Emerging therapies in acute ischemic stroke

Liaw, Nicholas; Liebeskind, David S

doi:10.12688/f1000research.21100.1

Cited by 38 publications

(25 citation statements)

References 49 publications

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“…The implementation of strict rules worldwide for combating the impact of severe acute respiratory syndrome coronavirus-2, such as closure of medical practices, reduction of seat places in waiting rooms in medical practices, social distancing, and “stay at home” campaigns, has resulted in a decline in the number of people seeking medical care and also in how people are coping with illnesses [ 1 , 2 , 3 , 4 , 5 ]. Amid the current situation, maintaining the delivery chain for the provision of medical care is essential for stroke neurologists and cardiologists, as time is the most important factor when it comes to saving brain/heart tissue in case of acute ischemia [ 6 ]. In the algorithm for the treatment of an acute ischemic vascular event, the first step, the patient's awareness in recognizing the dysfunction and calling for medical assistance, may well be the most critical of all [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Consultations Decline for Stroke, Transient Ischemic Attack, and Myocardial Infarction during the COVID-19 Pandemic in Germany

Tanislav

Jacob

Kostev³

2021

Neuroepidemiology

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Background: The coronavirus disease 2019 (COVID-19) pandemic raises the concern that other non-COVID conditions will be affected by a decline in care. Therefore, we aimed to investigate the decline in ambulatory presentations for vascular events (stroke, transient ischemic attack [TIA], and myocardial infarction [MI]) during the COVID-19 pandemic. Methods: Patients with a diagnosis of ischemic stroke, TIA, or MI documented anonymously in 1,262 general practices in Germany were included. We studied the differences between 2019 and 2020 (between April and June) in terms of rates and baseline characteristics by comparing monthly absolute frequencies. Results: A total of 3,496 patients with stroke (mean age: 72.2 years), 1,608 patients with TIA (mean age: 71.5 years), and 2,385 patients with MI (mean age: 66.8 years) were identified between April and June 2020, indicating a decrease of 10% (stroke), 16% (TIA), and 9% (MI) compared to 2019. For patients with stroke, the decrease in men was 13% (women: −6%) but reached 17% in the age category 51–60 years. For MI, the decrease was only obvious in males (14%). The largest decrease in stroke (−17%) and MI (−19%) was noted in April, while that for TIA occurred in May (−22%). In June for all 3 conditions, the previous year’s level was achieved. Only in TIA, the age differs between 2019 and 2020 (mean age: 69.9 vs. 71.5 years; p < 0.05). In patients with stroke and MI, the proportions of men were lower in 2019 than in 2020 (stroke: 54.8–50.5%, p < 0.05 and MI: 64–60.2%, p < 0.05). Conclusion: Although the decline in the number of patients presenting with stroke, TIA, and MI was not as noticeable in the ambulatory sector as it was in the area of emergency hospital-based care, our data indicate that the COVID-19 pandemic affected all sectors within the medical care system.

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Section: Introductionmentioning

confidence: 99%

Consultations Decline for Stroke, Transient Ischemic Attack, and Myocardial Infarction during the COVID-19 Pandemic in Germany

Tanislav

Jacob

Kostev³

2021

Neuroepidemiology

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“…Over the past several years, a few software platforms have been commercialized of which some of the most popular are RapidAI (iSchema View, Menlo Park, CA, USA), e-Stroke Suite (Brainomix, Oxford, England) in collaboration with Olea Sphere (Olea Medical Solutions, La Ciotat, France), and Viz.ai (Viz.ai, San Francisco, CA, USA) [17,48,49].…”

Section: Brain Imagingmentioning

confidence: 99%

How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods

Zeleňák

Krajina

Meyer

et al. 2021

Life

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Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and collecting of extremely big databases. Nowadays, the speed of internet connection is a limiting factor for robotic systems, which can be controlled and commanded potentially from various places in the world. Innovative technologies can be implemented for acute stroke patient management soon. Artificial intelligence (AI) and robotics are used increasingly often without the exception of medicine. Their implementation can be achieved in every level of stroke care. In this article, all steps of stroke health care processes are discussed in terms of how to improve them (including prehospital diagnosis, consultation, transfer of the patient, diagnosis, techniques of the treatment as well as rehabilitation and usage of AI). New ethical problems have also been discovered. Everything must be aligned to the concept of “time is brain”.

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“… 6 , 7 In addition to pharmacological treatment, mechanical clot removal via endovascular thrombectomy is increasingly used clinically for the treatment of large vessel occlusions, particularly with patients who respond poorly to rtPA treatment. 6 , 8 This technique involves the removal of the clot blockage from directly within the affected vessel, allowing immediate reversal of the clot's impact on blood flow. The prompt restoration of vital blood flow to the ischemic area is the primary clinical goal, with the potential to salvage vital tissue and cellular function, thus reducing the spread of increasing ischemic damage.…”

Section: Ischemic Stroke Diseasementioning

confidence: 99%

A review of experimental models of focal cerebral ischemia focusing on the middle cerebral artery occlusion model

Trotman‐Lucas

Gibson

2021

F1000Res

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Cerebral ischemic stroke is a leading cause of death and disability, but current pharmacological therapies are limited in their utility and effectiveness. In vitro and in vivo models of ischemic stroke have been developed which allow us to further elucidate the pathophysiological mechanisms of injury and investigate potential drug targets. In vitro models permit mechanistic investigation of the biochemical and molecular mechanisms of injury but are reductionist and do not mimic the complexity of clinical stroke. In vivo models of ischemic stroke directly replicate the reduction in blood flow and the resulting impact on nervous tissue. The most frequently used in vivo model of ischemic stroke is the intraluminal suture middle cerebral artery occlusion (iMCAO) model, which has been fundamental in revealing various aspects of stroke pathology. However, the iMCAO model produces lesion volumes with large standard deviations even though rigid surgical and data collection protocols are followed. There is a need to refine the MCAO model to reduce variability in the standard outcome measure of lesion volume. The typical approach to produce vessel occlusion is to induce an obstruction at the origin of the middle cerebral artery and reperfusion is reliant on the Circle of Willis (CoW). However, in rodents the CoW is anatomically highly variable which could account for variations in lesion volume. Thus, we developed a refined approach whereby reliance on the CoW for reperfusion was removed. This approach improved reperfusion to the ischemic hemisphere, reduced variability in lesion volume by 30%, and reduced group sizes required to determine an effective treatment response by almost 40%. This refinement involves a methodological adaptation of the original surgical approach which we have shared with the scientific community via publication of a visualised methods article and providing hands-on training to other experimental stroke researchers.

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Emerging therapies in acute ischemic stroke

Cited by 38 publications

References 49 publications

Consultations Decline for Stroke, Transient Ischemic Attack, and Myocardial Infarction during the COVID-19 Pandemic in Germany

Consultations Decline for Stroke, Transient Ischemic Attack, and Myocardial Infarction during the COVID-19 Pandemic in Germany

How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods

A review of experimental models of focal cerebral ischemia focusing on the middle cerebral artery occlusion model

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