Face the pain points of stroke treatment! Pay attention to brain cell protection and help stroke patients manage the whole course of the disease

The whole course of stroke is managed and brain cell protection is crucial
.

Stroke is the largest cause of death in adults in China, and the incidence rate ranks first
in the world.
There are about 4.
6 million new stroke cases each year, and the rate is increasing at a rate of 8.
7% per year, of which about 82% are ischemic
strokes.
The vast majority of ischemic stroke patients in China have an average time of 20.
1 hours from onset to hospital, often missing the time window for thrombolysis treatment, resulting in poor prognosis and bringing heavy burden
to the country, society and family.

In the face of this challenge, while strengthening the construction of stroke emergency system, the medical community at home and abroad is also actively thinking about new ways of stroke treatment, and the concept of "brain cell protection" came into being, and has made revolutionary achievements
in clinical research in recent years.
Based on this, the Chinese Stroke Society launched the "Stroke New Language International Academic Summit" project, aiming to deeply discuss hot and difficult topics in the field and carry out multidisciplinary exchanges and cooperation
.

The "Stroke New Language International Academic Summit Phase IV" seminar was held on October 29, 2022 in the 16th China Neurology Forum in the cerebrovascular disease forum II, and simultaneously set up Wuhan, Zhengzhou, Jinan, Taiyuan venues, this conference, from the field of stroke at home and abroad on the construction of acute ischemic stroke stroke unit construction, patient whole course management, thrombectomy therapy, reperfusion injury prevention and brain cell protection and other hot topics shared brilliantly
。

Share clinical experience at home and abroad, and promote the construction of stroke units

The stroke unit is an effective organizational medical and rehabilitation management model for stroke, focusing on early rehabilitation is its characteristics, and is generally recommended
by stroke rehabilitation treatment guidelines in various countries.
At the beginning of the conference, Professor David Wang from the Barrow Institute of Neurology, St.
Joseph's Medical Center, USA, shared his clinical practice experience
in stroke unit construction with the participants.

Professor David Wang first described the history of stroke units, he pointed out that stroke units have a history of more than 50 years in Western countries, it refers to the designated stroke diagnosis and treatment ward established in non-intensive care units, equipped with professional stroke diagnosis and treatment medical teams, life monitoring support systems and necessary rehabilitation, physiotherapy, social work and other teams, with the development of evidence-based medicine, the academic community found that although the construction cost of stroke units is not low, However, there is multiple evidence that stroke units reduce mortality, disability, and the likelihood of living independently
.
He noted that both formally built stroke units and flexible stroke units or teams can benefit patients; A hospital with a dedicated stroke-related treatment team would be far better than not having such a team, because such a team will have a more up-to-date concept, faster action, and more efficient cooperation
.
Furthermore, the stroke unit has now been extended to pre-hospital emergency care and post-treatment rehabilitation, and through multidisciplinary cooperation, the stroke unit will be able to better improve patient outcomes and enhance the patient experience
.

Figure 1: Professor David Wang gave a presentation

Professor Yue Yunhua from Shanghai Yangpu Central Hospital, Professor Jing Ping from Wuhan Central Hospital, Professor Xia Lei from Zhoukou Central Hospital, Professor Sun Qinjian from the Provincial Hospital Affiliated to Shandong First Medical University, and Professor Han Xuebin from Shanxi Cardiovascular Hospital shared their experience
in the construction of stroke centers based on clinical practice.

• The stroke center of Yangpu Central Hospital, where Professor Yue Yunhua works, has established an integrated management model of pre-hospital, in-hospital and post-hospital, and has covered many surrounding community hospitals with remote diagnosis and treatment, realizing the forward movement of the threshold and effectively improving the level of regional stroke prevention and treatment.
  

• Professor Jing Ping concluded that integrating resources, carrying out multidisciplinary cooperation, as well as process optimization and ensuring the smooth flow of stroke green channels are the two keys to the construction of stroke centers.
  

• Starting from the experience of the construction of municipal stroke centers, Professor Xia Lei believes that the rapid identification of stroke (or suspected) patients by medical institutions at all levels, reasonable transfer processes, standardized stroke diagnosis and treatment technologies, and standardization and implementation of stroke information sharing for graded diagnosis and treatment can ultimately promote the establishment of a stroke health system covering cities.
  

• Professor Sun Qinjian believes that the key to the construction of stroke units lies in good overall deployment, which can ensure relevant policies for multidisciplinary cooperation, cooperation and process formulation between departments, continuous quality control and improvement, and standardized technology and training.
  

• Professor Han Xuebin believes that the construction of the stroke center is carried out in an all-round way of "six in one", and the screening of high-risk factors, pre-hospital first aid, in-hospital green channels, in-hospital treatment and rehabilitation, health education and patient follow-up are indispensable
  .
  

Figure 2: 5 The conference venue is connected to share the experience of stroke center construction

The whole course of stroke is managed and brain cell protection is crucial

In China, the construction of stroke units and stroke centers is also deepening and developing, and a stroke prevention and control system
with Chinese characteristics has gradually formed.
Professor Liu Xueyuan from the Tenth People's Hospital of Tongji University shared the experience
of the 10th Hospital in the management of the whole course of stroke.
He pointed out that stroke prevention and control has been China's national strategy, but at present, the construction of stroke centers in most regions is still facing problems such as insufficient construction of pre-hospital integrated emergency system, very few ultra-early rehabilitation, less bedside vascular ultrasound screening, and insufficient construction of one-stop stroke follow-up clinics.

The Stroke Center of Shanghai Tenth People's Hospital, where Professor Liu works, was established in 2013, and after more than 5 years of development, it has explored and built a system
from organizational management, pre-hospital first aid, green channel, early rehabilitation, ultrasound screening to follow-up of stroke patients throughout the whole course of the disease.
The construction of this comprehensive and three-dimensional stroke diagnosis and treatment system has improved the diagnosis, diagnosis and treatment methods of stroke, and effectively promoted the management
of the whole course of stroke.

While improving the construction of stroke diagnosis and treatment system, Professor Liu Xueyuan also pointed out that there is still a huge gap
between the current stroke treatment plan and the clinical needs of patients in China.
For example, the use of recombinant tissue plasminogen activator (rt-PA) has a strict time window and is associated with a risk of bleeding; Mechanical embolectomy is also reserved for 5% to 10% of patients
.
Therefore, the above problems
can be solved clinically by extending the window of reperfusion therapy with brain cell protection or reducing the risk of bleeding.
In particular, brain cell protection includes neuronal protection, vascular protection, and glial protection, which can benefit
the whole brain.
Professor Liu Xueyuan mentioned that the "Chinese Expert Consensus on the Clinical Assessment and Treatment of Ischemic Semi-Dark Zone of Acute Cerebral Infarction" officially published on August 27, 2021 pointed out: "A large-sample multi-center clinical study found that edaravone dextrol with multi-target brain cell protection can improve the neurological function of stroke patients"
.
In addition, Professor Liu pointed out that the number of hospital stays and the average cost of patients in the department after using edaravone dextrol have decreased, suggesting that rational drug use accelerates patients' recovery
.

Figure 3: Professor Liu Xueyuan gave a report

Endovascular therapy combined with brain cell protection, multi-pronged escort throughout the process

Professor Miao Zhongrong from Tiantan Hospital affiliated to Capital Medical University and Professor Cheng Xin from Huashan Hospital affiliated to Fudan University shared
topics such as mechanical thrombectomy, reperfusion injury and brain cell protection.

Endovascular treatment is a hot topic
in ischemic stroke research in recent years.
Professor Miao Zhongrong pointed out that the results of meta-analysis of various clinical trials in recent years have shown that the re-entry rate and bleeding risk of bridging therapy are high, and there is no clear evidence of the benefit of bridging therapy, and even if there is a benefit, the benefit is small; Clinically, patients should be brought to direct thrombectomy more quickly
.
In the two studies of ATTENTION and BAOCHE, the prognosis of direct embolectomy was significantly better than that of the control group
.
In addition, the RESCUE-Japan LIMIT study showed that large core infarction was also suitable for endovascular therapy, and the functional outcomes in the endovascular treatment group were significantly better than those of conservative medical treatment
.
Based on these results, Professor Miao believes that the indications for endovascular therapy will be broadened, and the rewriting of the guidelines may be in the foreseeable future
.

Figure 4: Professor Miao Zhongrong gave a report

In addition, can the prognosis of patients treated with endovascular therapy be further improved? Brain cell-protective therapy may be the answer
.
Professor Miao mentioned that the TASTE-2 study led by the National Clinical Research Center for Neurological Diseases is underway to evaluate the efficacy and safety of edaravone dextrol in patients with acute ischemic stroke undergoing reperfusion therapy, and believes that the research results will create a new era
for the application of brain cell protection therapy in stroke treatment.

Figure 5: The TASTE-2 study will add new evidence for edaravone dextrol combined with reperfusion therapy

Professor Cheng Xin pointed out that the pathological mechanism of ischemia-reperfusion injury is complex, ischemia itself can lead to nerve damage, and reperfusion restores oxygen supply, resulting in calcium ion overload, glutamate excitatory poisoning, oxidative stress, inflammatory response, calcium cell apoptosis, blood-brain barrier destruction and a series of changes, which can further aggravate nerve damage
.
Reperfusion injury is an important cause of poor patient outcomes, and is common in stroke patients treated with mechanical thrombectomy and is associated with
a poorer prognosis.

In recent years, the field of reperfusion therapy has advanced by leaps and bounds, but the drug to reduce reperfusion injury has made slow
progress.
In the exploration of brain cell protection drugs, the United States established the Stroke Treatment Academic Industry Roundtable, and the academic and industrial circles gradually reached the following consensus: 1) Brain cell protection is preferably a drug with multi-target therapeutic effects; 2) The preclinical study should be revised to preclinical trial and set up phases I.
, II.
, III.
; 3) Brain cell protection should be combined
with reperfusion therapy.
Under the guidance of these consensuses, certain breakthroughs have been made in brain cell protection therapy, and the dual-target brain cell protection drug edaravone dextrol is one of the bright stars
.

Edaravone can scavenge a variety of oxidative free radicals, reduce brain tissue damage and cerebral edema; D-camperol has anti-inflammatory effects and can effectively inhibit the expression of inflammatory cytokines caused by ischemia, thereby intervening in the formation
of thrombosis inflammation with multiple targets.
On February 16, 2021, the official journal of the American Heart/Stroke Association (AHA/ASA) STROKE published the results of
the phase III clinical TASTE study of edaravone dextrol online.
Compared with edaravone, edaravone dextrol significantly increased the proportion of
patients with acute ischemic stroke who were functionally independent at day 90 with an odds ratio (OR) of 1.
42.
In China, a number of studies on edaravone dextrol combined with endovascular therapy are underway, such as edaravone dextrovanol combined with intravenous thrombolytic therapy led by Huashan Hospital affiliated to Fudan University, and edaravone dextrol combined with mechanical thrombectomy led by the Northern Theater General Hospital, which will add a strong link
to the evidence chain for the treatment of acute ischemic stroke.

Figure 6: Professor Cheng Xin gave a report

In summary, reperfusion therapy is the main treatment of acute ischemic stroke, but there are many defects in this treatment, and reperfusion injury is a problem
that cannot be ignored in stroke emergency.
Based on this situation, brain cell protection drugs will have great prospects
.
Edaravone dextrofenol, a dual-target brain cell protector, can scavenge free radicals and control inflammation, and evidence-based evidence has confirmed that it can significantly increase the proportion of stroke patients with functional independence at 90 days and improve the prognosis
of patients.
A number of studies evaluating the efficacy and safety of edaravone dextrocamprol combined with reperfusion therapy are underway, and we look forward to early and amazing results and a new era of
stroke treatment.

*This article is intended only to provide scientific information to healthcare professionals and does not represent the views of the Platform