Cerebral Ischemic Reperfusion Injury Following Recanalization of Large Vessel Occlusions

Abstract

Although stroke has recently dropped to become the nation's fifth leading cause of mortality, it remains the top leading cause of morbidity and disability in the US. Recent advances in stroke treatment, including intravenous fibrinolysis and mechanical thromboembolectomy, allow treatment of a greater proportion of stroke patients than ever before. While intra-arterial fibrinolysis with recombinant tissue plasminogen is an effective for treatment of a broad range of acute ischemic strokes, endovascular mechanical thromboembolectomy procedures treat severe strokes due to large artery occlusions, often resistant to intravenous drug. Together, these procedures result in a greater proportion of revascularized stroke patients than ever before, up to 88% in 1 recent trial (EXTEND-IA). Subsequently, there is a growing need for neurointensivists to develop more effective strategies to manage stroke patients following successful reperfusion. Cerebral ischemic reperfusion injury (CIRI) is defined as deterioration of brain tissue suffered from ischemia that concomitantly reverses the benefits of re-establishing cerebral blood flow following mechanical or chemical therapies for acute ischemic stroke. Herein, we examine the pathophysiology of CIRI, imaging modalities, and potential neuroprotective strategies. Additionally, we sought to lay down a potential treatment approach for patients with CIRI following emergent endovascular recanalization for acute ischemic stroke.

Electroacupuncture ameliorates cerebral ischemia/reperfusion injury by suppressing autophagy via the SIRT1-FOXO1 signaling pathway

“…Delays in achieving reperfusion, incomplete recanalization, hemorrhagic transformation, and secondary injury following reperfusion are some of the limitations of intravenous thrombolysis [ 7 ]. Blood reperfusion can result in a series of pathological reactions, including oxidative stress [ 8 ], inflammation [ 9 ], endoplasmic reticulum stress [ 10 ], apoptosis [ 11 , 12 ], and autophagy [ 13 ], leading to cerebral ischemia/reperfusion (CIR) injury, which has been defined as a biochemical cascade causing further worsening of ischemic brain tissue that concomitantly reverses the benefits of restoring circulation following stroke occurrence [ 14 ]. Therefore, it is essential to explore an alternative or complementary medicine including numerous types of pretreatment measurements to prevent or limit CIR injury.…”

Novel Intranasal Drug Delivery: Geraniol Charged Polymeric Mixed Micelles for Targeting Cerebral Insult as a Result of Ischaemia/Reperfusion

“…Oxidative stress results as an effect of oxidative phosphorylation that occurs in an attempt to restore nutrient supply and oxygenation to ischaemic cerebellum. Oxidative phosphorylation results in the production of reactive oxygen species (ROS) by the mitochondria; eventually, ROS production associated with reperfusion injury is considered as the "necessary evil" [5]; damage to cerebral tissue after I/R is referred to as "cerebral reperfusion injury" [6].…”

Olfactory Mucosa Mesenchymal Stem Cells Ameliorate Cerebral Ischemic/Reperfusion Injury Through Modulation of UBIAD1 Expression

“…Although restoration of cerebral blood flow by mechanical or chemical therapies is essential to prevent irreversible brain damage, reestablishing blood flow paradoxically amplifies the initial brain tissue damage. This phenomenon is termed as cerebral ischemia/reperfusion (I/R) injury (Al-Mufti et al, 2018). It can be defined as a deterioration of ischemic brain tissue that reverses the benefits of endovascular recanalization (Jung et al, 2010).…”

“…It can be defined as a deterioration of ischemic brain tissue that reverses the benefits of endovascular recanalization (Jung et al, 2010). Ischemic stroke outcome in the forms of moderate to severe neurological deficits and mortality mainly results from cerebral I/R injury (Al-Mufti et al, 2018). Multiple biomechanisms play a role in the pathology of this injury, including oxidative stress, leukocyte infiltration, inflammation, and apoptosis.…”