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Therapeutic Window Beyond Cerebral Ischemic Reperfusion Injury

  • Wengui Yu
  • Liping Liu
Chapter
Part of the Springer Series in Translational Stroke Research book series (SSTSR)

Abstract

Reperfusion therapy has been one of the major breakthroughs in clinical medicine. Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (tPA) remains the only FDA approved therapy for acute ischemic stroke (AIS). It is effective within 4.5 h of symptom onset and better if given earlier. More recently, five randomized controlled trials (RCTs) demonstrated the efficacy of endovascular therapy (EVT) for AIS from large vessel occlusion (LVO) in the anterior circulation within 6–12 h of symptom onset. Reperfusion injury with symptomatic intracerebral hemorrhage (sICH) is the most feared complication of reperfusion therapy. However, the rate of sICH only increases slightly with longer delay to reperfusion. Numerous case reports and cohort studies have supported the expanding of therapeutic window up to 24 h in the anterior circulation and beyond in the posterior circulation. In patients with acute stroke from LVO in the posterior circulation, EVT up to 48 h after symptom onset was seldom futile in the absence of extensive baseline ischemia and longer treatment delay does not increase the risk of sICH. Such clinical studies have clearly pushed the boundary of our understanding about reperfusion injury and therapeutic time window. Laboratory and translational studies may better define collateral circulation, venous drainage, and the molecular mechanisms of contrast extravasation, hemorrhagic conversion, and sICH. A solid scientific foundation is needed for expanding therapeutic window way beyond reperfusion injury.

Keywords

Acute ischemic stroke Anterior circulation Basilar artery occlusion Posterior circulation Reperfusion injury Therapeutic window Thrombectomy And thrombolysis 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of CaliforniaIrvineUSA
  2. 2.Department of Neurology, Tiantan HospitalBeijing Capital Medical UniversityBeijingChina

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