Advances in stroke medicine

Abstract

Summary In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management. Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imaging. Endovascular thrombectomy (via angiography) effectively reduces risk of death or dependency in patients with large vessel occlusion (internal carotid, proximal middle cerebral and basilar arteries) if applied within 6 hours of the time they were last known to be well. Endovascular thrombectomy is also beneficial 6–24 hours from the last known well time in selected patients with favourable brain imaging. Thus, some patients with wake‐up stroke are now treatable, and protocols for stroke need to include computed tomography (CT) perfusion scan and CT angiography as routine, in addition to the non‐contrast CT brain scan. Optimised pre‐hospital and emergency department systems (eg, code stroke response teams, pre‐notification by ambulance, direct transport from triage to CT scanner) are essential to maximise the benefit of these strongly time‐dependent therapies. Telemedicine is increasingly providing specialist guidance for these more complex treatment decisions in rural areas. Important developments in secondary stroke prevention include the use of direct oral anticoagulants or left atrial appendage occlusion for atrial fibrillation, and endovascular closure of patent foramen ovale.

Hyperbaric Oxygen Improves Cerebral Ischemia/Reperfusion Injury in Rats Probably via Inhibition of Autophagy Triggered by the Downregulation of Hypoxia-Inducing Factor-1 Alpha

“…Although reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischemic stroke have made great progress, stroke is the second highest cause of death globally and a leading cause of disability [29,30]. Therefore, the concept of combined or multiple therapies is meaningful for complicated stroke, and HBO therapy is one of the promising candidates [10].…”

Recent Advances in Nanomaterials for Diagnosis, Treatments, and Neurorestoration in Ischemic Stroke

“…But the loss of gray matter–white matter differentiation is a limitation for non-contrast CT to make a positive diagnosis of stroke based on early ischemic changes (Bal et al, 2015 ). In addition to the non-contrast CT brain scan, diagnosis for stroke includes computed tomography (CT) perfusion scan and CT angiography as routine (Campbell, 2019 ). Here’s how these two technologies work: based on the intravenous injection of an iodinated contrast agent, via a static acquisition to assess the cerebral vasculature is CT angiography, via a time-resolved series is CT perfusion.…”

Annexin V‐Modified Platelet‐Biomimetic Nanomedicine for Targeted Therapy of Acute Ischemic Stroke

“…Frequent direct cause of ischemic stroke is attributed to the occurrence of cerebrovascular atherosclerotic plaque rupture resulting in thrombosis which occludes cerebral vessels and blocks blood flow contributing to the deficit of oxygen and glucose in brain. [ 4 ] Energy deficiency facilitates the dysfunction of ATPase pump, further exacerbates the damage of blood– brain barrier (BBB) integrity and produces the excitotoxicity, necrosis of neurons, and inflammatory injury. [ 5 ] If the intervention is not timely, the infarct zone may continue to expand resulting in irreversible damage of neurological function, even patient's death.…”