Vignesh Subramanian, Class of 2024

Figure 1: A thrombectomy is a surgical procedure aimed at removing blood clots lodged in an artery of the brain.

A stroke is a medical emergency in which blood flow to the brain is disrupted. Strokes may be ischemic (lacking blood supply to brain tissue due to a blocked artery) or hemorrhagic (involving bleeding into the brain tissue due to rupture or leakage of a weakened artery) and typically require pharmacological or surgical interventions. In recent decades, endovascular thrombectomy (EVT) has emerged as a popular, minimally invasive surgical procedure to treat acute ischemic stroke. EVT involves the insertion of a catheter at the wrist or groin, which is guided toward the clot or thrombus occluding the brain’s artery using cerebral angiography. Once localized, a stent retriever is delivered to the site and used to capture and suction out the blockage, expanding or “recanalizing” the vessel in the process.

Despite the significant impact EVT has had in reducing mortality due to stroke, many treated patients demonstrate poor functional outcomes and long-term disability, even following successful recanalization. To close the gap between surgical interventions and symptomatic improvements, researchers at Stony Brook University sought to review how the paired use of various neuroprotective therapies in post-thrombectomy care may augment recovery from both the initial damage induced by the stroke and the side effects of EVT treatment. One such side effect is ischemia-reperfusion injury (IRI), in which cells are effectively overwhelmed by the sudden restoration of blood flow following stroke treatment, undergoing resultant systemic inflammation and oxidative damage that exacerbates cerebral tissue dysfunction and death.

The researchers’ meta-analysis found that fourteen neuroprotective therapies have been shown by previous studies to be particularly effective in improving post-stroke care outcomes. Several agents and derivative molecules, such as imatinib and verapamil, function as inhibitors and antagonists of key receptors that often trigger blood-brain barrier (BBB) breakdown, calcium release-induced excitotoxicity, and the release of pro-inflammatory mediators. By binding to and dampening the effects of such receptors, these agents reduce edema and decrease infarct size. Other agents, including uric acid and nerinetide, are antioxidants and synthetic compounds that clear oxidative species and inactivate clotting factors, reducing inflammation and neurotoxic signaling that would worsen post-stroke brain injury. Other treatments, including regional hypothermia, normobaric oxygen, and remote ischemic conditioning, reduce the scope and spread of ischemic damage by regulating the affected brain region’s temperature, oxygen supply, or hypoxia tolerance. Altogether, this broad range of therapies demonstrated strong neuroprotective effects that may bolster post-EVT outcomes in stroke patients.

Works Cited:

[1] Dammavalam, V., Lin, S., Nessa, S., Daksla, N., Stefanowski, K., Costa, A., & Bergese, S. (2024). Neuroprotection during thrombectomy for acute ischemic stroke: A review of future therapies. MDPI, 25(2), 891. doi: 10.3390/ijms25020891 

[2] Image retrieved from: https://commons.wikimedia.org/wiki/File:Merci_L5.jpg