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   Table of Contents      
EDITORIAL
Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 1-2

Forward thinking in stroke treatment: Advances in cerebrovascular reperfusion and neurorehabilitation


Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

Date of Submission19-Apr-2015
Date of Acceptance23-Jun-2015
Date of Web Publication30-Sep-2015

Correspondence Address:
Xunming Ji
Xuanwu Hospital, Capital Medical University, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-8108.166347

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How to cite this article:
Ji X. Forward thinking in stroke treatment: Advances in cerebrovascular reperfusion and neurorehabilitation. Brain Circ 2015;1:1-2

How to cite this URL:
Ji X. Forward thinking in stroke treatment: Advances in cerebrovascular reperfusion and neurorehabilitation. Brain Circ [serial online] 2015 [cited 2022 Dec 6];1:1-2. Available from: http://www.braincirculation.org/text.asp?2015/1/1/1/166347

Reperfusion therapies aiming to achieve recanalization of vessels have been the main focal point in the treatment of acute ischemic-related pathologies in the fields of both cardiology and neurology. Within neurology, the realm of stroke treatment remains very dynamic and has undergone a significant degree of advancement that began with the use of intravenous tissue plasminogen activator (tPA) in 1996 that was shown to be efficacious for the treatment of acute ischemic strokes by the National Institute of Neurological Disorders and Stroke (NINDS) trial of techniques that focused on achieving a higher degree of revascularization augmented by intra-arterial modalities. [1]

Globally, in recent years, widely implemented reperfusion therapies, especially the application of endovascular mechanical thrombectomy, have significantly enhanced the success rate of stroke treatment. [2],[3],[4],[5],[6] These progresses and innovations in technology are leading to a new concept of neuroprotection in which revascularization-based neuroprotection and prolongation of revascularization time window are emphasized. We expect that the new therapeutic theories and strategies will decrease the side effects, expand indications of treatment, and increase the neuroprotective effects of revascularization.

But revascularization alone may not be the magic bullet therapy for ischemic stroke. Due to the pleiotropic mechanisms of ischemia/reperfusion injury and the differences between animal species, a large number of single target neuroprotective agents effective in animal experiments failed in clinical testing, which seems to indicate that the door to neuroprotective therapy for ischemia might be closed. However, nondrug neuroprotective therapies, which usually affect multiple targets, such as hypothermia, [7] hypoxic/ischemic preconditioning, [8] ultrasound, [9] laser, [10] and oxygen therapy [11] showed unique effects on preventing ischemic brain damage. We expect that a combination of these nondrug therapies will open up a new paradigm for the study of stroke neuroprotection.

In addition to novel nondrug neuroprotective strategies, the degree of collateral circulation is intimately related to the survival of ischemic tissue, especially the penumbra. [12],[13],[14] More collateral circulation will lead to bigger size and longer survival of the penumbra as well as better brain functional recovery after revascularization. Previous studies have indicated that many neuroprotective agents have brain protective effects on penumbra through collateral circulation. We expect that the combination of cerebral microcirculation improving agents, which enhance the collateral circulation and neuroprotection, will be effective to rescue ischemic penumbra and to promote the long-term functional recovery from stroke.

The year 2015 is pivotal to the world of endovascular surgical neuroradiology/interventional neurology as the results of these aforementioned trials have shown the benefit of combining newer generation endovascular treatment with best medical management for the treatment of acute ischemic strokes. [3],[4],[5],[6] These trials have shown favorable results, both short-term and 90-day follow-up. Several exciting breakthroughs were reported in the 2015 International Stroke Conference including mechanical thrombectomy, motion image technology, and gradually disseminating remote stroke treatment, which are all related to protection of cerebral blood flow and revascularization. Revascularization-based neuroprotection is, therefore, the theoretical basis of stroke study and translation and also a widely accepted treatment model.

There are many kinds of scientific journals dedicated to cerebral vascular disease all over the world including both specialized journals such as "Stroke", "Journal of Cerebral Blood Flow and Metabolism", "Translational Stroke Research", and comprehensive journals such as "Neurology and Neurosurgery." These journals play an important role in promoting the research on cerebral vascular disease and developing prevention and treatment methods. Our new journal "Brain Circulation" is committed to building a unique academic platform for studying both reperfusion and neuroprotection strategies by focusing on the mechanical recanalization, nondrug cerebral protection therapy, and restoration and improvement of cerebral collateral circulation. I hope our efforts will boost the academic communication and medical translation of brain circulation research.

 
  References Top

1.
Tissue-plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581-7.  Back to cited text no. 1
    
2.
Ding D. Endovascular mechanical thrombectomy for acute ischemic stroke: A new standard of care. J Stroke 2015;17:123-6.  Back to cited text no. 2
    
3.
Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11-20.  Back to cited text no. 3
    
4.
Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009-18.  Back to cited text no. 4
    
5.
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019-30.  Back to cited text no. 5
    
6.
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296-306.  Back to cited text no. 6
    
7.
Hemmen TM, Raman R, Guluma KZ, Meyer BC, Gomes JA, Cruz-Flores S, et al. ICTuS-L Investigators. Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L): Final results. Stroke 2010;41:2265-70.  Back to cited text no. 7
    
8.
Meng R, Asmaro K, Meng L, Liu Y, Ma C, Xi C, et al. Upper limb ischemic preconditioning prevents recurrent stroke in intracranial arterial stenosis. Neurology 2012;79:1853-61.  Back to cited text no. 8
    
9.
IMS II Trial Investigators. The Interventional Management of Stroke (IMS) II Study. Stroke 2007;38:2127-35.  Back to cited text no. 9
    
10.
Zivin JA, Albers GW, Bornstein N, Chippendale T, Dahlof B, Devlin T, et al. NeuroThera Effectiveness and Safety Trial-2 Investigators. Effectiveness and safety of transcranial laser therapy for acute ischemic stroke. Stroke 2009;40:1359-64.  Back to cited text no. 10
    
11.
Churchill S, Weaver LK, Deru K, Russo AA, Handrahan D, Orrison WW Jr, et al. A prospective trial of hyperbaric oxygen for chronic sequelae after brain injury (HYBOBI). Undersea Hyperb Med 2013;40:165-93.  Back to cited text no. 11
    
12.
Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R, et al. SYNTHESIS Expansion Investigators. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013;368:904-13.  Back to cited text no. 12
    
13.
Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013;368:914-23.  Back to cited text no. 13
    
14.
Liebeskind DS. Collateral lessons from recent acute ischemic stroke trials. Neurol Res 2014;36:397-402.  Back to cited text no. 14
    



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