Calcium antagonists for acute ischemic stroke

Abstract

BackgroundThe sudden loss of blood supply in ischemic stroke is associated with an increase of calcium ions within neurons. Inhibiting this increase could protect neurons and might reduce neurological impairment, disability, and handicap a er stroke. ObjectivesTo assess the e ects of calcium antagonists for reducing the risk of death or dependency a er acute ischemic stroke. We investigated the influence of di erent drugs, dosages, routes of administration, time intervals a er stroke, and trial design on the outcomes.

Antihypertensive Interventions in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis Evaluating Clinical Outcomes Through an Emergency Medicine Paradigm

“…This finding is consistent with the Cochrane review, which found that ACEI, ARA, and BB had a neutral effect on death and dependency outcomes of patients with acute stroke [26]. Moreover, meta-analyses analyzing the effects of calcium antagonists in AIS patients did not find any significant difference in deaths and dependency between the treatment and control groups [36,37].…”

Antihypertensive Interventions in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis Evaluating Clinical Outcomes Through an Emergency Medicine Paradigm

“…This finding is consistent with the Cochrane review, which found that ACEI, ARA, and BB had a neutral effect on death and dependency outcomes of patients with acute stroke [26]. Moreover, meta-analyses analyzing the effects of calcium antagonists in AIS patients did not find any significant difference in deaths and dependency between the treatment and control groups [36,37].…”

Excitatory Synaptic Transmission in Ischemic Stroke: A New Outlet for Classical Neuroprotective Strategies

“…Although numerous studies revealed the neuroprotective effects of VGCC blockers, the evidence observed that this dependence is gradually weakened with the prolongation of the neuronal ischemic latency [61,81]. The strategy of preventing and treating ischemic brain injury by simple antagonism of calcium channels no longer meets the clinical application requirements, which agrees with the conclusion of a meta-analysis involving 34 randomized controlled calcium antagonists [82]. Thus, the treatment with VGCC blockers remains controversial due to mixed results.…”

Microcirculation Dysfunction in Subacute Stroke: The Role of Delayed Capillary Pericyte Loss

“…Early clinical studies investigating the effects of calcium antagonists on the outcomes of stroke patients have shown inconsistent results [ 23 - 26 ]. A recent meta-analysis found that adding calcium antagonists to the treatment regimen did not improve clinical outcomes including mortality and dependence, in stroke patients [ 27 ]. We found that fasudil monotherapy did not improved capillary perfusion or prevent pericytes loss on day 14, although increased capillary perfusion was observed on day 3.…”

Antihypertensive Interventions in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis Evaluating Clinical Outcomes Through an Emergency Medicine Paradigm

“…This finding is consistent with the Cochrane review, which found that ACEI, ARA, and BB had a neutral effect on death and dependency outcomes of patients with acute stroke [26]. Moreover, meta-analyses analyzing the effects of calcium antagonists in AIS patients did not find any significant difference in deaths and dependency between the treatment and control groups [36,37].…”

Excitatory Synaptic Transmission in Ischemic Stroke: A New Outlet for Classical Neuroprotective Strategies

“…Although numerous studies revealed the neuroprotective effects of VGCC blockers, the evidence observed that this dependence is gradually weakened with the prolongation of the neuronal ischemic latency [61,81]. The strategy of preventing and treating ischemic brain injury by simple antagonism of calcium channels no longer meets the clinical application requirements, which agrees with the conclusion of a meta-analysis involving 34 randomized controlled calcium antagonists [82]. Thus, the treatment with VGCC blockers remains controversial due to mixed results.…”

Microcirculation Dysfunction in Subacute Stroke: The Role of Delayed Capillary Pericyte Loss

“…Early clinical studies investigating the effects of calcium antagonists on the outcomes of stroke patients have shown inconsistent results [ 23 - 26 ]. A recent meta-analysis found that adding calcium antagonists to the treatment regimen did not improve clinical outcomes including mortality and dependence, in stroke patients [ 27 ]. We found that fasudil monotherapy did not improved capillary perfusion or prevent pericytes loss on day 14, although increased capillary perfusion was observed on day 3.…”

Antihypertensive Interventions in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis Evaluating Clinical Outcomes Through an Emergency Medicine Paradigm

“…This finding is consistent with the Cochrane review, which found that ACEI, ARA, and BB had a neutral effect on death and dependency outcomes of patients with acute stroke [26]. Moreover, meta-analyses analyzing the effects of calcium antagonists in AIS patients did not find any significant difference in deaths and dependency between the treatment and control groups [36,37].…”

Excitatory Synaptic Transmission in Ischemic Stroke: A New Outlet for Classical Neuroprotective Strategies

“…Although numerous studies revealed the neuroprotective effects of VGCC blockers, the evidence observed that this dependence is gradually weakened with the prolongation of the neuronal ischemic latency [61,81]. The strategy of preventing and treating ischemic brain injury by simple antagonism of calcium channels no longer meets the clinical application requirements, which agrees with the conclusion of a meta-analysis involving 34 randomized controlled calcium antagonists [82]. Thus, the treatment with VGCC blockers remains controversial due to mixed results.…”

Microcirculation Dysfunction in Subacute Stroke: The Role of Delayed Capillary Pericyte Loss

“…Early clinical studies investigating the effects of calcium antagonists on the outcomes of stroke patients have shown inconsistent results [ 23 - 26 ]. A recent meta-analysis found that adding calcium antagonists to the treatment regimen did not improve clinical outcomes including mortality and dependence, in stroke patients [ 27 ]. We found that fasudil monotherapy did not improved capillary perfusion or prevent pericytes loss on day 14, although increased capillary perfusion was observed on day 3.…”