Iodinated Contrast Agents Reduce the Efficacy of Intravenous Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients: a Multicenter Cohort Study

Chen, Zhicai; Xu, Chao; Zhong, Wansi; Gong, Xiaoxian; Hu, Haitao; Zhang, Xuting; Chen, Yi; Li, Qingqing; Luo, Zhongyu; Chen, Zhuojian; Lou, Min

doi:10.1007/s12975-020-00846-5

Cited by 1 publication

(1 citation statement)

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“…Despite these limitations, early arterial recanalization following AIS has been shown to improve cerebral blood perfusion, functional outcome, and survival. The conventional window for reperfusion has not been challenged beyond these time points mostly due to the risk of ischemia/reperfusion injury [ 7 ], hemorrhagic transformation risk [ 8 ], early arterial reocclusion [ 9 ], and other associated deleterious outcomes [ 10 ]. Most AIS patients fail to receive intervention due to delays that increase the door-to-needle time (DNT) or door-to-puncture time (DPT), e.g., failure in early diagnosis, onset of unidentified symptoms, and/or other associated limitations in current stroke protocols [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Macrophage Infiltration Reduces Neurodegeneration and Improves Stroke Recovery after Delayed Recanalization in Rats

Pang

Matei

Peng

et al. 2022

Oxidative Medicine and Cellular Longevity

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Background. Recent cerebrovascular recanalization therapy clinical trials have validated delayed recanalization in patients outside of the conventional window. However, a paucity of information on the pathophysiology of delayed recanalization and favorable outcomes remains. Since macrophages are extensively studied in tissue repair, we anticipate that they may play a critical role in delayed recanalization after ischemic stroke. Methods. In adult male Sprague-Dawley rats, two ischemic stroke groups were used: permanent middle cerebral artery occlusion (pMCAO) and delayed recanalization at 3 days following middle cerebral artery occlusion (rMCAO). To evaluate outcome, brain morphology, neurological function, macrophage infiltration, angiogenesis, and neurodegeneration were reported. Confirming the role of macrophages, after their depletion, we assessed angiogenesis and neurodegeneration after delayed recanalization. Results. No significant difference was observed in the rate of hemorrhage or animal mortality among pMCAO and rMCAO groups. Delayed recanalization increased angiogenesis, reduced infarct volumes and neurodegeneration, and improved neurological outcomes compared to nonrecanalized groups. In rMCAO groups, macrophage infiltration contributed to increased angiogenesis, which was characterized by increased vascular endothelial growth factor A and platelet-derived growth factor B. Confirming these links, macrophage depletion reduced angiogenesis, inflammation, neuronal survival in the peri-infarct region, and favorable outcome following delayed recanalization. Conclusion. If properly selected, delayed recanalization at day 3 postinfarct can significantly improve the neurological outcome after ischemic stroke. The sanguineous exposure of the infarct/peri-infarct to macrophages was essential for favorable outcomes after delayed recanalization at 3 days following ischemic stroke.

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