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Gyawali P, Lillicrap TP, Esperon CG, Bhattarai A, Bivard A, Spratt N. Whole Blood Viscosity and Cerebral Blood Flow in Acute Ischemic Stroke. Semin Thromb Hemost 2024; 50:580-591. [PMID: 37813371 DOI: 10.1055/s-0043-1775858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Existing effective treatments for ischemic stroke restore blood supply to the ischemic region using thrombolysis or mechanical removal of clot. However, it is increasingly recognized that successful removal of occlusive thrombus from the large artery-recanalization, may not always be accompanied by successful restoration of blood flow to the downstream tissues-reperfusion. Ultimately, brain tissue survival depends on cerebral perfusion, and a functioning microcirculation. Because capillary diameter is often equal to or smaller than an erythrocyte, microcirculation is largely dependent on erythrocyte rheological (hemorheological) factors such as whole blood viscosity (WBV). Several studies in the past have demonstrated elevated WBV in stroke compared with healthy controls. Also, elevated WBV has shown to be an independent risk factor for stroke. Elevated WBV leads to endothelial dysfunction, decreases nitric oxide-dependent flow-mediated vasodilation, and promotes hemostatic alterations/thrombosis, all leading to microcirculation sludging. Compromised microcirculation further leads to decreased cerebral perfusion. Hence, modulating WBV through pharmacological agents might be beneficial to improve cerebral perfusion in stroke. This review discusses the effect of elevated WBV on endothelial function, hemostatic alterations, and thrombosis leading to reduced cerebral perfusion in stroke.
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Affiliation(s)
- Prajwal Gyawali
- Heart and Stroke Program, Hunter Medical Research Institute and School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Thomas P Lillicrap
- Heart and Stroke Program, Department of Neurology, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Carlos G Esperon
- Heart and Stroke Program, Department of Neurology, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Aseem Bhattarai
- Department of Biochemistry, Institute of Medicine, Kathmandu, Nepal
| | - Andrew Bivard
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Neil Spratt
- Heart and Stroke Program, Department of Neurology, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, University of Newcastle, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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2
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Shrouder JJ, Calandra GM, Filser S, Varga DP, Besson-Girard S, Mamrak U, Dorok M, Bulut-Impraim B, Seker FB, Gesierich B, Laredo F, Wehn AC, Khalin I, Bayer P, Liesz A, Gokce O, Plesnila N. Continued dysfunction of capillary pericytes promotes no-reflow after experimental stroke in vivo. Brain 2024; 147:1057-1074. [PMID: 38153327 DOI: 10.1093/brain/awad401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023] Open
Abstract
Incomplete reperfusion of the microvasculature ('no-reflow') after ischaemic stroke damages salvageable brain tissue. Previous ex vivo studies suggest pericytes are vulnerable to ischaemia and may exacerbate no-reflow, but the viability of pericytes and their association with no-reflow remains under-explored in vivo. Using longitudinal in vivo two-photon single-cell imaging over 7 days, we showed that 87% of pericytes constrict during cerebral ischaemia and remain constricted post reperfusion, and 50% of the pericyte population are acutely damaged. Moreover, we revealed ischaemic pericytes to be fundamentally implicated in capillary no-reflow by limiting and arresting blood flow within the first 24 h post stroke. Despite sustaining acute membrane damage, we observed that over half of all cortical pericytes survived ischaemia and responded to vasoactive stimuli, upregulated unique transcriptomic profiles and replicated. Finally, we demonstrated the delayed recovery of capillary diameter by ischaemic pericytes after reperfusion predicted vessel reconstriction in the subacute phase of stroke. Cumulatively, these findings demonstrate that surviving cortical pericytes remain both viable and promising therapeutic targets to counteract no-reflow after ischaemic stroke.
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Affiliation(s)
- Joshua James Shrouder
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Gian Marco Calandra
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Severin Filser
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
- Core Research Facilities and Services-Light Microscope Facility, German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Daniel Peter Varga
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Simon Besson-Girard
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Uta Mamrak
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Maximilian Dorok
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Buket Bulut-Impraim
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Fatma Burcu Seker
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Fabio Laredo
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Antonia Clarissa Wehn
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
- Department of Neurosurgery, LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Igor Khalin
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
- Normandie University, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Institute Blood and Brain @ Caen-Normandie (BB@C), 14000 Caen, France
| | - Patrick Bayer
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Arthur Liesz
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Ozgun Gokce
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
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3
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van der Knaap N, Franx BAA, Majoie CBLM, van der Lugt A, Dijkhuizen RM. Implications of Post-recanalization Perfusion Deficit After Acute Ischemic Stroke: a Scoping Review of Clinical and Preclinical Imaging Studies. Transl Stroke Res 2024; 15:179-194. [PMID: 36653525 PMCID: PMC10796479 DOI: 10.1007/s12975-022-01120-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
The goal of reperfusion therapy for acute ischemic stroke (AIS) is to restore cerebral blood flow through recanalization of the occluded vessel. Unfortunately, successful recanalization does not always result in favorable clinical outcome. Post-recanalization perfusion deficits (PRPDs), constituted by cerebral hypo- or hyperperfusion, may contribute to lagging patient recovery rates, but its clinical significance remains unclear. This scoping review provides an overview of clinical and preclinical findings on post-ischemic reperfusion, aiming to elucidate the pattern and consequences of PRPD from a translational perspective. The MEDLINE database was searched for quantitative clinical and preclinical studies of AIS reporting PRPD based on cerebral circulation parameters acquired by translational tomographic imaging methods. PRPD and stroke outcome were mapped on a charting table, creating an overview of PRPD after AIS. Twenty-two clinical and twenty-two preclinical studies were included. Post-recanalization hypoperfusion is rarely reported in clinical studies (4/22) but unequivocally associated with detrimental outcome. Post-recanalization hyperperfusion is more commonly reported (18/22 clinical studies) and may be associated with positive or negative outcome. PRPD has been replicated in animal studies, offering mechanistic insights into causes and consequences of PRPD and allowing delineation of possible courses of PRPD. Complex relationships exist between PRPD and stroke outcome. Diversity in methods and lack of standardized definitions in reperfusion studies complicate the characterization of reperfusion patterns. Recommendations are made to advance the understanding of PRPD mechanisms and to further disentangle the relation between PRPD and disease outcome.
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Affiliation(s)
- Noa van der Knaap
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Bart A A Franx
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
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4
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Wu H, Qian J, Shen W, Zhu J, Wu Y, Gu J, Zhang Q. Impact of prior antiplatelet therapy on outcomes of acute ischemic stroke undergoing endovascular treatment: A systematic review and meta-analysis. J Clin Neurosci 2024; 119:22-29. [PMID: 37976911 DOI: 10.1016/j.jocn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
It is unclear how prior antiplatelet (APT) therapy affects outcomes of acute ischemic stroke (AIS) undergoing endovascular treatment. This review pooled data from the literature to compare outcomes of AIS between prior APT users vs non-users. PubMed, Embase, CENTRAL, and Scopus for studies were searched for studies comparing outcomes of AIS between APT users vs non-users up to 30th May 2023. Ten studies were included comparing 2648 APT users with 5076 non-users. Meta-analysis failed to demonstrate any statistically significant difference in symptomatic intracranial hemorrhage (sICH) but there was a tendency of higher mortality rates in prior APT users vs non-users. Although patients with prior APT therapy had significantly higher rates of successful recanalization as compared to patients with no prior APT treatment, meta-analysis showed significantly lower odds of functional independence amongst APT users vs non-users (OR: 0.77 95% CI: 0.68, 0.87 I2 = 22%). However, pooled analysis of adjusted data with fewer studies showed that there was no difference in sICH (OR: 1.04 95% CI: 0.78, 1.39 I2 = 0%), mortality (OR: 0.89 95% CI: 0.47, 1.68 I2 = 68%), successful recanalization (OR: 1.34 95% CI: 0.96, 1.88 I2 = 54%), and functional independence (OR: 0.96 95% CI: 0.81, 1.14 I2 = 0%) between APT users and non-users. Analysis of crude data indicates that prior APT therapy may improve successful recanalization without increasing sICH rates in AIS patients treated with endovascular therapy. However, there was an adverse effect of APT therapy on 3-month functional and survival outcomes. After adjustment of confounders, there was no difference in the odds of sICH, mortality, successful recanalization, and functional independence between APT users vs non-users.
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Affiliation(s)
- Huichao Wu
- Department of Emergency, First People's Hospital of Jiashan County, China
| | - Jiale Qian
- Department of nursing, First People's Hospital of Jiashan County, China
| | - Wei Shen
- Department of Infectious Diseases, First People's Hospital of Jiashan County, China
| | - Jiayi Zhu
- Department of General Medicine, Youchegang Town Health Center, Xiuzhou District, Jiaxing City, China
| | - Yuanling Wu
- Department of Emergency, Jiashan County Hospital of Traditional Chinese Medicine, China
| | - Jingying Gu
- Department of Internal Medicine, Xitang Health Center, Jiashan County, China
| | - Qing Zhang
- Department of Emergency, First People's Hospital of Jiashan County, China.
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5
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Laredo C, Rodríguez A, Oleaga L, Hernández‐Pérez M, Renú A, Puig J, Román LS, Planas AM, Urra X, Chamorro Á. Adjunct Thrombolysis Enhances Brain Reperfusion following Successful Thrombectomy. Ann Neurol 2022; 92:860-870. [PMID: 36054449 PMCID: PMC9804472 DOI: 10.1002/ana.26474] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study was undertaken to investigate whether adjunct alteplase improves brain reperfusion following successful thrombectomy. METHODS This single-center, randomized, double-blind, placebo-controlled study included 36 patients (mean [standard deviation] = 70.8 [13.5] years old, 18 [50%] women) with large vessel occlusion undergoing thrombectomy resulting in near-normal (expanded Thrombolysis in Cerebral Infarction [eTICI] b50/67/2c, n = 23, 64%) or normal angiographic reperfusion (eTICI 3, n = 13, 36%). Seventeen patients were randomized to intra-arterial alteplase (0.225mg/kg), and 19 received placebo. At 48 hours, patients had brain perfusion/diffusion-weighted magnetic resonance imaging (MRI) and MRI-spectroscopy. The primary outcome was the difference in the proportion of patients with areas of hypoperfusion on MRI. Secondary outcomes were the infarct expansion ratio (final to initial infarction volume), and the N-acetylaspartate (NAA) peak relative to total creatine as a marker of neuronal integrity. RESULTS The prevalence of hypoperfusion was 24% with intra-arterial alteplase, and 58% with placebo (adjusted odds ratio = 0.20, 95% confidence interval [CI] = 0.04-0.91, p = 0.03). Among 14 patients with final eTICI 3 scores, hypoperfusion was found in 1 of 7 (14%) in the alteplase group and 3 of 7 (43%) in the placebo group. Abnormal brain perfusion was associated with worse functional outcome at day 90. Alteplase significantly reduced the infarct expansion ratio compared with placebo (median [interquartile range (IQR)] = 0.7 [0.5-1.2] vs 3.2 [1.8-5.7], p = 0.01) and resulted in higher NAA peaks (median [IQR] = 1.13 [0.91-1.36] vs 1.00 [0.74-1.22], p < 0.0001). INTERPRETATION There is a high prevalence of areas of hypoperfusion following thrombectomy despite successful reperfusion on angiography. Adjunct alteplase enhances brain reperfusion, which results in reduced expansion of the infarction and improved neuronal integrity. ANN NEUROL 2022;92:860-870.
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Affiliation(s)
- Carlos Laredo
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain
| | - Alejandro Rodríguez
- Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain
| | - Laura Oleaga
- Neuroradiology ServiceHospital Clinic of BarcelonaBarcelonaSpain
| | - María Hernández‐Pérez
- Neuroscience Department, Stroke UnitGermans Trias i Pujol University HospitalBadalonaSpain
| | - Arturo Renú
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain
| | - Josep Puig
- Department of RadiologyDr Josep Trueta Hospital, Girona Biomedical Research InstituteGironaSpain
| | - Luis San Román
- Neuroradiology ServiceHospital Clinic of BarcelonaBarcelonaSpain
| | - Anna M. Planas
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of Brain Ischemia and NeurodegenerationBarcelona Institute of Biomedical Research–Spanish National Research CouncilBarcelonaSpain
| | - Xabier Urra
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain,Area of NeuroscienceUniversity of Barcelona, School of MedicineBarcelonaSpain
| | - Ángel Chamorro
- Area of NeuroscienceAugust Pi i Sunyer Biomedical Research InstituteBarcelonaSpain,Department of NeuroscienceComprehensive Stroke Center, Hospital Clinic of BarcelonaBarcelonaSpain,Area of NeuroscienceUniversity of Barcelona, School of MedicineBarcelonaSpain
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6
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Girolamo F, Errede M, Bizzoca A, Virgintino D, Ribatti D. Central Nervous System Pericytes Contribute to Health and Disease. Cells 2022; 11:1707. [PMID: 35626743 PMCID: PMC9139243 DOI: 10.3390/cells11101707] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/11/2022] Open
Abstract
Successful neuroprotection is only possible with contemporary microvascular protection. The prevention of disease-induced vascular modifications that accelerate brain damage remains largely elusive. An improved understanding of pericyte (PC) signalling could provide important insight into the function of the neurovascular unit (NVU), and into the injury-provoked responses that modify cell-cell interactions and crosstalk. Due to sharing the same basement membrane with endothelial cells, PCs have a crucial role in the control of endothelial, astrocyte, and oligodendrocyte precursor functions and hence blood-brain barrier stability. Both cerebrovascular and neurodegenerative diseases impair oxygen delivery and functionally impair the NVU. In this review, the role of PCs in central nervous system health and disease is discussed, considering their origin, multipotency, functions and also dysfunction, focusing on new possible avenues to modulate neuroprotection. Dysfunctional PC signalling could also be considered as a potential biomarker of NVU pathology, allowing us to individualize therapeutic interventions, monitor responses, or predict outcomes.
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Affiliation(s)
- Francesco Girolamo
- Unit of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy; (M.E.); (D.V.); (D.R.)
| | - Mariella Errede
- Unit of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy; (M.E.); (D.V.); (D.R.)
| | - Antonella Bizzoca
- Physiology Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy;
| | - Daniela Virgintino
- Unit of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy; (M.E.); (D.V.); (D.R.)
| | - Domenico Ribatti
- Unit of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy; (M.E.); (D.V.); (D.R.)
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Abstract
In 2001, the concept of the neurovascular unit was introduced at the Stroke Progress Review Group meeting. The neurovascular unit is an important element of the health and disease status of blood vessels and nerves in the central nervous system. Since then, the neurovascular unit has attracted increasing interest from research teams, who have contributed greatly to the prevention, treatment, and prognosis of stroke and neurodegenerative diseases. However, additional research is needed to establish an efficient, low-cost, and low-energy in vitro model of the neurovascular unit, as well as enable noninvasive observation of neurovascular units in vivo and in vitro. In this review, we first summarize the composition of neurovascular units, then investigate the efficacy of different types of stem cells and cell culture methods in the construction of neurovascular unit models, and finally assess the progress of imaging methods used to observe neurovascular units in recent years and their positive role in the monitoring and investigation of the mechanisms of a variety of central nervous system diseases.
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Affiliation(s)
- Taiwei Dong
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Min Li
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Feng Gao
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Peifeng Wei
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Jian Wang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Provinve, China
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8
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Couture M, Finitsis S, Marnat G, Richard S, Bourcier R, Constant-Dits-Beaufils P, Dargazanli C, Arquizan C, Mazighi M, Blanc R, Eugène F, Vannier S, Spelle L, Denier C, Touzé E, Barbier C, Saleme S, Macian F, Rosso C, Clarençon F, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Viguier A, Cognard C, Lebras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Lapergue B, Consoli A, Gory B, Sibon I. Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results. Stroke 2021; 52:3864-3872. [PMID: 34538083 DOI: 10.1161/strokeaha.121.034670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The influence of prior antiplatelet therapy (APT) uses on the outcomes of patients with acute ischemic stroke treated with endovascular therapy is unclear. We compared procedural and clinical outcomes of endovascular therapy in patients on APT or not before stroke onset. METHODS We analyzed 2 groups from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke registry in France: patients on prior APT (APT+) and patients without prior APT (APT-) treated by endovascular therapy, with and without intravenous thrombolysis. Multilevel mixed-effects logistic models including center as random effect were used to compare angiographic (rates of reperfusion at the end of procedure, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to APT subgroups. Comparisons were adjusted for prespecified confounders (age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, intravenous thrombolysis, and time from onset to puncture), as well as for meaningful baseline between-group differences. RESULTS A total of 2939 patients were analyzed, of whom 877 (29.8%) were on prior APT. Patients with prior APT were older, had more frequent vascular risk factors, cardioembolic stroke mechanism, and prestroke disability. Rates of complete reperfusion (37.9% in the APT- group versus 42.7 % in the APT+ group; aOR, 1.09 [95% CI, 0.88-1.34]; P=0.41) and periprocedural complication (16.9% versus 13.3%; aOR, 0.90 [95% CI, 0.7-1.2]; P=0.66) did not differ between the two groups. Symptomatic intracerebral hemorrhage (aOR, 0.93 [95% CI, 0.63-1.37]; P=0.73), 3 months favorable clinical outcome (modified Rankin Scale score of 0-2; aOR, 0.98 [95% CI, 0.77-1.25]; P=0.89), and mortality (aOR, 0.95 [95% CI, 0.72-1.26]; P=0.76) at 90 days did not differ between the groups. CONCLUSIONS Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.
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Affiliation(s)
- Marie Couture
- Department of Neurology, Stroke Center (M.C., I.S.), University Hospital of Bordeaux, France
| | - Stephanos Finitsis
- Interventional and Diagnostic Neuroradiology Department, AHEPA University Hospital, Thessaloniki, Greece (S.F.)
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology (G.M.), University Hospital of Bordeaux, France
| | - Sébastien Richard
- Stroke Unit, Department of Neurology, CHRU-Nancy (S.R.), Université de Lorraine, France.,INSERM U1116, CHRU-Nancy, France (S.R.)
| | - Romain Bourcier
- Departments of Neuroradiology (R.B.), University Hospital of Nantes, France
| | | | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France (C.D.)
| | - Caroline Arquizan
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France (C.A.)
| | - Mikaël Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.M., R.B.)
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.M., R.B.)
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, France (F.E.)
| | - Stéphane Vannier
- Stroke Unit, Department of Neurology, University Hospital of Rennes, France (S.V.)
| | - Laurent Spelle
- Neuroradiolology (L.S.), CHU Kremlin Bicêtre, Paris, France
| | - Christian Denier
- Departments of Neurology (C.D.), CHU Kremlin Bicêtre, Paris, France
| | | | | | - Suzana Saleme
- Diagnostic and Interventional Neuroradiology (S.S), University Hospital of Limoges, France
| | - Francisco Macian
- Departments of Neurology (F.M.), University Hospital of Limoges, France
| | - Charlotte Rosso
- Departments of Neurology (C.R.), CHU Pitié-Salpétrière, Paris, France
| | | | | | - Guillaume Turc
- Departments of Neurology (G.T.), Hôpital Saint Anne, Paris, France
| | | | | | - Alain Viguier
- Departments of Neurology (A.V.), CHU Toulouse, France
| | | | - Anthony Lebras
- Departments of Neurology (A.L.), CH Bretagne Atlantique, Vannes, France
| | - Sarah Evain
- Neuroradiolology (S.E.), CH Bretagne Atlantique, Vannes, France
| | - Valérie Wolff
- Departments of Neurology (V.W.), CHU Strasbourg, France
| | - Raoul Pop
- Neuroradiolology (R.P.), CHU Strasbourg, France
| | - Serge Timsit
- Departments of Neurology (S.T.), CHU Brest, France
| | | | | | - Louis Veunac
- Neuroradiolology (L.V.), CH Côte Basque, Bayonne, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital (B.L.), Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C.), Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy (B.G.), Université de Lorraine, France.,IADI, INSERM U1254 (B.G.), Université de Lorraine, France
| | - Igor Sibon
- Department of Neurology, Stroke Center (M.C., I.S.), University Hospital of Bordeaux, France
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9
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Grossi C, Artusi C, Meroni P, Borghi MO, Neglia L, Lonati PA, Oggioni M, Tedesco F, De Simoni MG, Fumagalli S. β2 glycoprotein I participates in phagocytosis of apoptotic neurons and in vascular injury in experimental brain stroke. J Cereb Blood Flow Metab 2021; 41:2038-2053. [PMID: 33444093 PMCID: PMC8323337 DOI: 10.1177/0271678x20984551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Beta-2 Glycoprotein I (β2-GPI) is the main target of anti-phospholipid antibodies (aPL) in the autoimmune anti-phospholipid syndrome, characterized by increased risk of stroke. We here investigated the antibody independent role of β2-GPI after ischemia/reperfusion, modeled in vivo by transient middle cerebral artery occlusion (tMCAo) in male C57Bl/6J mice; in vitro by subjecting immortalized human brain microvascular endothelial cells (ihBMEC) to 16 h hypoxia and 4 h re-oxygenation. ApoH (coding for β2-GPI) was upregulated selectively in the liver at 48 h after tMCAo. At the same time β2-GPI circulating levels increased. β2-GPI was detectable in brain parenchyma and endothelium at all time points after tMCAo. Parenchymal β2-GPI recognized apoptotic neurons (positive for annexin V, C3 and TUNEL) cleared by CD68+ brain macrophages. Hypoxic ihBMEC showed increased release of IL-6, over-expression of thrombomodulin and IL-1α after re-oxygenation with β2-GPI alone. β2-GPI interacted with mannose-binding lectin in mouse plasma and ihBMEC medium, potentially involved in formation of thrombi. We show for the first time that brain ischemia triggers the hepatic production of β2-GPI. β2-GPI is present in the ischemic endothelium, enhancing vascular inflammation, and extravasates binding stressed neurons before their clearance by phagocytosis. Thus β2-GPI may be a new mediator of brain injury following ischemic stroke.
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Affiliation(s)
- Claudia Grossi
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immuno-Rheumatology, Milan, Italy
| | - Carolina Artusi
- Rheumatology Department, ASST Gaetano Pini-CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - PierLuigi Meroni
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immuno-Rheumatology, Milan, Italy
| | - Maria Orietta Borghi
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immuno-Rheumatology, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura Neglia
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Neuroscience, Milan, Italy
| | - Paola Adele Lonati
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immuno-Rheumatology, Milan, Italy
| | - Marco Oggioni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Neuroscience, Milan, Italy
| | - Francesco Tedesco
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immuno-Rheumatology, Milan, Italy
| | - Maria-Grazia De Simoni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Neuroscience, Milan, Italy
| | - Stefano Fumagalli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Neuroscience, Milan, Italy
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10
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Liang W, Wang Y, Du Z, Mang J, Wang J. Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review. Neurology 2021; 96:1080-1090. [PMID: 33893205 DOI: 10.1212/wnl.0000000000012069] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the real-world practice of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the analysis of intraprocedural angiographic signs (IPASs) still challenges neurointerventionists. This review provides insights into the significance of these subtle changes for predicting underlying etiology, technical feasibility, and patient prognosis, thus promoting the potential real-time application of these signs. METHODS A systematic literature search was conducted using PubMed, Ovid Medline/Embase, and Cochrane. The search focused on studies published between January 1995 and August 2020 that reported findings related to intraprocedural angiographic manifestations in endovascular recanalization therapy for AIS. RESULTS We identified 12 IPASs in 22 studies involving 1,683 patients. The IPASs were assigned into 3 subsets according to their clinical meanings. CONCLUSION The systematic analysis of IPAS in clinical trials and practice will lead to a better understanding of treatment effects, responses, and mechanisms during EVT. Studies of larger cohorts using more robust statistical methods are needed.
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Affiliation(s)
- Wenzhao Liang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Yimeng Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Zhihua Du
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Jing Mang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China.
| | - Jun Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
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11
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Intravenous Infusion of Mesenchymal Stem Cells Enhances Therapeutic Efficacy of Reperfusion Therapy in Cerebral Ischemia. World Neurosurg 2021; 149:e160-e169. [PMID: 33618048 DOI: 10.1016/j.wneu.2021.02.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Reperfusion therapy is a standard therapeutic strategy for acute stroke. Non-favorable outcomes are thought to partially result from impaired microcirculatory flow in ischemic tissue. Intravenous infusion of mesenchymal stem cells (MSCs) reduces stroke volume and improves behavioral function in stroke. One suggested therapeutic mechanism is the restoration of the microvasculature. The goal of this study was to determine whether infused MSCs enhance the therapeutic efficacy of reperfusion therapy following stroke in rats. METHODS First, to establish a transient middle cerebral artery occlusion (MCAO) model displaying approximately identical neurologic function and lesion volume as seen in permanent MCAO (pMCAO) at day 7 after stroke induction, we transiently occluded the MCA for 90, 110, and 120 minutes. We found that the 110-minute occlusion met these criteria and was used as the transient MCAO (tMCAO) model. Next, 4 MCAO groups were used to compare the therapeutic efficacy of infused MSCs: (1) pMCAO+vehicle, (2) tMCAO+vehicle, (3) pMCAO+MSC, and (4) tMCAO+MSC. Our ischemic model was a unique ischemic model system in which both pMCAO and tMCAO provided similar outcomes during the study period in the groups without MSC infusion groups. Behavioral performance, ischemic volume, and regional cerebral blood flow (rCBF) using arterial spin labeling-magnetic resonance imaging and histologic evaluation of microvasculature was performed. RESULTS The behavioral function, rCBF, and restoration of microvasculature were greater in group 4 than in group 3. Thus, infused MSCs facilitated the therapeutic efficacy of MCA reperfusion in this rat model system. CONCLUSIONS Intravenous infusion of MSCs may enhance therapeutic efficacy of reperfusion therapy.
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12
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Ter Schiphorst A, Charron S, Hassen WB, Provost C, Naggara O, Benzakoun J, Seners P, Turc G, Baron JC, Oppenheim C. Tissue no-reflow despite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study. J Cereb Blood Flow Metab 2021; 41:253-266. [PMID: 32960688 PMCID: PMC8370008 DOI: 10.1177/0271678x20954929] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite early thrombectomy, a sizeable fraction of acute stroke patients with large vessel occlusion have poor outcome. The no-reflow phenomenon, i.e. impaired microvascular reperfusion despite complete recanalization, may contribute to such "futile recanalizations". Although well reported in animal models, no-reflow is still poorly characterized in man. From a large prospective thrombectomy database, we included all patients with intracranial proximal occlusion, complete recanalization (modified thrombolysis in cerebral infarction score 2c-3), and availability of both baseline and 24 h follow-up MRI including arterial spin labeling perfusion mapping. No-reflow was operationally defined as i) hypoperfusion ≥40% relative to contralateral homologous region, assessed with both visual (two independent investigators) and automatic image analysis, and ii) infarction on follow-up MRI. Thirty-three patients were eligible (median age: 70 years, NIHSS: 18, and stroke onset-to-recanalization delay: 208 min). The operational criteria were met in one patient only, consistently with the visual and automatic analyses. This patient recanalized 160 min after stroke onset and had excellent functional outcome. In our cohort of patients with complete and stable recanalization following thrombectomy for intracranial proximal occlusion, severe ipsilateral hypoperfusion on follow-up imaging associated with newly developed infarction was a rare occurrence. Thus, no-reflow may be infrequent in human stroke and may not substantially contribute to futile recanalizations.
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Affiliation(s)
- Adrien Ter Schiphorst
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Sylvain Charron
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Wagih Ben Hassen
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Corentin Provost
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Olivier Naggara
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Joseph Benzakoun
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Pierre Seners
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Guillaume Turc
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Jean-Claude Baron
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Catherine Oppenheim
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
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13
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Zhao W, Wu C, Dornbos D, Li S, Song H, Wang Y, Ding Y, Ji X. Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes. Brain Circ 2020; 6:11-18. [PMID: 32166195 PMCID: PMC7045534 DOI: 10.4103/bc.bc_58_19] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/29/2019] [Accepted: 01/17/2020] [Indexed: 12/24/2022] Open
Abstract
While several large pivotal clinical trials recently revealed a substantial benefit of endovascular thrombectomy for acute ischemic stroke (AIS) caused by large-vessel occlusion, many patients still experience mediocre prognosis. Enlargement of the ischemic core, failed revascularization, incomplete reperfusion, distal embolization, and secondary reperfusion injury substantially impact the salvaging of brain tissue and the functional outcomes of AIS. Here, we propose novel concept of “Multiphase Adjuvant Neuroprotection” as a new paradigm that may help guide our search for adjunctive treatments to be used together with thrombectomy. The premise of multiphase adjuvant neuroprotection is based on the diverse and potentially nonoverlapping pathophysiologic mechanisms that are triggered before, during, and after thrombectomy therapies. Before thrombectomy, strategies should focus on preventing the growth of the ischemic core; during thrombectomy, improving recanalization while reducing distal embolization and maximizing reperfusion are of significant importance; after reperfusion, strategies should focus on seeking targets to reduce secondary reperfusion injury. The concept of multiphase adjuvant neuroprotection, wherein different strategies are employed throughout the various phases of clinical care, might provide a paradigm to minimize the final infarct size and improve functional outcome in AIS patients treated with thrombectomy. With the success of thrombectomy in selected AIS patients, there is now an opportunity to revisit stroke neuroprotection. Notably, if the underlying mechanisms of these neuroprotective strategies are identified, their role in the distinct phases will provide further avenues to improve patient outcomes of AIS.
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Affiliation(s)
- Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - David Dornbos
- Department of Neurological Surgery, Semmes-Murphey Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sijie Li
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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14
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Affiliation(s)
- Turgay Dalkara
- From the Department of Neurology, Faculty of Medicine and Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey; and Department of Radiology, Massachusetts General Hospital, Harvard University, Boston
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15
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Puntonet J, Richard ME, Edjlali M, Ben Hassen W, Legrand L, Benzakoun J, Rodriguez-Régent C, Trystram D, Naggara O, Méder JF, Boulouis G, Oppenheim C. Imaging Findings After Mechanical Thrombectomy in Acute Ischemic Stroke. Stroke 2019; 50:1618-1625. [PMID: 31060439 DOI: 10.1161/strokeaha.118.024754] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julien Puntonet
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Marie-Edith Richard
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Myriam Edjlali
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Wagih Ben Hassen
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Laurence Legrand
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Joseph Benzakoun
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Christine Rodriguez-Régent
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Denis Trystram
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Olivier Naggara
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Jean-Francois Méder
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Grégoire Boulouis
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
| | - Catherine Oppenheim
- From the Imaging Department, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266 INSERM, Sainte-Anne Hospital, Paris Descartes University, France
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16
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Abstract
Recent stroke research has shifted the focus to the microvasculature from neuron-centric views. It is increasingly recognized that a successful neuroprotection is not feasible without microvascular protection. On the other hand, recent studies on pericytes, long-neglected cells on microvessels have provided insight into the regulation of microcirculation. Pericytes play an essential role in matching the metabolic demand of nervous tissue with the blood flow in addition to regulating the development and maintenance of the blood-brain barrier (BBB), leukocyte trafficking across the BBB and angiogenesis. Pericytes appears to be highly vulnerable to injury. Ischemic injury to pericytes on cerebral microvasculature unfavorably impacts the stroke-induced tissue damage and brain edema by disrupting microvascular blood flow and BBB integrity. Strongly supporting this, clinical imaging studies show that tissue reperfusion is not always obtained after recanalization. Therefore, prevention of pericyte dysfunction may improve the outcome of recanalization therapies by promoting microcirculatory reperfusion and preventing hemorrhage and edema. In the peri-infarct tissue, pericytes are detached from microvessels and promote angiogenesis and neurogenesis, and hence positively effect stroke outcome. Expectedly, we will learn more about the place of pericytes in CNS pathologies including stroke and devise approaches to treat them in the next decades.
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17
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Kaesmacher J, Dobrocky T, Heldner MR, Bellwald S, Mosimann PJ, Mordasini P, Bigi S, Arnold M, Gralla J, Fischer U. Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited. J Neurol Neurosurg Psychiatry 2018; 89. [PMID: 29519899 PMCID: PMC6109240 DOI: 10.1136/jnnp-2017-317602] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE A reperfusion quality of thrombolysis in cerebral infarction (TICI)≥2b has been set as the therapeutic angiography target for interventions in patients with acute ischaemic stroke. This study addresses whether the distinction between TICI2b and TICI3 reperfusions shows a clinically relevant difference on functional outcome. METHODS A systematic literature review and meta-analysis was carried out and presented in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to test the primary hypothesis that TICI2b and TICI3 reperfusions are associated with different rates of modified Rankin Scale (mRS) ≤2 at day 90. Secondary endpoints included rates of haemorrhagic transformations, mortality and excellent functional outcome (mRS ≤1). Summary estimates of ORs (sOR) with 95% CI were calculated using the inverse variance heterogeneity model accounting for multiple true effect sizes. RESULTS Fourteen studies on 2379 successfully reperfused patients were included (1131 TICI3, 1248 TICI2b). TICI3 reperfusions were associated with higher rates of functional independence (1.74, 95% CI 1.44 to 2.10) and excellent functional outcomes (2.01, 95% CI 1.60 to 2.53), also after including adjusted estimates. The safety profile of patients with TICI3 was superior, as demonstrated by lower rates of mortality (sOR 0.59, 95% CI 0.37 to 0.92) and symptomatic intracranial haemorrhages (sOR 0.42, 95% CI 0.25 to 0.71). CONCLUSION TICI3 reperfusions are associated with superior outcome and better safety profiles than TICI2b reperfusions. This effect seems to be independent of time and collaterals. As reperfusion quality is the most important modifiable predictor of patients' outcome, a more conservative definition of successful therapy and further evaluation of treatment approaches geared towards achieving TICI3 reperfusions are desirable.
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Affiliation(s)
- Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern, Switzerland
| | - Tomas Dobrocky
- University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| | - Sebastian Bellwald
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| | - Pascal J Mosimann
- University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern, Switzerland
| | - Sandra Bigi
- Division of Child Neurology, Department of Pediatrics, University of Bern, Inselspital, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
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