Re-canalization in acute ischemic stroke: The strategies

Abstract

Thrombolytic stroke therapy is based on the "re-canalization hypothesis," i.e., that reopening of occluded vessels improves clinical outcome in acute ischemic stroke through regional reperfusion and salvage of threatened tissues. Re-canalization is an important predictor of stroke outcome in all the modalities of thrombolysis. Thrombolysis in acute ischemic stroke evolved from clinical trials with intravenous (IV) tissue plasminogen activator (tPA) to combination treatments with Intra-arterial (IA)/mechanical reperfusion techniques. The combined approach reduces time to initiation of treatment and may increase re-canalization and chances of a good clinical outcome. In IV thrombolysis overall re-canalization rate is 46.2% during the first 6-24 hrs. Intra-arterial thrombolysis has higher early re-canalization rate, 63.2%. The highest re-canalization rate is seen with mechanical thrombolysis, 83.6%. Other factors in addition to re-canalization: stroke severity, older age, systolic hypertension, location of arterial occlusion, collateral blood supply, and time from stroke onset to treatment play an important role in determining the clinical outcome following thrombolysis with tPA. Future trials should look at the interplay of various factors like re-canalization, reperfusion, and collateral flow and clot burden in the evaluation of reperfusion therapies in acute ischemic stroke.

Emerging Therapies: Pleiotropic Multi-target Drugs to Treat Stroke Victims

“…), a plasminogen activator that promotes thrombolysis by activating the endogenous fibrinolytic system [22–25], and in 22–40% of patients promotes partial or full recanalization [26–31], but recanalization rates are highly variable. The article by Soltani and colleagues [32] in this issue of TSR elaborates on the use of sonothrombolysis to promote recanalization, either alone or in combination with tPA, but recanalization may be insufficient therapeutically.…”

Evaluating behavioral disorders in rat after treatment with candesartan in ischemic stroke

“…Many studies have been conducted on the introduction of new therapeutic interventions with protective effects, with positive outcomes reported in laboratory studies, but so far many of them have not been used to treat human beings in the clinic or have not had a successful outcome (16). The cause this, on the one hand, is linked to the complexity of the pathophysiology of ischemic stroke and, on the other hand, the limitation of the use of many single-dose protective interventions has not been successful in treating patients with cerebrovascular anesthesia.…”

A Review on Molecular Mechanisms of Reocclusion Following Thrombolytic Therapy in Ischemic Stroke Patients

“…Continues monitoring with transcranial Doppler (TCD) in combination with tPA therapy show higher recanalization rate than tPA without the use of TCD [41]. Other adjunct modalities such as the use of microspheres/nanobubbles may also increase the chance of recanalization [42]. Recent experimental studies showed that administration of activated protein C (APC) analogs prevent ischemic stroke and extends the therapeutic window of tPA [43].…”