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Systematic Review - Combining Neuroprotection With Reperfusion in Acute Ischemic Stroke
E M Vos1, V J Geraedts1,2, A van der Lugt3
1Department of Neurology, The Hague Medical Center, The Hague, Netherlands.
Frontiers in Neurology
|April 4, 2022
Summary
Neuroprotective agents show promise for acute ischemic stroke (AIS) when combined with reperfusion therapies like intravenous thrombolysis (IVT) or endovascular therapy (EVT). Specific agents like uric acid and nerinetide demonstrated improved outcomes in certain patient groups undergoing reperfusion.
Area of Science:
- Neurology
- Pharmacology
- Emergency Medicine
Background:
- Clinical trials for neuroprotection in acute ischemic stroke (AIS) have yielded disappointing results.
- Reperfusion therapy may be crucial for neuroprotective treatments to be effective in AIS.
- This review examines the efficacy of neuroprotective agents used concurrently with reperfusion in AIS.
Approach:
- A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library, Emcare) up to September 2021.
- Included were randomized controlled trials of neuroprotective strategies administered within 12 hours of stroke onset alongside intravenous thrombolysis (IVT), endovascular therapy (EVT), or both.
- 30 studies involving 16,160 patients were analyzed.
Key Points:
- Fifteen studies evaluated neuroprotectants in patients receiving reperfusion therapies (IVT and/or EVT).
- Positive clinical outcomes were associated with uric acid (with EVT and IVT), nerinetide (with EVT, no IVT), imatinib (with IVT, with or without EVT), remote ischemic perconditioning (with IVT), and high-flow normobaric oxygen (after EVT, with or without IVT).
- Significant heterogeneity in outcome measures was noted across studies.
Conclusions:
- Research combining neuroprotective agents with reperfusion therapies in AIS is limited.
- Future studies should standardize functional outcome measures.
- Future research should prioritize combining neuroprotective agents with reperfusion or include subgroup analyses for IVT/EVT treatments.
