Novel Approach to Neuroprotection for Acute Ischemic Stroke

The litany of failed neuroprotection trials in acute ischemic stroke is well known after several decades of considerable investment, according to strongly supportive, basic science work. However, renewed efforts have arisen to evaluate approaches to protecting various components of the neurovascular unit against the cellular and biochemical consequences of cerebral ischemia in the modern era of endovascular therapy of acute ischemic stroke due to large-vessel occlusion. Many patients have poor access to reperfusion therapy and, even when they do have it, do not have a satisfactory recovery despite achieving a good technical result of recanalization of an occluded vessel. Moreover, in showing the benefits of endovascular therapy within a 6- to 24-hour onset-to-treatment time window in patients with a large ischemic lesion, recent trials have also challenged understanding about how viable vs dead neuronal tissue is defined on brain imaging. Therefore, a clear rationale persists for cytoprotective therapies having a place as an adjuvant treatment of acute ischemic stroke. Thus, the study by Fu et al published in this issue of JAMA Neurology, a carefully conducted, placebo-controlled, randomized trial showing that the sublingual combination of edaravone dexborneol improved clinical outcomes after acute ischemic stroke, is most encouraging but warrants scrutiny over reliability and applicability.
Source: JAMA Neurology - Category: Neurology Source Type: research