Stroke: Advances in Medical Therapy and Acute Stroke Intervention

Abstract

Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

Ketogenic Diet Improves Brain Ischemic Tolerance and Inhibits NLRP3 Inflammasome Activation by Preventing Drp1-Mediated Mitochondrial Fission and Endoplasmic Reticulum Stress

“…Ischemic stroke, a leading cause of destructive cerebrovascular diseases, is characterized by disrupted blood flow and glucose/oxygen deprivation of brain cells, which may result in cellular dysfunction (Fisher and Saver, 2015 ). Current treatments for ischemic stroke are limited because of its complex molecular mechanisms (Barrett et al, 2015 ). Inflammation plays an important role in the pathogenesis of ischemic stroke, and the role of nucleotide-binding domain (NOD)-like receptor protein 3 (NLRP3) inflammasome in stroke has been a focus in current studies (Kawabori and Yenari, 2015 ).…”

Ruscogenin Attenuates Cerebral Ischemia-Induced Blood-Brain Barrier Dysfunction by Suppressing TXNIP/NLRP3 Inflammasome Activation and the MAPK Pathway

“…Ischemic stroke is the leading cause of destructive cerebrovascular disease, which can have serious effects on human health and is characterized by high morbidity, high mortality, and high incidence [ 1 ]. To date, the treatment options for ischemic stroke still have several limitations, due to the complexity of the biochemical and molecular mechanisms underlying the disease [ 2 ]. Among previous findings, there is increasing evidence indicating that blood-brain barrier (BBB) dysfunction is one of the key pathological mechanisms in ischemic stroke [ 3 ].…”

Maternally Expressed Gene 3 (MEG3) Enhances PC12 Cell Hypoxia Injury by Targeting MiR-147

“…Ischemic stroke, accounts for 80% of stroke, which is mainly caused by an insufficient supply of glucose and oxygen to central nervous system (CNS) tissue and thus resulting in a significant amount of cell damages [2]. A series of complex cellular and biochemical molecular mechanisms are involved in the pathology, such as the excitotoxicity, mitochondrial dysfunction, ionic imbalance, oxidative stress, and inflammation, eventually leading to a loss of neurological functions and even cell death [3, 4]. Hypoxia is a critical factor for cell death or survival in ischemic stroke [5].…”