Cerebral Ischemic Reperfusion Injury: Preventative and Therapeutic Strategies

Abstract

Acute ischemic stroke is a leading cause of morbidity and mortality in the United States. Treatment goals remain focused on restoring blood flow to compromised areas. However, a major concern arises after reperfusion occurs. Cerebral ischemic reperfusion injury is defined as damage to otherwise salvageable brain tissue occurring with the reestablishment of the vascular supply to that region. The pool of eligible patients for revascularization continues to grow, especially with the recently expanded endovascular therapeutic window. Neurointensivists should understand and manage complications of successful recanalization. In this review, we examine the pathophysiology, diagnosis, and potential management strategies in cerebral ischemic reperfusion injury.

The progression of surgical intervention for arterial reocclusion after mechanical thrombectomy for acute cerebral infarction

“…This process can significantly impair cerebral function. [6][7][8] Factors such as free radicals, intracellular calcium overload, mitochondrial damage, and impaired energy metabolism are crucial in the pathogenesis of ischemia-reperfusion injury. 9,10 During reperfusion, oxygen free radicals damage cell membranes, leading to cell and organelle swelling and impaired cellular function.…”

“…Repeated reperfusion and occlusion of the target vessel can exacerbate ischemia-reperfusion injury and oxidative stress in the occluded vessel, key mechanisms behind vessel reocclusion after recanalization. This process can significantly impair cerebral function 6–8 . Factors such as free radicals, intracellular calcium overload, mitochondrial damage, and impaired energy metabolism are crucial in the pathogenesis of ischemia-reperfusion injury 9,10 .…”