Advances and controversies in ischemic stroke management: from prevention to diagnosis and acute treatment

Stroke is a leading cause of mortality and the primary cause of disability worldwide, with ischemic stroke accounting for approximately 70% of all cases globally. Recent advancements in brain imaging techniques have significantly expanded the treatment window for reperfusion therapies in carefully selected patients, resulting in improved functional outcomes in the short and long term. Intravenous thrombolysis (IVT) has proven effective in reducing disability when administered for up to 9 hours in patients with detectable salvageable brain tissue on perfusion imaging. Endovascular thrombectomy (EVT) has emerged as a beneficial intervention for a wide range of patients with large vessel occlusion, even up to 24 hours after stroke onset, provided appropriate patient selection based on imaging criteria. Conversely, recent trials have demonstrated the superior efficacy of intensive pharmacological approaches, such as dual antiplatelet therapy (DAPT), in preventing ischemic stroke recurrence, particularly in high-risk patients. Despite significant advancements, several controversies persist in the field of ischemic stroke management. These controversies encompass various topics, including determining the optimal secondary prevention strategy for patients with patent foramen ovale or strategies for ischemic stroke prevention in patients with atrial fibrillation following intracerebral hemorrhage. Furthermore, ongoing debates exist regarding the actual effectiveness of EVT in patients with large ischemic core, distal vessel occlusion, mild stroke syndromes, or high baseline disability. Additionally, the comparative utility of IVT versus dual antiplatelet therapy for minor ischemic strokes remains a contentious issue. Moreover, discussions revolve around identifying the optimal delivery paradigm for EVT, such as the choice between the "drip and ship" approach versus the "mothership" model.

By examining the latest evidence in ischemic stroke management, this Research Topic aims to explore recent advancements, challenges, and ongoing debates throughout the entire spectrum of ischemic stroke management, including prevention strategies, diagnostic techniques, and acute treatment approaches. The studies included in this research endeavor will contribute to the ongoing efforts to enhance clinical practice, improve patient outcomes, and guide the future direction of stroke care.

This Research Topic welcomes original research, systematic reviews, narrative reviews, and meta-analysis.