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Published on: January 15, 2017
Extension of fundamental stroke research into clinical care
1Department of Neurology & Neuroscience, Cornell University Medical College, New York, NY 10021, USA.
Abstract:
Clinical efforts in stroke prevention have measurably reduced the incidence of stroke in persons experiencing a number of risk factors. Clinical efforts to reduce stroke size once the process starts, however, have been disappointing. A variety of agents aimed at blocking the effects of excitotoxic neurotransmitters or interfering with intracellular calcium entry have been tested but with little success on clinical outcome. Satisfactory explanation of the paradox between animal and clinical outcome studies has not been forthcoming. Accordingly, clinical investigators are exploring the potential value of surgical craniectomy in efforts to improve the presently devastated outcome that marks the course of severe, large acute cerebral infarctions.
Insights
Stroke prevention is improving, but treatments to reduce stroke size after onset have failed. Researchers are now investigating surgical craniectomy for severe strokes to improve patient outcomes.
Area of Science:
- Neuroscience
- Neurosurgery
- Stroke Medicine
Background:
- Stroke prevention strategies have successfully reduced stroke incidence.
- Current treatments to minimize brain damage after stroke onset have yielded disappointing clinical results.
- Previous therapeutic approaches targeting excitotoxicity and intracellular calcium have shown limited efficacy.
Purpose of the Study:
- To address the limited success of current medical interventions in reducing acute stroke size.
- To explore novel therapeutic strategies for severe, large acute cerebral infarctions.
- To evaluate the potential of surgical decompression via craniectomy in improving outcomes for major ischemic strokes.
Main Methods:
- Review of clinical outcomes from previous stroke treatment trials.
- Analysis of the translational gap between animal models and human clinical studies in stroke research.
- Investigation into the feasibility and potential benefits of decompressive craniectomy in severe stroke cases.
Main Results:
- Despite advances in stroke prevention, effective treatments to limit infarct size remain elusive.
- Pharmacological agents targeting excitotoxic neurotransmitters and calcium influx have not translated into significant clinical benefits.
- A significant discrepancy persists between the efficacy observed in animal stroke models and human clinical trials.
Conclusions:
- Current medical therapies are insufficient for reducing stroke-related brain damage once a large infarction has occurred.
- Surgical craniectomy is being explored as a promising intervention for managing severe, large acute cerebral infarctions.
- Further research and clinical trials are needed to establish the role of craniectomy in improving outcomes for devastating stroke events.
