Intracranial Bleeding after Reperfusion Therapy in Acute Ischemic Stroke

  • 44k

    Total downloads

  • 221k

    Total views and downloads

Download PDFDownload EPUB

About this Research Topic

Submission closed

Background

The use of reperfusion therapy with intravenous (iv) thrombolytic agents (alteplase and tenecteplase) and /or endovascular treatment in ischemic stroke patients is now a standard of care. Intracranial bleeding, however, is the most feared complication of reperfusion therapy. The bleeding can occur either within the infarcted brain tissue (referred to as hemorrhagic transformation (HT)) or in the tissue remote from the cerebral ischemia (referred to as remote parenchymal hemorrhage (rPH)). HT occurs spontaneously during the evolution of the cerebral infarct, and risk is further increased with reperfusion therapy. In the positive iv alteplase trials (NINDS and ECASS III), the risk from iv alteplase in an approved time window (<3h and 3-4.5h respectively) was increased; however, it did not translate into excess mortality. This argument is now commonly used in support of iv alteplase. The EXTEND-IA tenecteplase trial showed symptomatic hemorrhage risk which was similar between the iv alteplase and iv tenecteplase arms of the trial. In the late time window, the HERMES trialists noted that the rate of symptomatic intracranial bleeding was similar in patients treated with endovascular therapy and those with iv alteplase.

Whereas these clinical data have been reassuring, our goal should be to mitigate the risk of intracranial bleeding also at an individual patient level. Various approaches can be adopted towards this goal. For example, by identifying patients with imaging profiles linked to increased bleeding risk (e.g. very low cerebral blood volume, prolonged Tmax delay, poor or absent collateral flow, an elevated hypoperfusion intensity ratio, and disrupted blood brain barrier), one can exclude them from receiving reperfusion therapy; use this information to discuss risk with patient and family, and nevertheless go ahead and treat these patients; weigh in the risks associated with reperfusion therapy and adopt neuroprotective measures to prevent worse outcome; and design studies to test the role of novel interventions (e.g. neuroprotectants; sonothrombolysis) in reperfusion therapy and use these imaging approaches to stratify patient population and add to the robustness of the trials. Thrombolytic agents like desmoteplase and tenecteplase appear to have better safety and efficacy profiles compared to iv alteplase but need further investigation, particularly with respect to bleeding risk and efficacy profile within the approved time window. Antithrombotic agents like argatroban and abciximab need continued investigation to assess whether greater recanalization rates are associated with increased bleeding risk in acute ischemic stroke patients. There is therefore a critical need to develop a better understanding of the pathomechanism linked to intracranial bleeding in these patients treated with various reperfusion strategies.

We therefore welcome reports on human studies for this Research Topic. We aim to educate our readership about the contemporary knowledge on the pathomechanism of intracranial bleeding in ischemic stroke patients who receive reperfusion therapy, and about research methodology that can be adopted to reduce this risk. For this Research Topic we welcome articles relevant to the following topics:

• History of intracranial bleeding after reperfusion therapy;
• Pathomechanisms of intracranial bleeding following iv alteplase;
• Pathomechanisms of intracranial bleeding following endovascular therapy;
• Safety and efficacy of Desmoteplase, Tenecteplase and Urokinase;
• Patterns and implications of blood brain barrier disruption;
• Neuroimaging predictors of hemorrhagic transformation;
• Hemorrhagic transformation in patients treated with Sonothrombolysis;
• Management of Intracranial Hemorrhage following reperfusion therapy;
• Intracranial hemorrhage in patients with milder strokes;
• Intracranial hemorrhage in patients with ischemic stroke linked to small vessel disease;
• Clinical trials and future directions in preventing the risk of intracranial bleeding following reperfusion therapy.

Keywords: Hemorrhagic transformation, ischemic stroke, imaging, reperfusion therapy, thrombolysis

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Topic editors

Frequently asked questions

  • Frontiers' Research Topics are collaborative hubs built around an emerging theme.Defined, managed, and led by renowned researchers, they bring communities together around a shared area of interest to stimulate collaboration and innovation.

    Unlike section journals, which serve established specialty communities, Research Topics are pioneer hubs, responding to the evolving scientific landscape and catering to new communities.

  • The goal of Frontiers' publishing program is to empower research communities to actively steer the course of scientific publishing. Our program was implemented as a three-part unit with fixed field journals, flexible specialty sections, and dynamically emerging Research Topics, connecting communities of different sizes and maturity.

    Research Topics originate from the scientific community. Many of our Research Topics are suggested by existing editorial board members who have identified critical challenges or areas of interest in their field.

  • As an editor, Research Topics will help you build your journal, as well as your community, around emerging, cutting-edge research. As research trailblazers, Research Topics attract high-quality submissions from leading experts all over the world.

    A thriving Research Topic can potentially evolve into a new specialty section if there is sustained interest and a growing community around it.

  • Each Research Topic must be approved by the specialty chief editor, and it falls under the editorial oversight of our editorial boards, supported by our in-house research integrity team. The same standards and rigorous peer review processes apply to articles published as part of a Research Topic as for any other article we publish.

    In 2023, 80% of the Research Topics we published were edited or co-edited by our editorial board members, who are already familiar with their journal's scope, ethos, and publishing model. All other topics are guest edited by leaders in their field, each vetted and formally approved by the specialty chief editor.

  • Publishing your article within a Research Topic with other related articles increases its discoverability and visibility, which can lead to more views, downloads, and citations. Research Topics grow dynamically as more published articles are added, causing frequent revisiting, and further visibility.

    As Research Topics are multidisciplinary, they are cross-listed in several fields and section journals – increasing your reach even more and giving you the chance to expand your network and collaborate with researchers in different fields, all focusing on expanding knowledge around the same important topic.

    Our larger Research Topics are also converted into ebooks and receive social media promotion from our digital marketing team.

     

  • Frontiers offers multiple article types, but it will depend on the field and section journals in which the Research Topic will be featured. The available article types for a Research Topic will appear in the drop-down menu during the submission process.

    Check available article types here 

  • Yes, we would love to hear your ideas for a topic. Most of our Research Topics are community-led and suggested by researchers in the field. Our in-house editorial team will contact you to talk about your idea and whether you’d like to edit the topic. If you’re an early-stage researcher, we will offer you the opportunity to coordinate your topic, with the support of a senior researcher as the topic editor. 

    Suggest your topic here 

  • A team of guest editors (called topic editors) lead their Research Topic. This editorial team oversees the entire process, from the initial topic proposal to calls for participation, the peer review, and final publications.

    The team may also include topic coordinators, who help the topic editors send calls for participation, liaise with topic editors on abstracts, and support contributing authors. In some cases, they can also be assigned as reviewers.

  • As a topic editor (TE), you will take the lead on all editorial decisions for the Research Topic, starting with defining its scope. This allows you to curate research around a topic that interests you, bring together different perspectives from leading researchers across different fields and shape the future of your field. 

     

    You will choose your team of co-editors, curate a list of potential authors, send calls for participation and oversee the peer review process, accepting or recommending rejection for each manuscript submitted.

  • As a topic editor, you're supported at every stage by our in-house team. You will be assigned a single point of contact to help you on both editorial and technical matters. Your topic is managed through our user-friendly online platform, and the peer review process is supported by our industry-first AI review assistant (AIRA).

  • If you’re an early-stage researcher, we will offer you the opportunity to coordinate your topic, with the support of a senior researcher as the topic editor. This provides you with valuable editorial experience, improving your ability to critically evaluate research articles and enhancing your understanding of the quality standards and requirements for scientific publishing, as well as the opportunity to discover new research in your field, and expand your professional network.

  • Yes, certificates can be issued on request. We are happy to provide a certificate for your contribution to editing a successful Research Topic.

  • Research Topics thrive on collaboration and their multi-disciplinary approach around emerging, cutting-edge themes, attract leading researchers from all over the world.

  • As a topic editor, you can set the timeline for your Research Topic, and we will work with you at your pace. Typically, Research Topics are online and open for submissions within a few weeks and remain open for participation for 6 – 12 months. Individual articles within a Research Topic are published as soon as they are ready.

    Find out more about our Research Topics

  • Our fee support program ensures that all articles that pass peer review, including those published in Research Topics, can benefit from open access – regardless of the author's field or funding situation.

    Authors and institutions with insufficient funding can apply for a discount on their publishing fees. A fee support application form is available on our website.

  • In line with our mission to promote healthy lives on a healthy planet, we do not provide printed materials. All our articles and ebooks are available under a CC-BY license, so you can share and print copies.

     

Impact

  • 221kTopic views
  • 173kArticle views
  • 44kArticle downloads
View impact