Research Topic

Management of Acute Stroke with Large Core

About this Research Topic

Acute ischemic stroke involving large brain areas is frequently seen in clinics. Management in these patients is complex, as they have a lower probability of achieving a good functional outcome and there are more cases with complications including symptomatic intracerebral hemorrhage (ICH), cerebral edema, and a need for decompressive surgery. The absence of randomized evidence for efficacy and safety of reperfusion therapy using endovascular thrombectomy and evidence against the use of IV tPA from early trials, make these patients ineligible to receive any reperfusion therapy. Issues regarding neurocritical care management are also frequent.

Evaluation of patients with large ischemic cores using different neuroimaging modalities is also complicated. Various imaging modalities represent different tissue-level characteristics; CT measures tissue density and water content, MR DWI measures restriction of diffusion, and perfusion imaging evaluates various blood flow and volume parameters. These modalities may not agree with one another and eligibility for various life-saving treatments may differ based on various proposed definitions.

In this Research Topic, we aim to investigate various issues pertaining to the diagnosis, acute management, and long-term consequences of large core strokes. We will explore the impact of:
• time management,
• outcome prediction based on various clinical, laboratory, and imaging evaluation,
• the potential utility and pitfalls of various treatment strategies including intravenous alteplase/tenecteplase and endovascular thrombectomy using stent retrievers/aspiration,
• the role of metabolic and hemodynamic control,
• management of complications including cerebral edema,
• and symptomatic ICH and their consequences.

Areas of interest include, but are not limited to the following:

1. Diagnostic imaging of acute stroke with large core
Comparison of imaging diagnostic accuracy:
a. Simple imaging with NCCTH (ASPECTS < 6, > 1/3 MCA).
b. Advanced imaging (CTP (rCBF <30%) ≥ 50 cc, MRI ADC ≥ 50 cc)

2. IV thrombolysis in acute stroke with large core
a. Assessment of safety and potential efficacy

3. Endovascular thrombectomy in acute stroke with large core
a. Assessment of safety and potential efficacy
b. Evaluation of imaging modalities to select patients with large core for thrombectomy
c. Potentially Perspective/Opinion papers on clinical trials for thrombectomy in large core strokes

4. Hemicraniectomy management of large core strokes

5. Management of cerebral edema in large core strokes
a. Osmotic therapy
b. Intravenous BIIB093 (Glibenclamide) (CHARM trial)


Topic Editor, Prof. Amrou Sarraj, received financial support from Stryker, Neurovascular. The other Topic Editors declare no competing interests with regard to the Research Topic subject.


Keywords: Stroke, Large Core, Endovascular, Neuroprotection, 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.

Acute ischemic stroke involving large brain areas is frequently seen in clinics. Management in these patients is complex, as they have a lower probability of achieving a good functional outcome and there are more cases with complications including symptomatic intracerebral hemorrhage (ICH), cerebral edema, and a need for decompressive surgery. The absence of randomized evidence for efficacy and safety of reperfusion therapy using endovascular thrombectomy and evidence against the use of IV tPA from early trials, make these patients ineligible to receive any reperfusion therapy. Issues regarding neurocritical care management are also frequent.

Evaluation of patients with large ischemic cores using different neuroimaging modalities is also complicated. Various imaging modalities represent different tissue-level characteristics; CT measures tissue density and water content, MR DWI measures restriction of diffusion, and perfusion imaging evaluates various blood flow and volume parameters. These modalities may not agree with one another and eligibility for various life-saving treatments may differ based on various proposed definitions.

In this Research Topic, we aim to investigate various issues pertaining to the diagnosis, acute management, and long-term consequences of large core strokes. We will explore the impact of:
• time management,
• outcome prediction based on various clinical, laboratory, and imaging evaluation,
• the potential utility and pitfalls of various treatment strategies including intravenous alteplase/tenecteplase and endovascular thrombectomy using stent retrievers/aspiration,
• the role of metabolic and hemodynamic control,
• management of complications including cerebral edema,
• and symptomatic ICH and their consequences.

Areas of interest include, but are not limited to the following:

1. Diagnostic imaging of acute stroke with large core
Comparison of imaging diagnostic accuracy:
a. Simple imaging with NCCTH (ASPECTS < 6, > 1/3 MCA).
b. Advanced imaging (CTP (rCBF <30%) ≥ 50 cc, MRI ADC ≥ 50 cc)

2. IV thrombolysis in acute stroke with large core
a. Assessment of safety and potential efficacy

3. Endovascular thrombectomy in acute stroke with large core
a. Assessment of safety and potential efficacy
b. Evaluation of imaging modalities to select patients with large core for thrombectomy
c. Potentially Perspective/Opinion papers on clinical trials for thrombectomy in large core strokes

4. Hemicraniectomy management of large core strokes

5. Management of cerebral edema in large core strokes
a. Osmotic therapy
b. Intravenous BIIB093 (Glibenclamide) (CHARM trial)


Topic Editor, Prof. Amrou Sarraj, received financial support from Stryker, Neurovascular. The other Topic Editors declare no competing interests with regard to the Research Topic subject.


Keywords: Stroke, Large Core, Endovascular, Neuroprotection, 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.

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Submission Deadlines

30 September 2021 Abstract
18 December 2021 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

30 September 2021 Abstract
18 December 2021 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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