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*Only for medical professionals to read for reference.
Where can we go? The possibility of neuroprotection Stroke is a serious threat to human health.
It has the characteristics of high morbidity, recurrence, disability and mortality.
Acute ischemic stroke accounts for about 70% of strokes.
Improving cerebral blood circulation and neuroprotection are the main treatment measures for acute ischemic stroke [1].
At the recently held International Stroke Conference 2021 (International Stroke Conference 2021), Professor Nerses Sanossian from the Keck School of Medicine of the University of Southern California reported on the future development of neuroprotective therapy for stroke.
Multi-pronged, neuroprotective treatment of acute ischemic stroke through multiple mechanisms is brain tissue damage caused by cerebrovascular occlusion.
Its pathophysiological mechanisms mainly involve cellular energy failure, calcium ion overload, nerve excitotoxicity, and oxygen The excessive generation of free radicals, the imbalance of inflammatory immunity and apoptotic autophagy signals, etc.
, there are connections and interactions between the above mechanisms [2].
Remote ischemic preconditioning (RIC) refers to the short-term, non-fatal ischemia of remote organs to improve the tolerance of body tissues and organs to subsequent long-term, fatal ischemia.
RIC has an important role and broad application prospects in stroke neuroprotection [3].
Minocycline is a second-generation semi-synthetic tetracycline antibiotic.
Various animal experimental models and clinical trials have shown that it has neuroprotective effects.
Its mechanism is related to inhibiting apoptosis, reducing inflammatory response, reducing infarct volume and reducing blood vessels.
Damage related [4].
RIC and minocycline may be effective against ischemic stroke and intracerebral hemorrhage (ICH), and are very safe.
Both of these treatments can be carried out in an ambulance.
Other neuroprotective agents with multiple effects include uric acid (UA), Nerinetide (NA-1) and 3K3A-APC.
Figure 1.
Targeting multiple mechanisms for the whole process of management.
The use of targeted neuroprotective strategies at different stages is first of all pre-hospital treatment.
For patients with suspected stroke, first responders on the spot should conduct a brief assessment and necessary emergency treatment and send them to the hospital as soon as possible [1].
At present, the pre-hospital treatment of stroke still has room for improvement in cerebral hemorrhage (ICH) examination, large vessel occlusion (LVO) recognition and transportation methods.
Figure 2.
The future development of pre-hospital treatment is followed by emergency room treatment.
Due to the narrow treatment time window for acute ischemic stroke, timely assessment of the condition and rapid diagnosis are essential [1].
A lot of time is often wasted in imaging examinations and thrombolytic treatment decisions, so treatment drugs can be prepared in advance.
New thrombolytic drugs and neuroprotective agents can be considered for combined treatment strategies, such as tenecteplase combined with neuroprotective agents.
Figure 3.
Future development of emergency neuroprotective treatment Before endovascular treatment, the choice of neuroprotective drugs needs to consider their interaction with thrombolytic drugs.
NA-1 treatment can be used before performing endovascular thrombectomy (EVT).
Figure 4.
The future development of neuroprotective treatment before endovascular treatment After the patient is transferred to the neurosurgery intensive care unit (NICU) or stroke unit, neuroprotective treatment can be carried out for the mechanism of brain injury in the post-stroke period. Figure 5.
References for the future development of neuroprotective therapy in post-stroke [1] Chinese Medical Association Neurology Branch, Chinese Medical Association Neurology Branch Cerebrovascular Disease Group.
Chinese Acute Ischemic Stroke Diagnosis and Treatment Guide 2018[J].
Chinese Neurology Ke J, 2018, 51(9): 666-682.
[2] Zuo Kun, Yang Xinchun, Zhong Jiuchang.
Research progress on the mechanism of acute ischemic stroke injury and its therapeutic drugs[J].
Advances in Pharmaceutical Sciences.
2019; 43(8) ): 576-583.
[3] Zhang Jiang, Bi Heming, Chang Lisha.
Implementation methods of remote ischemic preconditioning and research progress of brain protection mechanism[J].
Modern Health (second half of the month).
2020; 20 (11) ：23-26.
[4] Li Zhenguang, Cui Xinghua, Zhang Jinbiao, et al.
Neuroprotective effects of minocycline on ischemic stroke[J].
International Journal of Cerebrovascular Diseases.
2017;25(06):550-554.
Where can we go? The possibility of neuroprotection Stroke is a serious threat to human health.
It has the characteristics of high morbidity, recurrence, disability and mortality.
Acute ischemic stroke accounts for about 70% of strokes.
Improving cerebral blood circulation and neuroprotection are the main treatment measures for acute ischemic stroke [1].
At the recently held International Stroke Conference 2021 (International Stroke Conference 2021), Professor Nerses Sanossian from the Keck School of Medicine of the University of Southern California reported on the future development of neuroprotective therapy for stroke.
Multi-pronged, neuroprotective treatment of acute ischemic stroke through multiple mechanisms is brain tissue damage caused by cerebrovascular occlusion.
Its pathophysiological mechanisms mainly involve cellular energy failure, calcium ion overload, nerve excitotoxicity, and oxygen The excessive generation of free radicals, the imbalance of inflammatory immunity and apoptotic autophagy signals, etc.
, there are connections and interactions between the above mechanisms [2].
Remote ischemic preconditioning (RIC) refers to the short-term, non-fatal ischemia of remote organs to improve the tolerance of body tissues and organs to subsequent long-term, fatal ischemia.
RIC has an important role and broad application prospects in stroke neuroprotection [3].
Minocycline is a second-generation semi-synthetic tetracycline antibiotic.
Various animal experimental models and clinical trials have shown that it has neuroprotective effects.
Its mechanism is related to inhibiting apoptosis, reducing inflammatory response, reducing infarct volume and reducing blood vessels.
Damage related [4].
RIC and minocycline may be effective against ischemic stroke and intracerebral hemorrhage (ICH), and are very safe.
Both of these treatments can be carried out in an ambulance.
Other neuroprotective agents with multiple effects include uric acid (UA), Nerinetide (NA-1) and 3K3A-APC.
Figure 1.
Targeting multiple mechanisms for the whole process of management.
The use of targeted neuroprotective strategies at different stages is first of all pre-hospital treatment.
For patients with suspected stroke, first responders on the spot should conduct a brief assessment and necessary emergency treatment and send them to the hospital as soon as possible [1].
At present, the pre-hospital treatment of stroke still has room for improvement in cerebral hemorrhage (ICH) examination, large vessel occlusion (LVO) recognition and transportation methods.
Figure 2.
The future development of pre-hospital treatment is followed by emergency room treatment.
Due to the narrow treatment time window for acute ischemic stroke, timely assessment of the condition and rapid diagnosis are essential [1].
A lot of time is often wasted in imaging examinations and thrombolytic treatment decisions, so treatment drugs can be prepared in advance.
New thrombolytic drugs and neuroprotective agents can be considered for combined treatment strategies, such as tenecteplase combined with neuroprotective agents.
Figure 3.
Future development of emergency neuroprotective treatment Before endovascular treatment, the choice of neuroprotective drugs needs to consider their interaction with thrombolytic drugs.
NA-1 treatment can be used before performing endovascular thrombectomy (EVT).
Figure 4.
The future development of neuroprotective treatment before endovascular treatment After the patient is transferred to the neurosurgery intensive care unit (NICU) or stroke unit, neuroprotective treatment can be carried out for the mechanism of brain injury in the post-stroke period. Figure 5.
References for the future development of neuroprotective therapy in post-stroke [1] Chinese Medical Association Neurology Branch, Chinese Medical Association Neurology Branch Cerebrovascular Disease Group.
Chinese Acute Ischemic Stroke Diagnosis and Treatment Guide 2018[J].
Chinese Neurology Ke J, 2018, 51(9): 666-682.
[2] Zuo Kun, Yang Xinchun, Zhong Jiuchang.
Research progress on the mechanism of acute ischemic stroke injury and its therapeutic drugs[J].
Advances in Pharmaceutical Sciences.
2019; 43(8) ): 576-583.
[3] Zhang Jiang, Bi Heming, Chang Lisha.
Implementation methods of remote ischemic preconditioning and research progress of brain protection mechanism[J].
Modern Health (second half of the month).
2020; 20 (11) ：23-26.
[4] Li Zhenguang, Cui Xinghua, Zhang Jinbiao, et al.
Neuroprotective effects of minocycline on ischemic stroke[J].
International Journal of Cerebrovascular Diseases.
2017;25(06):550-554.
