Oxford University, Oxford OX2 6GG, UK
Interests: neuroendovascular research; interventional neurology
Dr. Ghulam Md Ashraf

E-Mail Website
Guest Editor
1. Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
2. Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
Interests: natural products; medicine; neurology; dementia; proteomics
Special Issues, Collections and Topics in MDPI journals
Dr. Adam A. Dmytriw

E-Mail Website
Guest Editor
1. Department Medical Imaging, University Toronto, Toronto, ON B3H 1X5, Canada
2. Harvard Med School, Beth Israel Deaconess Medical Center, Department Surgery, Neurosurg Service, Boston, MA 02115, USA
Interests: neurosurgery
Dr. Fawaz Al-Mufti

E-Mail Website
Guest Editor
Department of Neurosurgery, Westchester Medical Center, 8137 New York Medical College, Valhalla, NY 10595, USA
Interests: neuroendovascular research

Special Issue Information

Dear Colleagues,

The MDPI Brain Sciences journal invites submissions to a Special Issue entitled “The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery, and Recurrence.”

Our understanding of the underlying pathophysiology of cerebral ischemia is growing every day, and the treatment of acute ischemic stroke continues to improve. Many studies have identified multiple prognostic factors and effect modifiers for ischemic stroke, with a continuously expanding list. These factors can affect patients’ short- and long-term outcomes, recovery rate, and risk of recurrence.

Intravenous thrombolysis with alteplase remains the mainstay of treatment, which has been shown to have benefits even in later treatment in patients selected with advanced imaging techniques. Tenecteplase has also been evaluated, and trials have shown that it has at least equivalent efficacy to alteplase. Endovascular therapy with mechanical thrombectomy, with a properly selected patient pool, is showing great results in terms of recanalization and long-term effects for proximal large vessel occlusion, with promising trials for individuals with distal occlusion.

This Special Issue welcomes submissions that provide new perspectives, introduce new challenges and tasks, and provide an overview of articles on cerebral ischemia. All article types will be considered.

Dr. Sherief Ghozy
Dr. Ghulam Md Ashraf
Dr. Adam A. Dmytriw
Dr. Fawaz Al-Mufti
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. Brain Sciences 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 2200 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

  • cerebral ischemia
  • acute ischemic stroke
  • recovery rate
  • intravenous thrombolysis
  • endovascular therapy
  • mechanical thrombectomy

Published Papers (5 papers)

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Research

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19 pages, 5107 KiB  
Article
Moderate Hyperkalemia Regulates Autophagy to Reduce Cerebral Ischemia-Reperfusion Injury in a CA/CPR Rat Model
by Xiaoqin Wang, Xinyue Tian, Haiying Shen, Xiaohua Zhang, Lu Xie and Menghua Chen
Brain Sci. 2023, 13(9), 1285; https://doi.org/10.3390/brainsci13091285 - 4 Sep 2023
Viewed by 1191
Abstract
Background: Cerebral ischemia-reperfusion injury (CIRI) can cause irreversible brain damage and autophagy has been implicated in the pathophysiology. Increasing serum potassium (K+) levels reduces CIRI, but the relationship between its protective mechanism and autophagy is unclear. In this study, we aimed [...] Read more.
Background: Cerebral ischemia-reperfusion injury (CIRI) can cause irreversible brain damage and autophagy has been implicated in the pathophysiology. Increasing serum potassium (K+) levels reduces CIRI, but the relationship between its protective mechanism and autophagy is unclear. In this study, we aimed to find the optimal degree of raising serum (K+) and to investigate the relationship between high (K+) and autophagy and the underlying mechanisms in a cardiac arrest/cardiopulmonary resuscitation (CA/CPR) rat model. Methods: Sprague Dawley (SD) rats were divided into four groups: S group, N group, P group, and Q group. The rats S group and N group were administered saline. The rats P group and Q group were administered 640 mg/kg of potassium chloride (KCl) continuously pumped at 4 mL/h (21.3 mg/(kg·min) and divided according to the electrocardiogram (ECG) changes during the administration of KCl. After 24-h of resuscitation, neural damage was assessed by measuring neurological deficit score (NDS), oxidative stress markers, and pathological staining of the cerebral cortex. The level of autophagy and the expression of mTOR-ULK1-Beclin1 pathway-related proteins were evaluated using transmission electron microscopy (TEM), immunostaining, and western blotting. Results: Our results revealed that high (K+) improved NDS and decreased the oxidative stress markers. The autophagosomes, autolysosomes, and lysosomes were decreased following treatment KCl. Furthermore, the levels of micro-tubule-associated protein 1 light chain 3 (LC3) Ⅱ/Ⅰ, Unc-51-like kinase 1 (ULK1), and Beclin1 were decreased, whereas mTOR expression was increased in the cortex. Conclusion: The results demonstrated that moderate hyperkalemia could alleviate autophagy after CIRI via regulating the mTOR-ULK1-Beclin1 pathway. Full article
(This article belongs to the Special Issue The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery, and Recurrence)
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12 pages, 1497 KiB  
Article
Poor Internal Jugular Venous Outflow Is Associated with Poor Cortical Venous Outflow and Outcomes after Successful Endovascular Reperfusion Therapy
by Wenjin Shang, Kaiyi Zhong, Liming Shu, Zhuhao Li and Hua Hong
Brain Sci. 2023, 13(1), 32; https://doi.org/10.3390/brainsci13010032 - 23 Dec 2022
Cited by 1 | Viewed by 1776
Abstract
Many patients show poor outcomes following endovascular reperfusion therapy (ERT), and poor cortical venous outflow is a risk factor for these poor outcomes. We investigated the association between the outflow of the internal jugular vein (IJV) and baseline cortical venous outflow and the [...] Read more.
Many patients show poor outcomes following endovascular reperfusion therapy (ERT), and poor cortical venous outflow is a risk factor for these poor outcomes. We investigated the association between the outflow of the internal jugular vein (IJV) and baseline cortical venous outflow and the outcomes after ERT. We retrospectively enrolled 78 patients diagnosed with an acute anterior circulation stroke and successful ERT. Poor IJV outflow on the affected side was defined as stenosis ≥50% or occlusion of ipsilateral IJV, and poor outflow of bilateral IJVs was defined as stenosis ≥50% or occlusion of both IJVs. Poor cortical venous outflow was defined as a cortical vein opacification score (COVES) of 0 on admission. Multivariate analysis showed that poor outflow of IJV on the affected side was an independent predictor for hemorrhagic transformation. The poor outflow of bilateral IJVs was an independent risk factor for poor clinical outcomes. These patients also had numerical trends of a higher incidence of symptomatic intracranial hemorrhage, midline shift >10 mm, and in-hospital mortality; however, statistical significance was not observed. Additionally, poor IJV outflow was an independent determinant of poor cortical venous outflow. For acute large vessel occlusion patients, poor IJV outflow is associated with poor baseline cortical venous outflow and outcomes after successful ERT. Full article
(This article belongs to the Special Issue The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery, and Recurrence)
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Graphical abstract

9 pages, 719 KiB  
Article
Clopidogrel with Aspirin versus Aspirin Alone following Intravenous Thrombolysis in Minor Stroke: A 1-Year Follow-Up Study
by Hai-Ming Cao, Hui-Wen Lian, Yan E, Rui Duan, Jun-Shan Zhou, Xiang-Liang Chen and Teng Jiang
Brain Sci. 2023, 13(1), 20; https://doi.org/10.3390/brainsci13010020 - 22 Dec 2022
Cited by 2 | Viewed by 2021
Abstract
Objective: The objective of this study was to investigate the long-term effect of dual antiplatelet therapy (DAPT) using clopidogrel plus aspirin versus aspirin monotherapy after intravenous thrombolysis on functional outcomes in patients with minor stroke. Methods: Patients with acute ischemic stroke with a [...] Read more.
Objective: The objective of this study was to investigate the long-term effect of dual antiplatelet therapy (DAPT) using clopidogrel plus aspirin versus aspirin monotherapy after intravenous thrombolysis on functional outcomes in patients with minor stroke. Methods: Patients with acute ischemic stroke with a National Institutes of Health Stroke Scale score ≤ 5 who received either DAPT or aspirin monotherapy following recombinant tissue plasminogen activator intravenous thrombolysis were studied. Data recorded between January 2017 and December 2020 were retrospectively analyzed. The primary efficacy outcome was functional improvement at 1 year, measured by a 1-point decrease across modified Rankin Scale (mRS) scores. Secondary outcomes included complete rehabilitation (mRS = 0), an excellent outcome (mRS = 0–1), and a favorable outcome (mRS = 0–2) at 1 year, as well as the rates of stroke recurrence and all-cause mortality within 1 year. Results: A total of 238 patients were included, and follow-up data were available for 205 patients (86.1%). The distribution of 1-year outcomes on the mRS favored DAPT over aspirin monotherapy (adjusted common odds ratio (OR), 2.19; 95% confidence interval (CI), 1.12–4.28; p = 0.022). Patients who received DAPT, compared with those receiving aspirin alone, were more likely to achieve complete rehabilitation (adjusted OR, 2.44; 95% CI, 1.21–4.95; p = 0.013) at the 1-year follow-up. Additionally, the percentages of an excellent outcome and a favorable outcome did not differ, and the rates of stroke recurrence and all-cause mortality were comparable during the 1-year follow-up. Conclusions: Clopidogrel with aspirin following intravenous thrombolysis was associated with improved functional outcome at the 1-year follow-up for patients with minor stroke, and it did not increase the stroke recurrence rate and mortality. Full article
(This article belongs to the Special Issue The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery, and Recurrence)
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Review

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10 pages, 3052 KiB  
Review
Common Data Elements Reported in Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review of Active Clinical Trials
by Sherief Ghozy, Nicole Hardy, Daniel J. Sutphin, Kevin M. Kallmes, Ramanathan Kadirvel and David F. Kallmes
Brain Sci. 2022, 12(12), 1679; https://doi.org/10.3390/brainsci12121679 - 7 Dec 2022
Cited by 2 | Viewed by 1688
Abstract
Background: New trials are planned regularly to provide the highest quality of evidence and invade new occlusion territories, which requires a pre-defined reporting strategy with consistent, common data elements for more straightforward collective evidence synthesis. We sought to review all active endovascular thrombectomy [...] Read more.
Background: New trials are planned regularly to provide the highest quality of evidence and invade new occlusion territories, which requires a pre-defined reporting strategy with consistent, common data elements for more straightforward collective evidence synthesis. We sought to review all active endovascular thrombectomy trials to investigate their patient selection criteria, intervention description, and reported outcomes. Methods: A literature search was systematically conducted on clinicaltrials.gov for active trials and all intervention, inclusion criteria, and outcomes reported were extracted. A qualitative synthesis of the frequency of study design types and data elements are graphically and narratively presented. Results: A total of 32 studies were tagged and included in the final qualitative analysis. The inclusion criteria were highly variable, including different cut-offs for the last well-known baseline National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and modified Rankin scale (mRS). Half of the studies (16/32) mentioned “thrombectomy” without defining which technique or device was used, and the final thrombolysis in cerebral infarction scale was provided in 19 (59.4%) studies. Heterogeneity was also present among the studies reporting a first-pass effect, both in how studies defined the outcome and in used ranges for mRS. Mortality and intracerebral hemorrhage (ICH) were more homogenous in their presentation and follow-up. Conclusions: There is a great degree of heterogeneity in the active thrombectomy trials concerning inclusion criteria, interventions used, and how outcomes are being reported. Full article
(This article belongs to the Special Issue The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery, and Recurrence)
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Other

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14 pages, 1997 KiB  
Systematic Review
Frailty as a Predictor of Outcomes in Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis
by Michael Fortunato, Fangyi Lin, Anaz Uddin, Galadu Subah, Rohan Patel, Eric Feldstein, Aiden Lui, Jose Dominguez, Matthew Merckling, Patricia Xu, Matthew McIntyre, Chirag Gandhi and Fawaz Al-Mufti
Brain Sci. 2023, 13(10), 1498; https://doi.org/10.3390/brainsci13101498 - 23 Oct 2023
Cited by 1 | Viewed by 1480
Abstract
Frailty is an emerging concept in clinical practice used to predict outcomes and dictate treatment algorithms. Frail patients, especially older adults, are at higher risk for adverse outcomes. Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with high morbidity and mortality rates [...] Read more.
Frailty is an emerging concept in clinical practice used to predict outcomes and dictate treatment algorithms. Frail patients, especially older adults, are at higher risk for adverse outcomes. Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with high morbidity and mortality rates that have previously been shown to correlate with frailty. However, the relationship between treatment selection and post-treatment outcomes in frail aSAH patients is not established. We conducted a meta-analysis of the relevant literature in accordance with PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar using “Subarachnoid hemorrhage AND frailty” and “subarachnoid hemorrhage AND frail” as search terms. Data on cohort age, frailty measurements, clinical grading systems, and post-treatment outcomes were extracted. Of 74 studies identified, four studies were included, with a total of 64,668 patients. Percent frailty was 30.4% under a random-effects model in all aSAH patients (p < 0.001). Overall mortality rate of aSAH patients was 11.7% when using a random-effects model (p < 0.001). There was no significant difference in mortality rate between frail and non-frail aSAH patients, but this analysis only included two studies and should be interpreted cautiously. Age and clinical grading, rather than frailty, independently predicted outcomes and mortality in aSAH patients. Full article
(This article belongs to the Special Issue The Aftermath of Cerebral Ischemia: Management, Effects, Prognostic Factor, Recovery, and Recurrence)
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