CSA & TISC 2021 ｜Interview with Prof. Xu Anding: The Effect of Antioxidant Therapy on Atherosclerotic Ischemic Stroke

Introduction China has a high incidence and recurrence rate of ischemic stroke, among which atherosclerosis is an important cause
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Therefore, clarifying the pathogenesis of atherosclerosis and managing from the source are of great significance to better achieve the secondary prevention of ischemic stroke
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At the 7th Chinese Stroke Society Academic Annual Meeting and Tiantan International Cerebrovascular Disease Conference (CSA & TISC 2021) held on July 9-11, Professor Xu Anding from the First Affiliated Hospital of Jinan University discussed the risk of ischemic stroke A special report on factors, etiology and pathogenesis was made.
Yimaitong was fortunate to have an exclusive interview with Professor Xu after the meeting and gave a further explanation
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Expert profile Professor Xu Anding • Second-level professor, chief physician, doctoral supervisor • Dean of the First Affiliated Hospital of Jinan University/First Clinical Medical College, Director of Cerebrovascular Disease Center • Director of the Institute of Clinical Neuroscience of Jinan University • Guangdong Province Leading medical talent and winner of the Chinese Stroke Award•Vice President of the Chinese Stroke Society•Member of the Quality Control Expert Committee of Neurological Diseases of the National Health Commission•Vice Leader of the Cerebrovascular Disease Group of the Neurology Branch of the Chinese Medical Association• Brain of the National Health and Family Planning Commission Member of the Standing Committee of the Stroke Prevention and Treatment Engineering Committee • Chairman of the Guangdong Provincial Stroke Association, Vice President of the Guangdong Provincial Medical Association and Chairman of the Neurologist Branch • Associate Editor of the Official SCI Journal of the Chinese Stroke Association "Stroke & Vascular Neurology" Yi Maitong: In this Temple of Heaven At the meeting, your report talked about the etiology classification of ischemic stroke, and mentioned whether the etiology classification concept is equivalent to the etiology concept is worthy of discussion.
The etiology classification has relative limitations.
You can simply Talk about it? Professor Xu Anding ischemic stroke itself is not a single disease, it is composed of a group of many diseases with very complicated etiology and pathogenesis
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Simply put, its etiological classification includes cardiogenic embolism, atherosclerosis-related infarction, inflammation or infarction caused by unknown causes, and small vessel disease-related infarctions mainly with high blood pressure as an important risk factor
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So, are all types of etiology equal to etiology? Not necessarily
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Give a simple example-small vessel disease related to high blood pressure
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Hypertension itself is a very important risk factor for small vessel disease, and it may even be a direct cause.
It causes hyalinosis or degeneration of small blood vessels, so it may be the cause itself
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It can be seen that the etiology classification has certain limitations, and any classification is in the process of continuous development
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Based on this, more than ten years ago, Chinese scholars first proposed the CISS classification based on etiology and pathogenesis, and hoped to promote a more comprehensive understanding of ischemic stroke
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Yimaitong: There are many subtypes of ischemic stroke, both of which are ischemic strokes.
The underlying pathogenesis is very different.
Please briefly introduce the pathogenesis of atherosclerotic large vessel occlusion
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In the CISS classification launched by Prof.
Xu Anding in China, he elaborated and classified the pathogenesis related to large atherosclerosis, which are mainly divided into four categories: ➤The first category is that atherosclerotic plaque blocks perforating arteries As the carrier atherosclerosis progresses, stenosis/plaque blocks different parts of the perforating artery
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➤The second category is artery-to-artery embolism
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➤The third category is watershed infarction caused by vascular stenosis and microthrombus removal obstacles
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First, blood flow is decreased due to vascular stenosis; secondly, there are a large number of microemboli clearing obstacles, causing microemboli deposition, leading to watershed infarction
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➤The fourth type, the mixed type of the first three types of different combinations, is more common in clinical practice
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There have been data showing that more than 60% of patients have two or more pathogenesis, especially in the two pathogenesis mechanisms of arterial-to-arterial embolism and microemboli clearance, both of which include atherosclerosis.
The shadow of hardened plaque
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Yimaitong: Oxidative stress is an important risk factor in the early stage of atherosclerosis.
What role do you think antioxidant therapy has in blocking atherosclerosis? Professor Xu Anding Atherosclerosis is a long-term process, and it is currently recognized as a chronic inflammatory reaction of blood vessels throughout the body
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Oxidative stress, especially oxidized low-density lipoprotein, plays a very important role in the occurrence, development, and eventual development of atherosclerosis into thromboembolic events
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Because oxidative stress is a very important mechanism of action, related treatments for oxidized low-density lipoproteins, namely antioxidant treatments, are theoretically effective.
Of course, this theoretical inference is not enough, and more relevant evidence-based medicine is needed.
Evidence
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So far, in some large-scale international multi-center studies, natural antioxidants have all been negative results, which proves that natural antioxidants cannot achieve the expected effects
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However, some synthetic antioxidants have shown positive results, such as Probucol.
A series of small-sample clinical studies in China and Japan have shown that Probucol has a certain degree of reversing plaque, preventing vascular events, or changing Preliminary findings on the nature of plaques
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A recent study in East Asia (PICASSO study) involving three countries and regions included thousands of patients with ischemic stroke and relatively high risk of bleeding, aiming to observe whether probucol plus antiplatelet drugs can With additional benefits, the study showed positive results
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It can be seen that with probucol treatment, the incidence of major vascular events has decreased, and the recurrence of stroke and coronary events have decreased
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However, the overall sample size is now limited.
In the future, more and higher-quality clinical studies should be conducted on synthetic antioxidants to verify whether they have the effect of inhibiting or reversing atherosclerosis
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Yimaitong: Can you expand on how antioxidant therapy blocks the mechanism of atherosclerosis? Professor Xu Anding's oxidation effect is widely present in many links such as inflammation or aging in the body
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Antioxidant therapy will have a certain effect from the occurrence and development of atherosclerosis to the final plaque instability, thrombosis, brain tissue ischemia.
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It will have a certain effect, and its chain of action is very long and multi-targeted.
, Any antioxidant process can play a certain role
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