Advances in Neuroprotection for Thrombectomy in Acute Ischemic Stroke

Ritikitwa Berguyse^*
*Correspondence: Ritikitwa Berguyse, Department of Anesthesiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia, Email:

Introduction

Advances in neuroprotection for thrombectomy in acute ischemic stroke represent a burgeoning area of research aimed at improving outcomes for stroke patients undergoing endovascular intervention. Thrombectomy, a minimally invasive procedure involving the removal of blood clots from cerebral arteries, has revolutionized acute stroke care, leading to improved recanalization rates and functional outcomes. However, despite the efficacy of thrombectomy, a significant proportion of patients still experience adverse neurological sequelae, including ischemic injury and neuronal death. Neuroprotective strategies seek to mitigate the detrimental effects of ischemic stroke on brain tissue by preserving neuronal integrity, reducing inflammation and preventing secondary injury cascades [1]. While numerous neuroprotective agents have shown promise in preclinical studies, translating these findings into clinical practice has been challenging, with few therapies demonstrating efficacy in randomized controlled trials. Nonetheless, recent advances in neuroprotective research offer renewed hope for the development of effective adjunctive therapies to complement thrombectomy and improve outcomes for stroke patients. This study aims to provide an overview of current and emerging neuroprotective strategies for thrombectomy in acute ischemic stroke. By examining the underlying mechanisms of neuroprotection, exploring preclinical and clinical evidence and discussing future directions, this review seeks to elucidate the potential of neuroprotective therapies to enhance the effectiveness of thrombectomy and mitigate ischemic brain injury. Understanding the evolving landscape of neuroprotection in acute stroke care is essential for guiding research efforts, informing clinical decision-making and ultimately improving outcomes for patients undergoing thrombectomy for acute ischemic stroke [2].

Description

This review provides a comprehensive overview of neuroprotection strategies aimed at enhancing outcomes for patients undergoing thrombectomy for acute ischemic stroke. Thrombectomy, a minimally invasive procedure, has revolutionized acute stroke treatment by rapidly restoring blood flow to the affected brain tissue. However, despite its efficacy, ischemic brain injury and neurological deficits still occur in a subset of patients following thrombectomy. The review discusses the underlying pathophysiology of ischemic stroke and the mechanisms by which neuroprotective agents may mitigate neuronal damage. It examines a range of neuroprotective strategies, including pharmacological agents, therapeutic hypothermia and novel approaches targeting inflammation, excitotoxicity and oxidative stress. Preclinical and clinical evidence supporting the efficacy of these neuroprotective interventions is evaluated, with a focus on their potential to complement thrombectomy and improve functional outcomes. Furthermore, the review explores challenges and limitations associated with translating neuroprotective therapies from preclinical models to clinical practice. Factors such as treatment timing, patient selection and heterogeneity of stroke etiology are discussed, along with the need for robust clinical trials to establish the safety and efficacy of neuroprotective agents in the context of thrombectomy. On-going research efforts are also exploring innovative approaches to neuroprotection, including the development of neuroregenerative therapies, gene therapy and stem cellbased interventions [3].

These cutting-edge strategies hold the potential to promote neuronal repair and regeneration in the ischemic brain, offering new avenues for improving long-term outcomes in stroke survivors. Moreover, advances in imaging modalities, such as functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography (PET), are enabling researchers to better understand the dynamic changes in brain metabolism, perfusion and connectivity following stroke. By leveraging these advanced imaging techniques, clinicians can tailor neuroprotective interventions to target specific pathophysiological processes and individualize treatment strategies based on each patient's unique neuroanatomical and neurophysiological profile. In parallel, efforts to enhance public awareness and education about stroke risk factors, warning signs and the importance of seeking timely medical attention are crucial for facilitating early intervention and optimizing treatment outcomes. Community-based stroke prevention programs, public health campaigns and telestroke initiatives can help disseminate knowledge about stroke prevention and management, empowering individuals to take proactive steps to reduce their risk of stroke and improve their overall cardiovascular health [4,5].

Conclusion

Neuroprotective strategies offer a promising approach to mitigating ischemic brain injury and enhancing the effectiveness of thrombectomy. While numerous agents and interventions have shown promise in preclinical studies, translating these findings into clinical practice remains challenging. Nonetheless, on-going research efforts hold the potential to identify novel neuroprotective agents and optimize treatment strategies for acute ischemic stroke. Challenges such as treatment timing, patient selection and the need for robust clinical trials underscore the complexity of neuroprotection in acute stroke care. Addressing these challenges will require interdisciplinary collaboration, innovative research methodologies and a commitment to evidence-based practice. Ultimately, the integration of neuroprotective therapies into thrombectomy protocols has the potential to improve functional outcomes, reduce disability and enhance quality of life for stroke survivors. By advancing our understanding of neuroprotection in acute ischemic stroke and translating research findings into clinical practice, we can continue to optimize stroke care and improve outcomes for patients undergoing thrombectomy.

Acknowledgment

None.

Conflict of Interest

No conflict of interest.

References

1. Feigin, Valery L., Michael Brainin, Bo Norrving and Sheila Martins, et al. "World Stroke Organization (WSO): Global stroke fact sheet 2022." Int J Stroke 17 (2022): 18-29.

Google Scholar, Crossref, Indexed at

2. Chobanian, Aram V., George L. Bakris, Henry R. Black and William C. Cushman, et al. "The seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure: The JNC 7 report." JAMA 289 (2003): 2560-2571.

Google Scholar, Crossref, Indexed at

3. Lackland, Daniel T., Robert M. Carey, Adriana B. Conforto and Clive Rosendorff, et al. "Implications of recent clinical trials and hypertension guidelines on stroke and future cerebrovascular research." Stroke 49 (2018): 772-779.

Google Scholar, Crossref, Indexed at

4. Law, Malcom R., Joan K. Morris and NJ Wald. "Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies." BMJ 338 (2009).

Google Scholar, Crossref, Indexed at

5. Amarenco, P. "For the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) investigators: High-dose atorvastatin after stroke or transient ischemic attack." N Engl J Med 355 (2006): 549-559.

Google Scholar, Crossref, Indexed at