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| EDITORIAL |
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| Year : 2015 | Volume
: 1
| Issue : 1 | Page : 1-2 |
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Forward thinking in stroke treatment: Advances in cerebrovascular reperfusion and neurorehabilitation
Xunming Ji
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| Date of Submission | 19-Apr-2015 |
| Date of Acceptance | 23-Jun-2015 |
| Date of Web Publication | 30-Sep-2015 |
Correspondence Address:
Xunming Ji
Xuanwu Hospital, Capital Medical University, Beijing
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2394-8108.166347
How to cite this article:
Ji X. Forward thinking in stroke treatment: Advances in cerebrovascular reperfusion and neurorehabilitation. Brain Circ 2015;1:1-2 |
Reperfusion therapies aiming to achieve recanalization of vessels have been the main focal point in the treatment of acute ischemic-related pathologies in the fields of both cardiology and neurology. Within neurology, the realm of stroke treatment remains very dynamic and has undergone a significant degree of advancement that began with the use of intravenous tissue plasminogen activator (tPA) in 1996 that was shown to be efficacious for the treatment of acute ischemic strokes by the National Institute of Neurological Disorders and Stroke (NINDS) trial of techniques that focused on achieving a higher degree of revascularization augmented by intra-arterial modalities. [1]
Globally, in recent years, widely implemented reperfusion therapies, especially the application of endovascular mechanical thrombectomy, have significantly enhanced the success rate of stroke treatment. [2],[3],[4],[5],[6] These progresses and innovations in technology are leading to a new concept of neuroprotection in which revascularization-based neuroprotection and prolongation of revascularization time window are emphasized. We expect that the new therapeutic theories and strategies will decrease the side effects, expand indications of treatment, and increase the neuroprotective effects of revascularization.
But revascularization alone may not be the magic bullet therapy for ischemic stroke. Due to the pleiotropic mechanisms of ischemia/reperfusion injury and the differences between animal species, a large number of single target neuroprotective agents effective in animal experiments failed in clinical testing, which seems to indicate that the door to neuroprotective therapy for ischemia might be closed. However, nondrug neuroprotective therapies, which usually affect multiple targets, such as hypothermia, [7] hypoxic/ischemic preconditioning, [8] ultrasound, [9] laser, [10] and oxygen therapy [11] showed unique effects on preventing ischemic brain damage. We expect that a combination of these nondrug therapies will open up a new paradigm for the study of stroke neuroprotection.
In addition to novel nondrug neuroprotective strategies, the degree of collateral circulation is intimately related to the survival of ischemic tissue, especially the penumbra. [12],[13],[14] More collateral circulation will lead to bigger size and longer survival of the penumbra as well as better brain functional recovery after revascularization. Previous studies have indicated that many neuroprotective agents have brain protective effects on penumbra through collateral circulation. We expect that the combination of cerebral microcirculation improving agents, which enhance the collateral circulation and neuroprotection, will be effective to rescue ischemic penumbra and to promote the long-term functional recovery from stroke.
The year 2015 is pivotal to the world of endovascular surgical neuroradiology/interventional neurology as the results of these aforementioned trials have shown the benefit of combining newer generation endovascular treatment with best medical management for the treatment of acute ischemic strokes. [3],[4],[5],[6] These trials have shown favorable results, both short-term and 90-day follow-up. Several exciting breakthroughs were reported in the 2015 International Stroke Conference including mechanical thrombectomy, motion image technology, and gradually disseminating remote stroke treatment, which are all related to protection of cerebral blood flow and revascularization. Revascularization-based neuroprotection is, therefore, the theoretical basis of stroke study and translation and also a widely accepted treatment model.
There are many kinds of scientific journals dedicated to cerebral vascular disease all over the world including both specialized journals such as "Stroke", "Journal of Cerebral Blood Flow and Metabolism", "Translational Stroke Research", and comprehensive journals such as "Neurology and Neurosurgery." These journals play an important role in promoting the research on cerebral vascular disease and developing prevention and treatment methods. Our new journal "Brain Circulation" is committed to building a unique academic platform for studying both reperfusion and neuroprotection strategies by focusing on the mechanical recanalization, nondrug cerebral protection therapy, and restoration and improvement of cerebral collateral circulation. I hope our efforts will boost the academic communication and medical translation of brain circulation research.
| References | |  |
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