Most Promising Approaches to Improve Stroke Outcomes: The Stroke Treatment Academic Industry Roundtable XII Workshop

Stroke, Год журнала: 2023, Номер 54(12), С. 3202 - 3213

Опубликована: Окт. 27, 2023

The Stroke Treatment Academic Industry Roundtable XII included a workshop to discuss the most promising approaches improve outcome from acute stroke. brought together representatives academia, industry, and government representatives. discussion examined in 4 epochs: pre-reperfusion, reperfusion, post-reperfusion, access stroke interventions. participants identified areas of priority for developing new existing treatments outcomes. Although many advances therapy have been achieved, more work is necessary reperfusion therapies benefit possible patients. Prioritization should help guide use resources investigator efforts.

Язык: Английский

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Risk Factors, Pathophysiologic Mechanisms, and Potential Treatment Strategies of Futile Recanalization after Endovascular Therapy in Acute Ischemic Stroke

Aging and Disease, Год журнала: 2023, Номер 14(6), С. 2096 - 2096

Опубликована: Янв. 1, 2023

Endovascular therapy is the first-line treatment for acute ischemic stroke. However, studies have shown that, even with timely opening of occluded blood vessels, nearly half all patients treated endovascular stroke still poor functional recovery, a phenomenon called “futile recanalization.”. The pathophysiology futile recanalization complex and may include tissue no-reflow (microcirculation reperfusion failure despite large artery), early arterial reocclusion (reocclusion recanalized artery 24-48 hours post therapy), collateral circulation, hemorrhagic transformation (cerebral bleeding following primary stroke), impaired cerebrovascular autoregulation, hypoperfusion volume. Therapeutic strategies targeting these mechanisms been attempted in preclinical research; however, translation to bedside remains be explored. This review summarizes risk factors, pathophysiological mechanisms, targeted recanalization, focusing on deepen understanding this provide new translational research ideas potential intervention targets improving efficacy

Язык: Английский

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No‐reflow after stroke reperfusion therapy: An emerging phenomenon to be explored

CNS Neuroscience & Therapeutics, Год журнала: 2024, Номер 30(2)

Опубликована: Фев. 1, 2024

In the field of stroke thrombectomy, ineffective clinical and angiographic reperfusion after successful recanalization has drawn attention. Partial or complete microcirculatory failure achievement full patency a former obstructed large vessel, known as "no-reflow phenomenon" "microvascular obstruction," was first reported in 1960s later detected both experimental models patients with stroke. The no-reflow phenomenon (NRP) to result from intraluminal occlusions formed by blood components extraluminal constriction exerted surrounding structures vessel wall. More recently, an emerging number studies have estimated prevalence NRP following therapy, ranging 3.3% 63% depending on its evaluation methods study population. Studies also demonstrated detrimental effects infarction progress neurological outcomes. this review, we discuss research advances, underlying pathogenesis, diagnostic techniques, management approaches concerning population provide comprehensive understanding offer references for future investigations.

Язык: Английский

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Impacts of futile reperfusion and reperfusion injury in acute ischemic stroke

Brain Circulation, Год журнала: 2024, Номер 10(1), С. 1 - 4

Опубликована: Янв. 1, 2024

Acute ischemic stroke (AIS) remains to be a challenging cerebrovascular disease. The mainstay of AIS management is endovascular reperfusion therapy, including thrombectomy and thrombolysis. However, ineffective (futile) (FR) or injury (RI) can seen in significant number patients undergoing strategy. In this article, we discuss two clinically relevant concepts known as "time window" "tissue that impact the clinical outcome therapy. We also explore patient risk factors, leading FR RI well an emerging concept "no-reflow phenomenon" reperfusion. These fundamental provide insight into references for future research.

Язык: Английский

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Endothelial Cells and the Blood–Brain Barrier: Critical Determinants of Ineffective Reperfusion in Stroke

European Journal of Neuroscience, Год журнала: 2025, Номер 61(3)

Опубликована: Фев. 1, 2025

ABSTRACT Ineffective reperfusion remains a critical challenge in neurointerventional treatment following ischemic stroke, with the integrity of blood–brain barrier (BBB) being key determinant patient outcomes. This review explores distinctive characteristics and roles brain endothelial cells (ECs) context stroke ineffective reperfusion. We examine unique properties ECs compared to their counterparts other tissues, focusing on pathophysiological changes, functional impairments inflammatory cascades that follow stroke. Differences gene expression between those organs offer deeper insights into role neuroprotective therapies. Additionally, drawing parallels from similar ischemia–reperfusion injury profiles may inspire novel therapeutic approaches. highlights importance understanding nuanced BBB regulation, which ultimately impacts

Язык: Английский

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Influence of Asymptomatic Hemorrhagic Transformation After Endovascular Treatment on Stroke Outcome

Neurology, Год журнала: 2025, Номер 104(9)

Опубликована: Апрель 14, 2025

In patients with acute ischemic stroke (AIS), the impact of hemorrhagic transformation (HT) after endovascular treatment (EVT) on poorer outcome is well established when associated clinical deterioration. However, influence asymptomatic HT remains unclear. We aimed to examine EVT functional and mortality. Drawing Catalan (Spain) population-based prospective registry data, we included from 10 comprehensive centers anterior circulation AIS (2017-2023) who underwent EVT, excluding without data presence or at 3 months follow-up. was categorized as parenchymal hemorrhage (PH), infarct (HI) types 1 2, remote PH (rPH). Asymptomatic defined any not causing death NIH Stroke Scale (NIHSS) score increase by ≥ 4 points. Functional centrally assessed using modified Rankin (mRS). The primary end point a shift in 3-month mRS score. After symptomatic intracerebral (sICH), multivariable ordinal regression analyses (adjusted age, mRS, baseline NIHSS score, Alberta Program Early CT Score, Thrombolysis Cerebral Infarction ≥2b) were performed test for association point. 3,067 (72.0 ± 13.6 years, 50.7% women), 179 (5.8%) sICH 612 (20.0%) HT. category frequencies 8.9% HI1, 7.2% HI2, 4.4% PH1, 3.8% PH2, 1.5% rPH. percentage showed hierarchical distribution, ranging 93.4% HI1 25.0% PH2. analysis, outcomes (common odds ratio [cOR] 2.24, 95% CI 1.89-2.66) higher mortality 1.50, 1.17-1.91). sensitivity analyses, remained significant each category, PH2 showing highest (cOR 3.15, 1.46-6.83). undergoing mortality, suggesting that HT, regardless its radiologic should be considered an additional safety measure.

Язык: Английский

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Stress hyperglycemia as a modifiable predictor of futile recanalization in patients undergoing mechanical thrombectomy for acute ischemic stroke

Frontiers in Neurology, Год журнала: 2023, Номер 14

Опубликована: Май 19, 2023

Mechanical thrombectomy (MT) is the first line treatment in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Approximately half of patients treated with MT does not have a favorable outcome 3 months after stroke. The aim this study was identify predictors futile recanalization (FR) LVO MT.A retrospective analysis consecutive anterior circulation who underwent MT. Patients TICI score 2b or were included. We distinguished two groups, FR and meaningful (MR), according patients' disability three (FR: mRS > 2; MR: < 2).We enrolled 238 (FR, n = 129, 54.2%; MR, 109, 45.8%). Age (OR 1.05, 95% CI 1.01-1.09, p 0.012), female sex 2.43, 1.12-5.30, 0.025), stress hyperglycemia, as measured by GAR index, 1.17, 1.06-1.29, 0.002), NIHSS at admission 1.15, 1.07-1.25, 0.001) time from symptoms onset 1.01, 1.00-1.01, 0.020) independent FR. AUC for model combining age, sex, 0.81 (95% 0.76-0.87; 0.001). optimal index cut-off predict 17.9.FR common recognized older baseline non-modifiable On other hand, hyperglycemia modifiable pre- post-MT factors, respectively. Any effort should be encouraged reduce impact these predictors.

Язык: Английский

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Stress hyperglycemia is associated with futile recanalization in patients with anterior large vessel occlusion undergoing mechanical thrombectomy

European Stroke Journal, Год журнала: 2024, Номер 9(3), С. 613 - 622

Опубликована: Апрель 16, 2024

Introduction: Mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) due to anterior large vessel occlusion (LVO). Despite successful recanalization, some patients remain disabled after 3 months. Mechanisms that can cause futile recanalization (FR) are still largely unknown. We investigated if stress hyperglycemia might be associated with FR. Patients and methods: This a retrospective analysis of consecutive treated in four participating centers between January 2021 December 2022. According modified Rankin scale (mRS) status at months, were divided into two groups: FR, mRS score >2, useful (UR), ⩽2. Stress was estimated by glucose-to-glycated hemoglobin ratio (GAR) index. Results: A total 691 subjects included. At 403 (58.3%) included FR group, while remaining 288 (41.7%) UR group. multivariate analysis, variables independently following: age (OR 1.04, 95% CI 1.02–1.06, p < 0.001), GAR index 1.08, 1.03–1.14, = 0.003), NIHSS admission 1.16, 1.11–1.22; procedure length 1.01, 1.00–1.02; 0.009). observed model combining age, index, admission, had good predictive accuracy (AUC 0.78, 0.74–0.81). Conclusions: predicts MT. Further studies should explore managing may reduce recanalization. Additionally, we recommend paying close attention AIS greater than 24.8 who exhibit high risk

Язык: Английский

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Normobaric Hyperoxia Combined With Endovascular Treatment Based on Temporal Gradient: A Dose-Escalation Study

Stroke, Год журнала: 2024, Номер 55(6), С. 1468 - 1476

Опубликована: Май 15, 2024

Normobaric hyperoxia (NBO) has neuroprotective effects in acute ischemic stroke. Thus, we aimed to identify the optimal NBO treatment duration combined with endovascular treatment.

Язык: Английский

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A promising frontier: targeting NETs for stroke treatment breakthroughs

Cell Communication and Signaling, Год журнала: 2024, Номер 22(1)

Опубликована: Апрель 23, 2024

Abstract Stroke is a prevalent global acute cerebrovascular condition, with ischaemic stroke being the most frequently occurring type. After stroke, neutrophils accumulate in brain and subsequently generate release neutrophil extracellular traps (NETs). The accumulation of NETs exacerbates impairment blood‒brain barrier (BBB), hampers neovascularization, induces notable neurological deficits, worsens prognosis patients, can facilitate occurrence t-PA-induced cerebral haemorrhage subsequent to stroke. Alternative approaches pharmacological thrombolysis or endovascular thrombectomy are explored, targeting promising treatment that warrants further investigation.

Язык: Английский

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