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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Neurovascular Inflammation and Complications of Thrombolysis Therapy in Stroke

Qiang Liu1, Kaibin Shi2, Yongjun Wang2

  • 1Department of Neurology, Tianjin Medical University General Hospital, China (Q.L., F.-D.S.).

Stroke
|September 7, 2023
PubMed

Intravenous thrombolysis via tPA (tissue-type plasminogen activator) is the only approved pharmacological treatment for acute ischemic stroke, but its benefits are limited by hemorrhagic transformation. Emerging evidence reveals that tPA swiftly mobilizes immune cells which extravasate into the brain parenchyma via the cerebral vasculature, augmenting neurovascular inflammation, and tissue injury. In this review, we summarize the pronounced alterations of immune cells induced by tPA in patients with stroke and experimental stroke models. We argue that neuroinflammation, triggered by ischemia-induced cell death and exacerbated by tPA, compromises neurovascular integrity and the microcirculation, leading to hemorrhagic transformation. Finally, we discuss current and future approaches to attenuate thrombolysis-associated hemorrhagic transformation via uncoupling immune cells from the neurovascular unit.

Keywords:
inflammationinterleukinischemic strokemetalloproteinasetissue-type plasminogen activator

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