Future challenges of stroke treatment

Lattanzi, Simona; Silvestrini, Mauro

doi:10.1016/j.pjnns.2018.02.004

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…The number of AIS patients treated by means of IVT or MT has increased significantly in recent years [7][8][9]. As shown in other studies [10][11][12][13][14][15][16], we found that MT used to treat AIS in anticoagulated patients did not change long-term outcomes compared to non-coagulated AIS patients treated by MT.…”

Section: Discussionsupporting

confidence: 74%

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

Nowak

Włodarczyk²,

Porębska

et al. 2020

Neurol Neurochir Pol.

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Aim of study. Mechanical thrombectomy (MT) is one of the aetiological treatment options recommended for anticoagulated patients with acute ischaemic stroke (AIS). We analysed its long-term outcomes using the modified Rankin Score (mRS) or mortality on day 90.Clinical rationale for the study. Data describing the anticoagulant efficacy and safety of MT in patients with AIS is limited.Materials and methods. This study included 291 patients with AIS (49% women, mean [SD] age 66 [15] years) who underwent MT in the Comprehensive Stroke Centre in Krakow, Poland. Data describing demographics, stroke risk factors, NIHSS on admission, postprocedural thrombolysis in cerebral infarction score, 24-hour postprocedural haemorrhagic transformation (ECASS-2) as seen on computed tomography, and time between stroke onset and groin puncture was collected. The outcome measure was the mRS on day 90 after stroke onset (a favourable outcome was defined as an mRS not exceeding 2 points; an unfavourable outcome was death).Results. Thirty-seven patients (13%) were on therapeutic anticoagulation during MT. Univariate analysis showed that anticoagulated patients were older and more likely to have been diagnosed with hypertension, ischaemic heart disease, or atrial fibrillation. The patient groups did not differ in terms of clot location, postprocedural thrombolysis in cerebral infarction score, haemorrhagic transformation on computed tomography, or mRS on day 90. Multivariate logistic regression analysis showed that younger age, male sex, no history of diabetes mellitus, lower NIHSS score on admission, shorter time between stroke onset and groin puncture, and better recanalisation were associated with favourable outcomes at day 90, and that therapeutic anticoagulation was not (OR, 1.00; 95%CI, 0.46-2.15; p = 0.99). Anticoagulation did not affect mortality at day 90 (OR, 1.28; 95%CI, 0.56-2.92; p = 0.55). Conclusion and clinical implications.In anticoagulated patients with AIS, MT does not affect long-term outcomes.

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Section: Discussionsupporting

confidence: 74%

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

Nowak

Włodarczyk²,

Porębska

et al. 2020

Neurol Neurochir Pol.

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“…The prospects for effective therapeutic targeting of MMPs require the establishment of conditions to specifically modulate a given MMP isoform, or a subset of MMPs, in a given spatio-temporal context [131]. Further research is warranted to better understand the interactions between MMPs and their molecular and cellular environments, determine the optimal timing of MMPs inhibition for achieving a favorable therapeutic outcome, and implement the discovery of innovative selective agents to spare harmful effects before therapeutic strategies targeting MMPs can be successfully incorporated into routine practice [132,133].…”

Section: Clinical Implications and Future Perspectivesmentioning

confidence: 99%

Matrix Metalloproteinases in Acute Intracerebral Hemorrhage

et al. 2020

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Spontaneous intracerebral hemorrhage (ICH) accounts for 10-30% of all strokes and affects more than one million people every year worldwide, and it is the stroke subtype associated with the highest rates of mortality and residual disability. So far, clinical trials have mainly targeted primary cerebral injury and have substantially failed to improve clinical outcomes. The understanding of the pathophysiology of early and delayed injury after ICH is, hence, of paramount importance to identify potential targets of intervention and develop effective therapeutic strategies. Matrix metalloproteinases (MMPs) represent a ubiquitous superfamily of structurally related zinc-dependent endopeptidases able to degrade any component of the extracellular matrix. They are upregulated after ICH, in which different cell types, including leukocytes, activated microglia, neurons, and endothelial cells, are involved in their synthesis and secretion. The aim of this review is to summarize the available experimental and clinical evidence about the role of MMPs in brain injury following spontaneous ICH and provide critical insights into the underlying mechanisms.

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“…Despite advances in modern medicine and medications, stroke remains a burden affecting disability-adjusted life years ( 2 ). Strokes can cause significant impairments that include different degrees of cognitive and behavioral dysfunction, paralysis, dysphagia, aphasia, and motor dysfunction ( 3 ). The mortality rate of stroke has been gradually decreasing, but the disability rate of stroke remains high ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Traditional Chinese Medicine Interventions in the Rehabilitation of Cognitive and Motor Function in Patients With Stroke: An Overview and Evidence Map

et al. 2022

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Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aim of this evidence map is to provide a synopsis of the best clinical practices and interventions in stroke rehabilitative care and to identify areas with a paucity of evidence to guide future research. PubMed, EMBASE, CDSR, six Korean databases, and two Chinese databases were searched for SRs evaluating the effectiveness of any stroke rehabilitation intervention through October 2021. The quality of the SRs was assessed using AMSTAR 2. A bubble plot was used to graphically display clinical topics, the number of articles, the number of patients included, confidence, and effectiveness. In total, ninety-five SRs were identified; however, after methodological analysis, only 48 had sufficient quality to be included. In total, forty-eight SRs were included in the evidence mapping. The overall search identified SRs from 2015 to 2021. A total of four SRs focused on post-stroke cognitive impairment, whereas the other forty-four SRs focused on post-stroke motor function. In total, nineteen different traditional Chinese medicine (TCM) intervention modalities were included. Acupuncture was the most commonly used treatment. Overall, the quality of the included SRs was low or very low. Most SRs concluded that TCM interventions may have potential benefits in stroke rehabilitation. The results were more promising when acupuncture was used for shoulder–hand syndrome. However, the identified reviews cautioned that firm conclusions cannot be drawn. The evidence map provides a visual overview of the research volume and content involving TCM interventions in stroke rehabilitation. Evidence mapping can facilitate the process of knowledge translation from scientific findings to researchers and policymakers and possibly reduce waste in research.

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Future challenges of stroke treatment

Cited by 6 publications

References 40 publications

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

Matrix Metalloproteinases in Acute Intracerebral Hemorrhage

Traditional Chinese Medicine Interventions in the Rehabilitation of Cognitive and Motor Function in Patients With Stroke: An Overview and Evidence Map

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