Medical Management of Acute Cerebral Ischemia

Abstract

This review article discusses medical management of acute cerebral ischemia including recent advances. Expansion of the thrombolysis eligibility criteria are discussed. Tenecteplase as a promising new thrombolytic is explored and the evidence supporting the use of Mobile Stroke Units is presented.

A Novel Fluorogenic Spin Probe for Real-time Monitoring of Mitochondrial Reactive Oxygen Species (mROS) Generation in anin vitroStroke Model

“…Flash column chromatography of the residue on silica gel (CH 2 Cl 2 :MeOH, 20:1) afforded the desired compound 2 as a purple foam (2.28 g, 91.2%). 1 H NMR (400 MHz, CDCl 3 ) δ ppm 7.62-7.57 (m, 2H), 7.48-7.44 (m, 1H), 7.25 (m, 1H), 7.16-7.11 (m, 2H), 6.84 (d, J = 9.0 Hz, 2H), 6.69 (d, J = 2.4 Hz, 2H), 3.54 (h, J = 7.8 Hz, 8H), 3.29 (s, 4H), 3.19 (s, 4H), 1.33 (s, 9H), 1.22 (t, J = 7.8 Hz, 12H). 13 C NMR (100 MHz, CDCl 3 ) δ ppm 167.84, 157.87, 155.95, 155.78, 154.63, 135.23, 132.13, 130.92, 130.47, 130.26, 127.75, 114.23, 113.84, 96.44, 80.54, 46.22, 28.43, 12.70.…”

“…Flash column chromatography of the residue on silica gel (CH 2 Cl 2 : MeOH, 10:1) afforded the desired compound 3 as a purple foam (6.09 g, 66.3%). 1 H NMR (400 MHz, CDCl 3 ) δ ppm 7.66-7.59 (m, 2H), 7.55-7.49 (m, 1H), 7.33-7.26 (m, 1H), 7.10 (d, J = 9.5 Hz, 2H), 6.86 (dd, J = 9.6, 2.3 Hz, 2H), 6.69 (d, J = 2.4 Hz, 2H), 3.71 (s, 4H), 3.63-3.57 (m, 4H), 3.52-3.48 (m, 4H), 3.10 (s, 2H), 3.02 (s, 2H), 1.26 (t, J = 7.1 Hz, 12H). 13 C NMR (100 MHz, CDCl 3 ) δ ppm 167.35, 157.88, 155.87, 155.82, 134.63, 131.67, 131.19, 130.60, 130.40, 130.32, 127.80, 118.56, 115.63, 114.42, 113.76, 96.51, 46.24, 44.44, 42.76, 38.57, 12.65.…”

“…Flash column chromatography of the residue on silica gel (CH 2 Cl 2 : MeOH, 20:1) afforded the desired compound 5 as a purple foam (0.24 g, 59.6%). 1 H NMR (400 MHz, CDCl 3 ) δ ppm 7.71 (s, 1H), 7.62 (d, J = 3.9 Hz, 2H), 7.48 (s, 1H), 7.34-7.24 (m, 1H), 7.20-7.12 (m, 2H), 7.03-6.77 (m, 2H), 6.68 (s, 2H), 4.59 (t, J = 6.4 Hz, 2H), 3.76 (s, 2H), 3.70-3.46 (m, 10H), 3.45-3.35 (m, 6H), 3.27-3.20 (m, 4H), 3.01-2.84 (m, 2H), 2.24 (s, 2H), 1.26 (t, J = 7.1 Hz, 12H). 13 C NMR (100 MHz, CDCl 3 ) δ ppm 168.86, 167.93, 157.88, 155.88, 135.25, 132.17, 130.25, 127.69, 124.59, 114.68, 113.95, 96.22, 79.01, 73.66, 48.02, 47.89, 46.26, 45.42, 42.15, 41.83, 41.24 33.15, 12.76.…”

“…Flash column chromatography of the residue on silica gel (CH 2 Cl 2 : MeOH, 20:1) afforded the desired compound 6 as a purple foam (0.08 g, 51.8%). 1 H NMR (400 MHz, CDCl 3 ) δ ppm 7.72 (br, s), 7.24 (br, s), 6.66 (br, s), 4.68 (br, s), 3.59 (br, s), 1.38 (br, s). HRMS (FAB+) m/z 1134.72, calcd for C 62 H 85 N 16 O 5 1133.69.…”

“…However, both treatments are time-sensitive and must be administered within 4.5-6 hours from the beginning of the symptoms. 1,2 The primary limitation of these treatments is that they are most effective when administered early, and many stroke patients do not reach the hospital in time to receive them. Moreover, not all strokes are caused by large blood clots that can be easily removed or dissolved.…”