Reperfusion Combined with Neuroprotective Agents Treatment in Acute Ischemic Stroke: a Literature Review of Current Progress
Abstract
Acute ischemic stroke remains to be a heavy burden causing serious mortality and disability. Clinical studies of neuroprotective agents produced disappointing results in the treatment, and recanalization may be a precondition for it to be successful. By searching for relevant randomized controlled trials concerning combination therapy in the online databases and analyzing them, this literature review investigated the therapeutic effect of reperfusion combined with neuroprotective agents treatment in acute ischemic stroke. We found that reported trials specifically designed to investigate the efficacy of combination treatment are scarce. Overall, use of uric acid and nerinetide in the combination therapy exhibited positive results. These results indicate a high potential for clinical use with further confirmation. Future studies are still needed. They should focus on (1) designing clinical trials that investigate combination therapy specifically or include prespecified subgroup analyses for different types of recanalization, (2) reaffirming previous positive clinical trials with more patients of different characteristics or geographical locations, (3) employing multitarget neuroprotectant combinative therapy (cocktail therapy) to target multiple targets of ischemia-reperfusion injury instead of the currently prevalent single neuroprotectant with recanalization therapy.
References
[1] Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart As_x005fsociation. Circulation. Feb 21 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123
[2] Martina Puzio NM, John J. O’Connor. Neuroprotective strategies for acute ischemic stroke: Targeting oxidative stress and prolyl
hydroxylase domain inhibition in synaptic signalling. Brain Disorders. 2022;5
[3] McFarland J. Ischemic Stroke Treatment. American Heart Association. Available from: https://www.stroke.org/en/about-stroke/
types-of-stroke/ischemic-stroke-clots/ischemic-stroke-treatment. [Accessed 8th March 2023]
[4] Lapchak PA, Araujo DM. Advances in ischemic stroke treatment: neuroprotective and combination therapies. Expert Opin Emerg
Drugs. Mar 2007;12(1):97-112. doi:10.1517/14728214.12.1.97
[5] Bivard A, Lin L, Parsonsb MW. Review of stroke thrombolytics. J Stroke. May 2013;15(2):90-8. doi:10.5853/jos.2013.15.2.90
[6] Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of
individual patient data from five randomised trials. Lancet. Apr 23 2016;387(10029):1723-31. doi:10.1016/S0140-6736(16)00163-X
[7] Vanacker P, Lambrou D, Eskandari A, Mosimann PJ, Maghraoui A, Michel P. Eligibility and Predictors for Acute Revascularization
Procedures in a Stroke Center. Stroke. Jul 2016;47(7):1844-9. doi:10.1161/STROKEAHA.115.012577
[8] Papanagiotou P, Ntaios G. Endovascular Thrombectomy in Acute Ischemic Stroke. Circ Cardiovasc Interv. Jan 2018;11(1):e005362.
doi:10.1161/CIRCINTERVENTIONS.117.005362
[9] Link TW, Santillan A, Patsalides A. Intra-arterial neuroprotective therapy as an adjunct to endovascular intervention in acute
ischemic stroke: A review of the literature and future directions. Interv Neuroradiol. Aug 2020;26(4):405-415. 1591019920925677.
doi:10.1177/1591019920925677
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