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Vascular neurology
Now that the door is open: an update on ischemic stroke pharmacotherapeutics for the neurointerventionalist
  1. Justin F Fraser1,2,3,
  2. Shivani Pahwa1,3,
  3. Michael Maniskas4,
  4. Christopher Michas1,
  5. Mesha Martinez5,
  6. Keith R Pennypacker2,6,
  7. David Dornbos III1
  1. 1 Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
  2. 2 Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
  3. 3 Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
  4. 4 Department of Neurology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
  5. 5 Department of Neurointerventional Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
  6. 6 University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Justin F Fraser, Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA; Jfr235{at}uky.edu

Abstract

The last 10 years have seen a major shift in management of large vessel ischemic stroke with changes towards ever-expanding use of reperfusion therapies (intravenous thrombolysis and mechanical thrombectomy). These strategies ‘open the door’ to acute therapeutics for ischemic tissue, and we should investigate novel therapeutic approaches to enhance survival of recently reperfused brain. Key insights into new approaches have been provided through translational research models and preclinical paradigms, and through detailed research on ischemic mechanisms. Additional recent clinical trials offer exciting salvos into this new strategy of pairing reperfusion with neuroprotective therapy. This pairing strategy can be employed using drugs that have shown neuroprotective efficacy; neurointerventionalists can administer these during or immediately after reperfusion therapy. This represents a crucial moment when we emphasize reperfusion, and have the technological capability along with the clinical trial experience to lead the way in multiprong approaches to stroke treatment.

  • Stroke
  • Pharmacology
  • Thrombectomy
  • Drug

https://doi.org/10.1136/jnis-2022-019293

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    Footnotes

    • Twitter @doctorjfred, @MeshaMartinezMD, @DornbosIII_MD

    • Contributors All authors (JFF, SP, MiM, CM, MeM, KRP, DD) provided significant contribution to the research and drafting of this manuscript. Each author was responsible for drafting at least one section. All authors provided editing input for finalization of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.