The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches

Abstract

Ischemic stroke accounts for over 80% of all strokes and is one of the leading causes of mortality and permanent disability worldwide. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is an approved treatment strategy for acute ischemic stroke of large arteries within 4.5 h of onset, and mechanical thrombectomy can be used for large arteries occlusion up to 24 h after onset. Improving diagnostic work up for acute treatment, reducing onset-to-needle time and urgent radiological access angiographic CT images (angioCT) and Magnetic Resonance Imaging (MRI) are real problems for many healthcare systems, which limits the number of patients with good prognosis in real world compared to the results of randomized controlled trials. The applied endovascular procedures demonstrated high efficacy, but some cellular mechanisms, following reperfusion, are still unknown. Changes in the morphology and function of mitochondria associated with reperfusion and ischemia-reperfusion neuronal death are still understudied research fields. Moreover, future research is needed to elucidate the relationship between continuously refined imaging techniques and the variable structure or physical properties of the clot along with vascular permeability and the pleiotropism of ischemic reperfusion lesions in the penumbra, in order to define targeted preventive procedures promoting long-term health benefits.

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

“…It is crucial to comprehend the intricate relationship between the ever-refining imaging methodologies and factors like clot structure variability, vascular permeability, and the diverse manifestations of ischemic reperfusion damages, especially in the penumbra. Insights into these domains hold the key to devising targeted interventions that confer lasting health benefits [169].…”

Protein Carbonylation Contributes to Prothrombotic Fibrin Clot Phenotype in Acute Ischemic Stroke: Clinical Associations

“…Timely treatment of AIS is the key to favorable functional outcome; however, in some patients, reperfusion may paradoxically lead to increased oxidative stress and hemorrhagic transformation of ischemic core. 27 Several oxidative stress markers have been evaluated in the setting of AIS 28 ; however, data on PC in AIS are scarce. PC levels are increased in patients with stroke 29,30 and contribute to unfavorable functional outcome and mortality, 31 as well as to poststroke depression, 32 in thrombolysed AIS patients compared with healthy controls.…”