Despite the strong treatment effects of mechanical thrombectomy in acute ischaemic stroke, penumbral tissue loss before recanalization and ischaemia–reperfusion injury after diminish functional outcomes and call for adjunct treatments. Classical neuroprotection strategies could consequently be revived, but novel treatment targets are also emerging through mechanistic research.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Directional induction of neural stem cells, a new therapy for neurodegenerative diseases and ischemic stroke
Cell Death Discovery Open Access 01 July 2023
-
Distinct Alterations in Oxygenation, Ion Composition and Acid-Base Balance in Cerebral Collaterals During Large-Vessel Occlusion Stroke
Clinical Neuroradiology Open Access 07 June 2023
-
Delayed NLRP3 inflammasome inhibition ameliorates subacute stroke progression in mice
Journal of Neuroinflammation Open Access 04 January 2023
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Goyal, M. et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387, 1723–1731 (2016).
Jung, S. et al. Factors that determine penumbral tissue loss in acute ischaemic stroke. Brain 136, 3554–3560 (2013).
Hill, M. D. et al. Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial. Lancet 395, 878–877 (2020).
Shuaib, A. et al. Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target. Lancet Neurol. 10, 909–921 (2011).
Baron, J. C. Protecting the ischaemic penumbra as an adjunct to thrombectomy for acute stroke. Nat. Rev. Neurol. 14, 325–337 (2018).
Pham, M. & Bendszus, M. Facing time in ischemic stroke: an alternative hypothesis for collateral failure. Clin. Neuroradiol. 26, 141–151 (2016).
Desilles, J. P. et al. Downstream microvascular thrombosis in cortical venules is an early response to proximal cerebral arterial occlusion. J. Am. Heart. Assoc. 7, e007804 (2018).
Kollikowski, A. et al. Local leukocyte invasion during hyperacute human ischaemic stroke. Ann. Neurol. 87, 466–479 (2020).
Schuhmann, M. K. et al. CD84 links T cell and platelet activity in cerebral thrombo-inflammation in acute stroke. Circ. Res. https://doi.org/10.1161/CIRCRESAHA.120.316655 (2020).
Stoll, G. & Nieswandt, B. Thrombo-inflammation in acute ischaemic stroke - implications for treatment. Nat. Rev. Neurol. 15, 473–481 (2019).
Acknowledgements
Work cited in this comment was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Projektnummer 374031971 –TRR 240.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Rights and permissions
About this article
Cite this article
Stoll, G., Pham, M. Beyond recanalization — a call for action in acute stroke. Nat Rev Neurol 16, 591–592 (2020). https://doi.org/10.1038/s41582-020-00417-0
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41582-020-00417-0
This article is cited by
-
Delayed NLRP3 inflammasome inhibition ameliorates subacute stroke progression in mice
Journal of Neuroinflammation (2023)
-
Directional induction of neural stem cells, a new therapy for neurodegenerative diseases and ischemic stroke
Cell Death Discovery (2023)
-
Distinct Alterations in Oxygenation, Ion Composition and Acid-Base Balance in Cerebral Collaterals During Large-Vessel Occlusion Stroke
Clinical Neuroradiology (2023)
-
Platelet Activation and Chemokine Release Are Related to Local Neutrophil-Dominant Inflammation During Hyperacute Human Stroke
Translational Stroke Research (2022)
-
Platelets and lymphocytes drive progressive penumbral tissue loss during middle cerebral artery occlusion in mice
Journal of Neuroinflammation (2021)