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No-reflow after recanalization in ischemic stroke: From pathomechanisms to therapeutic strategies.

Authors :
Sun, Feiyue
Zhou, Jing
Chen, Xiangyu
Yang, Tong
Wang, Guozuo
Ge, Jinwen
Zhang, Zhanwei
Mei, Zhigang
Source :
Journal of Cerebral Blood Flow & Metabolism. Jun2024, Vol. 44 Issue 6, p857-880. 24p.
Publication Year :
2024

Abstract

Endovascular reperfusion therapy is the primary strategy for acute ischemic stroke. No-reflow is a common phenomenon, which is defined as the failure of microcirculatory reperfusion despite clot removal by thrombolysis or mechanical embolization. It has been reported that up to 25% of ischemic strokes suffer from no-reflow, which strongly contributes to an increased risk of poor clinical outcomes. No-reflow is associated with functional and structural alterations of cerebrovascular microcirculation, and the injury to the microcirculation seriously hinders the neural functional recovery following macrovascular reperfusion. Accumulated evidence indicates that pathology of no-reflow is linked to adhesion, aggregation, and rolling of blood components along the endothelium, capillary stagnation with neutrophils, astrocytes end-feet, and endothelial cell edema, pericyte contraction, and vasoconstriction. Prevention or treatment strategies aim to alleviate or reverse these pathological changes, including targeted therapies such as cilostazol, adhesion molecule blocking antibodies, peroxisome proliferator-activated receptors (PPARs) activator, adenosine, pericyte regulators, as well as adjunctive therapies, such as extracorporeal counterpulsation, ischemic preconditioning, and alternative or complementary therapies. Herein, we provide an overview of pathomechanisms, predictive factors, diagnosis, and intervention strategies for no-reflow, and attempt to convey a new perspective on the clinical management of no-reflow post-ischemic stroke. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
0271678X
Volume :
44
Issue :
6
Database :
Academic Search Index
Journal :
Journal of Cerebral Blood Flow & Metabolism
Publication Type :
Academic Journal
Accession number :
177341883
Full Text :
https://doi.org/10.1177/0271678X241237159