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Article ; Online: The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke.

Rudilosso, Salvatore / Rodríguez-Vázquez, Alejandro / Urra, Xabier / Arboix, Adrià

International journal of molecular sciences

2022 Volume 23, Issue 3

Abstract: Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral ...

Abstract	Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.
MeSH term(s)	Early Diagnosis ; Humans ; Neuroimaging/methods ; Reperfusion ; Secondary Prevention ; Stroke, Lacunar/diagnostic imaging ; Stroke, Lacunar/physiopathology ; Stroke, Lacunar/therapy ; Thrombolytic Therapy ; Translational Research, Biomedical
Language	English
Publishing date	2022-01-28
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms23031497
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Article ; Online: Thalamic perforating artery stroke on computed tomography perfusion in a patient with coronavirus disease 2019.

Rudilosso, Salvatore / Esteller, Diana / Urra, Xabier / Chamorro, Ángel

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2020 Volume 29, Issue 8, Page(s) 104974

Abstract: Emerging evidence suggests that patients with coronavirus disease 2019 (COVID-19) are at risk of thromboembolic complications, including ischemic strokes. We present a case illustrating the value of CT perfusion to identify acute small subcortical ... ...

Abstract	Emerging evidence suggests that patients with coronavirus disease 2019 (COVID-19) are at risk of thromboembolic complications, including ischemic strokes. We present a case illustrating the value of CT perfusion to identify acute small subcortical infarcts in a patient with COVID-19 admitted to an intensive care unit for bilateral pneumonia and pulmonary embolism presenting with sudden right limb weakness.
MeSH term(s)	Anticoagulants/therapeutic use ; Antiviral Agents/therapeutic use ; Betacoronavirus/isolation & purification ; Brain Infarction/diagnostic imaging ; Brain Infarction/therapy ; COVID-19 ; COVID-19 Testing ; Clinical Laboratory Techniques ; Coronavirus Infections/diagnosis ; Coronavirus Infections/drug therapy ; Coronavirus Infections/therapy ; Coronavirus Infections/virology ; Diffusion Magnetic Resonance Imaging ; Host Microbial Interactions ; Humans ; Male ; Middle Aged ; Noninvasive Ventilation ; Pandemics ; Perfusion Imaging/methods ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/therapy ; Pneumonia, Viral/virology ; Predictive Value of Tests ; Prosthesis Implantation/instrumentation ; SARS-CoV-2 ; Thalamic Diseases/diagnostic imaging ; Thalamic Diseases/therapy ; Tomography, X-Ray Computed ; Treatment Outcome ; Vena Cava Filters
Chemical Substances	Anticoagulants ; Antiviral Agents
Keywords	covid19
Language	English
Publishing date	2020-05-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2020.104974
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Article ; Online: The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

Salvatore Rudilosso / Alejandro Rodríguez-Vázquez / Xabier Urra / Adrià Arboix

International Journal of Molecular Sciences, Vol 23, Iss 1497, p

2022 Volume 1497

Abstract	Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.
Keywords	cerebrovascular disease ; stroke ; ischemic stroke ; lacunar stroke ; small vessel disease ; recent small subcortical infarcts ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke.

Wardlaw, Joanna M / Chabriat, Hugues / de Leeuw, Frank-Erik / Debette, Stéphanie / Dichgans, Martin / Doubal, Fergus / Jokinen, Hanna / Katsanos, Aristeidis H / Ornello, Raffaele / Pantoni, Leonardo / Pasi, Marco / Pavlovic, Aleksandra M / Rudilosso, Salvatore / Schmidt, Reinhold / Staals, Julie / Taylor-Rowan, Martin / Hussain, Salman / Lindgren, Arne G

European stroke journal

2024 Volume 9, Issue 1, Page(s) 5–68

Abstract: A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke ... ...

Abstract	A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, cognitive decline, mobility, gait, or mood disorders. We systematically reviewed the literature, assessed the evidence and where feasible formulated evidence-based recommendations, and expert concensus statements. We found little direct evidence, mostly of low quality. We recommend that patients with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.
MeSH term(s)	Humans ; Brain Ischemia/complications ; Cerebral Small Vessel Diseases/complications ; Lipids ; Platelet Aggregation Inhibitors/therapeutic use ; Stroke/prevention & control ; Stroke, Lacunar/therapy
Chemical Substances	Lipids ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2024-02-21
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	2851287-X
ISSN	2396-9881 ; 2396-9873
ISSN (online)	2396-9881
ISSN	2396-9873
DOI	10.1177/23969873231219416
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Article: Thalamic perforating artery stroke on computed tomography perfusion in a patient with coronavirus disease 2019

Rudilosso, Salvatore / Esteller, Diana / Urra, Xabier / Chamorro, Ángel

J Stroke Cerebrovasc Dis

Abstract	Emerging evidence suggests that patients with coronavirus disease 2019 (COVID-19) are at risk of thromboembolic complications, including ischemic strokes. We present a case illustrating the value of CT perfusion to identify acute small subcortical infarcts in a patient with COVID-19 admitted to an intensive care unit for bilateral pneumonia and pulmonary embolism presenting with sudden right limb weakness.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #665314
Database	COVID19

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Article ; Online: Effects of Achieving Rapid, Intensive, and Sustained Blood Pressure Reduction in Intracerebral Hemorrhage Expansion and Functional Outcome.

Rodriguez-Luna, David / Pancorbo, Olalla / Llull, Laura / Silva, Yolanda / Prats-Sanchez, Luis / Muchada, Marián / Rudilosso, Salvatore / Terceño, Mikel / Ramos-Pachón, Anna / Hernandez Guillamon, Mar / Coscojuela, Pilar / Blasco, Jordi / Perez-Hoyos, Santiago / Chamorro, Angel / Molina, Carlos A

Neurology

2024 Volume 102, Issue 9, Page(s) e209244

Abstract: Background and objectives: The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained ... ...

Abstract	Background and objectives: The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained maintenance of an intensive systolic BP (SBP) target with radiologic, clinical, and functional outcomes. Methods: Rapid, Intensive, and Sustained BP lowering in Acute ICH (RAINS) was a multicenter, prospective, observational cohort study of adult patients with ICH <6 hours and SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers during a 4.5-year period. Patients underwent baseline and 24-hour CT scans and 24-hour noninvasive BP monitoring. BP was managed under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mm Hg), and sustained (target stability for 24 hours) BP protocol. SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours (primary outcome), early neurologic deterioration (END, 24-hour increase in NIH Stroke Scale score ≥4), and 90-day ordinal modified Rankin scale (mRS) score. Analyses were adjusted by age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension. Results: We included 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male). Hematoma expansion occurred in 70/274 (25.6%) patients, END in 58/291 (19.9%), and the median 90-day mRS score was 4 (interquartile range, 2-5). SBP target achievement ≤60 minutes (178/312 [57.1%]) associated with a lower risk of hematoma expansion (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.23-0.77), lower END rate (aOR 0.43, 95% CI 0.23-0.80), and lower 90-day mRS scores (aOR 0.48, 95% CI 0.32-0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not related to expansion (aOR 0.99, 95% CI 0.95-1.04) but associated with higher END rate (aOR 1.15, 95% CI 1.09-1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04-1.10). Discussion: Among patients with acute ICH, achieving an intensive SBP target within 60 minutes was associated with lower hematoma expansion risk. Rapid SBP reduction and stable sustention within 24 hours were related to improved clinical and functional outcomes. These findings warrant the design of randomized clinical trials examining the impact of effectively achieving rapid, intensive, and sustained BP control on hematoma expansion. Classification of evidence: This study provides Class III evidence that in adults with spontaneous ICH and initial SBP ≥150 mm Hg, lowering SBP to <140 mm Hg within the first hour and maintaining this for 24 hours is associated with decreased hematoma expansion.
MeSH term(s)	Adult ; Humans ; Male ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Blood Pressure/physiology ; Antihypertensive Agents/therapeutic use ; Antihypertensive Agents/pharmacology ; Prospective Studies ; Cerebral Hemorrhage/diagnostic imaging ; Cerebral Hemorrhage/drug therapy ; Stroke/drug therapy ; Hypotension ; Hematoma/diagnostic imaging ; Hematoma/drug therapy ; Treatment Outcome
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2024-04-10
Publishing country	United States
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000209244
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Article ; Online: Different Perfusion Patterns in a Patient with Acute Ischemic Stroke.

Rudilosso, Salvatore / Laredo, Carlos / Urra, Xabier / Chamorro, Ángel

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2017 Volume 26, Issue 5, Page(s) e83–e84

Abstract: A 29-year-old male patient with aphasia and mild weakness of the right arm arrived at the emergency room 4 hours after symptom onset. The computed tomography perfusion showed a typical delay in the time-based maps in the left occipital lobe and another ... ...

Abstract	A 29-year-old male patient with aphasia and mild weakness of the right arm arrived at the emergency room 4 hours after symptom onset. The computed tomography perfusion showed a typical delay in the time-based maps in the left occipital lobe and another hyperperfused area in the left frontal lobe. The follow-up magnetic resonance imaging confirmed cortical ischemic lesions in both areas. This case shows that besides hypoperfusion, hyperperfusion can also be found in the first stages of acute stroke, and it is highly suggestive of established ischemic lesions.
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2017.02.025
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Article ; Online: Computed Tomography Perfusion and Diffusion-Weighted Imaging in Patients With Acute Stroke-Reply.

Rudilosso, Salvatore / Urra, Xabier / Chamorro, Ángel

JAMA neurology

2016 Volume 73, Issue 8, Page(s) 1032–1033

MeSH term(s)	Diffusion Magnetic Resonance Imaging ; Humans ; Stroke ; Tomography, X-Ray Computed
Language	English
Publishing date	2016--01
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2702023-X
ISSN	2168-6157 ; 2168-6149
ISSN (online)	2168-6157
ISSN	2168-6149
DOI	10.1001/jamaneurol.2016.1683
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Article ; Online: Altered Brain Computed Tomography Perfusion in Patients With Fluctuating Lacunar Syndrome and Normal Magnetic Resonance Imaging.

Rudilosso, Salvatore / Urra, Xabier / Chirife, Oscar / Chamorro, Ángel

JAMA neurology

2016 Volume 73, Issue 3, Page(s) 348–349

MeSH term(s)	Aged, 80 and over ; Brain Ischemia/diagnosis ; Brain Ischemia/diagnostic imaging ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Male ; Middle Aged ; Perfusion Imaging ; Stroke, Lacunar/diagnosis ; Stroke, Lacunar/diagnostic imaging ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2702023-X
ISSN	2168-6157 ; 2168-6149
ISSN (online)	2168-6157
ISSN	2168-6149
DOI	10.1001/jamaneurol.2015.4026
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Article ; Online: Higher Cerebral Small Vessel Disease Burden in Patients with White Matter Recent Small Subcortical Infarcts.

Rudilosso, Salvatore / Mena, Luis / Esteller, Diana / Olivera, Marta / Mengual, Juan José / Montull, Caterina / Castrillo, Laura / Urra, Xabier / Gómez-Choco, Manuel

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2021 Volume 30, Issue 7, Page(s) 105824

Abstract: Introduction: Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease (CSVD). We assessed whether the topography of RSSI was related to CSVD markers on magnetic resonance imaging (MRI).: Material ...

Abstract	Introduction: Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease (CSVD). We assessed whether the topography of RSSI was related to CSVD markers on magnetic resonance imaging (MRI). Material and methods: We screened the local registries of two independent stroke centers in Catalonia and selected patients with a symptomatic RSSI on MRI performed during admission. RSSI location was classified into brainstem, supratentorial subcortical structures (SSS), and centrum semiovale (CSO) regions. Clinical variables, including vascular risk factors, were collected. Radiological markers of CSVD on MRI were evaluated individually and by means of the global CSVD burden score. The associations between each RSSI location and CSVD markers were studied in uni- and multivariate logistic regression analysis. Results: Among 475 patients with RSSI, 152 (32%) had an infarct in the brainstem, 227 (48%) in SSS, and 96 (20%) in CSO region. The median CSVD burden score was 2 (IQR, 1-3). After adjusting for confounding factors, a RSSI in CSO was associated with higher periventricular and deep white matter hyperintensity scores [OR 1.64 (95% CI, 1.16-2.33), and OR 1.44 (95% CI, 1.07-1.93), respectively]. Higher CSVD burden score was positively associated with CSO [OR 1.48 (95% CI, 1.22-1.81)] and inversely associated with SSS [0.85 (95% CI, 0.72-0.99)] location after adjusting for relevant confounders. Conclusions: CSO RSSI were related to a higher burden of CSVD, particularly to white matter hyperintensities, compared to other RSSI locations. The pathophysiological significance of such findings should be investigated in the future with advanced neuroimaging techniques.
MeSH term(s)	Aged ; Aged, 80 and over ; Brain Stem Infarctions/diagnostic imaging ; Brain Stem Infarctions/etiology ; Cerebral Infarction/diagnostic imaging ; Cerebral Infarction/etiology ; Cerebral Small Vessel Diseases/complications ; Cerebral Small Vessel Diseases/diagnostic imaging ; Female ; Humans ; Leukoencephalopathies/diagnostic imaging ; Leukoencephalopathies/etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index
Language	English
Publishing date	2021-04-25
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2021.105824
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