The Quest for Arterial Recanalization in Acute Ischemic Stroke-The Past, Present and the Future

Abstract

Ischemic stroke is one of the major causes of mortality and longterm disability. In the recent past, only very few treatment options were available and a considerable proportion of stroke survivors remained permanently disabled. However, over the last 2 decades rapid advances in acute stroke care have resulted in a corresponding improvement in mortality rates and functional outcomes. In this review, we describe the evolution of systemic thrombolytic agents and various interventional devices, their current status as well as some of the future prospects. We reviewed literature pertaining to acute ischemic stroke reperfusion treatment. We explored the current accepted treatment strategies to attain cerebral reperfusion via intravenous modalities and compare and contrast them within the boundaries of their clinical trials. Subsequently we reviewed the trials for interventional devices for acute ischemic stroke, categorizing them into thrombectomy devices, aspiration devices, clot disruption devices and thrombus entrapment devices. Finally we surveyed several of the alternative reperfusion strategies available. We also shed some light on the controversies surrounding the current strategies of treatment of acute ischemic stroke. Acute invasive interventional strategies continue to improve along with the noninvasive modalities. Both approaches appear promising. We conducted a comprehensive chronological review of the existing treatments as well as upcoming remedies for acute ischemic stroke.

Temperature-sensitive liposome-mediated delivery of thrombolytic agents

“…The current management of thromboembolic diseases involves either systemic [25,26] or local catheter-mediated administration of thrombolytics [27], which has some efficacy but also significant associated risks (e.g. cerebral haemorrhage) [28].…”

Tackling issues in the path toward clinical translation in brain conditioning: Potential offered by nutraceuticals

“…[ 2 3 ] So far, the most accepted treatment in the clinic to counteract ischemic stroke is tissue type plasminogen activator, but its therapeutic window is restricted to 4.5 h after stroke onset. [ 4 5 ] While achieving recanalization using mechanical clot disruption, locally injected thrombolytic agents, or both intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia is also the focus of intense investigations,[ 6 ] the lack of pharmacological treatment for ischemic stroke resulting from the poor translation of neuroprotective approaches from experimental models to clinical trials accentuates the necessity of considering alternative methods for protecting the brain.…”