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Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes
Wenbo Zhao1, Chuanjie Wu2, David Dornbos III3, Sijie Li4, Haiqing Song2, Yuping Wang2, Yuchuan Ding5, Xunming Ji6
1 Department of Neurology; Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
2 Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
3 Department of Neurological Surgery, Semmes-Murphey Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
4 Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
5 China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
6 Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine; China-America Institute of Neuroscience; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
Correspondence Address:
Dr. Xunming Ji
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Changchun Street, No. 45, Xicheng District, Beijing 100053
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bc.bc_58_19
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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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